Monday, November 2, 2009

The First 870 Pages & the Ad War

That's how far I've gotten in the House bill -- 870 pages. So far, I'm pretty pleased with what I've read. Although the insurance exchange -- the marketplace where you could shop for insurance -- won't be up until 2013, and, thus, some of the important insurance reforms, like the elimination of pre-existing condition exclusions, won't take full effect until then, there are some provisions that would help in the meantime.

For example, there would be a national high risk pool for people who can't get insurance due to pre-existing conditions. The catch, though, is that you have to go without insurance for 6 months before you qualify.

And the current rules about pre-existing condition coverage -- if you have 18 month of continuous coverage and no break in coverage of 63 days or more, and they look back 12 months to see if you had a pre-existing condition -- would be relaxed. You'd only have to have 9 months of continuous coverage and they'd only look back 3 months.

Although the public option is in the plan, it is not the "robust" public option that the liberal Dems wanted -- reimbursement rates are not tied to Medicare, but instead, they would be negotiated, so providers will do better under this version. And states could have their own plans. Even co-ops would be an option.

There's a strong pilot plan for "medical homes" that should help coordinate care of people with chronic illnesses.

There's a lot more in this 1990 page draft. I'll report back when I know more.

But another thing struck me this week-end. I was watching the Sunday talk shows and there were so many commercials opposing health care reform. I hope you're looking at who's paying for the ads. The Chamber of Commerce hates the House plan because it includes an employer mandate -- employers whose annual payroll is over $500,000 will have to provide insurance for their employees or pay a fine.

But the one that gets me is this ad that tells Seniors that Medicare's going to be cut to pay for reform. I couldn't catch the name in tiny print at the bottom of the screen, but you can bet it's related to someone who doesn't really represent Seniors. I can tell you it was a group I've never heard of before.

The truth is that the House bill helps Seniors. The House bill begins to close the doughnut hole, making prescription drugs more affordable from Seniors starting on day one. The coverage gap -- currently, drug coverage stops at about $2800 and starts again at about $4500, so that leaves about $1700 out-of-pocket -- would be reduced by $500 immediately. And the drug companies would offer discounts on drugs during the doughnut hole. This has been one of the biggest obstacles for Seniors, and the House bill starts to eliminate it right away.

And yes, Medicare Advantage plans -- plans that already deny coverage more than traditional Medicare, but which are paid more than traditional Medicare costs -- would have their costs cut. Not services; costs. Medicare Advantage plans cost the government more than traditional Medicare because they are private insurance companies and they charge higher administrative fees than traditional Medicare. So those administrative fees are being slashed. Not services; just costs. Why should private insurers get more to run Medicare plan than it costs the federal government?

The House bill is by no means final. The House will debate the bill on the floor and there will be lots of Amendments. And then the Senate will pass something and the House and Senate bills will have to be combined in conference committee. But slowly but surely, we are making progress.

If only people don't buy into those commercials. In 1993-1994, health reform failed because of the famous "Harry and Louise" commercials that were paid for by the insurance companies. Let's not be so gullible this time. Jennifer

1 comment:

  1. The high risk pool in the state I'm in is so expensive--it was more than my rent.

    Pre-existing--when they add up with more than one condition, will they still be able to refuse to cover those conditions?

    If they give states a choice, the state I live in doesn't have anything for single adults with no children. It's red and they will opt out.

    What is a 'medical home'?

    How you doing?