I thought I would spend some time trying to read through the bill just introduced by the House. Purely from a layperson's perspective, here are some notable elements (comments and corrections are welcome):
It appears to make available an emergency "public option" ("the high risk pool program") beginning January 10, 2010 that will expire when the public option comes online. Who is eligible? Those who don't have benefits from a program under the Social Security Act (Medicare?), employer benefits (excluding COBRA), has not had employer benefits for 6 months preceding application to the program, has applied for but been denied coverage, and has an eligible medical condition. Quite frankly, it is very confusing and unclear. Obviously, though, it does not just extend to everyone who is uninsured; there is a whole process involved to get this coverage. It looks like 5 billion dollars has been allocated to this program (if the program runs out of money, they can increase premiums and reduce benefits! Just like a private insurer!). There will, then, be premiums, a maximum deductible of $1500 for individuals (but maximum cost sharing of 5K for individuals, 10K for families…how does that jibe with the 1500 deductible, I wonder?).
The bill also says that if the "medical loss ratio" (the amount of premiums that actually go to paying medical expenses, that is, paying claims [these are considered "losses"]–here is a great article explaining the Orwellian nature of this term) of insurers offering group plans falls below a certain amount (not less than 85%), the company has to pay a rebate to enrollees. Hmmm…that sounds good. But highly anti-capitalistic, I mean, what kind of law is it, that in the good old USA, would dare to limit profit, the extraction of surplus value from our bodies? Ah, I found the loophole. The same will only apply to individual plans as long as it does not "destabilize the market." Capitalism regained. I am only on page 28 of a 1990 page bill. It's going to be a long night.
On rescission (i.e. an insurer dumping someone from an individual plan after they get an expensive illness, claiming they forgot to report a pre-existing condition–something like acne, a hangnail–before they enrolled): it appears to require notification before they are dumped and an opportunity for an independent third party review…sounds a like a tedious process to be going through while someone is gravely ill.
Insurers have to submit a justification to the government for any price increase. I'm sure our government, so independent from the insurance industry, will be really tough on insurers on this count. Especially during our next Republican administration.
Group health plans have to cover "kids" until they are 27.
Page 37…to be continued.
–Suzanne Verderber