Thursday, August 27, 2009

HR 3200

I've downloaded and started reading HR 3200 (the Health Care Reform Bill). I'm up to page 35 (of 1017 pages). That's not too much of a feat considering that approx. 8 pages are the "table of contents" for the Bill.

The Bill is not an easy read as there are constant and repeated references to other sections in the bill. "such and such is defined as blah blah blah as referenced in Sec.3 par. 2line 23" and wouldn't you know I get to page 39 where I start reading:

PLAIN LANGUAGE.—In this subsection, the term ‘‘plain language’’ means language
that the intended audience, including individuals with limited English
proficiency, can readily understand and use because that language is clean,
concise, well-organized, and follows other best practices of plain language

And I thought to myself. o O (... unlike this bill)

There are measures in the bill for reforming the existing health care industry that I'm not against, but there's a lot more there that makes me very leery.

I've read a little about the "Health Benefits Advisory Committee" (pp. 30-37) which I'm guessing is one of two possible committees I've read about thus far that may be the "death panel" that Sarah Palin referred to in her comments on the bill. As the bill reads now the advisory committee would determine standards and guidelines for what insurance companies do and do not cover. This committee would be chaired by the Surgeon General and appointed by the president to serve on 3 year terms. That sent up warning sirens...

Even those who support and like Obama-- keep this in mind, if this bill passes... After Obama's out of office, say there's a Republican president appointing a Republican Surgeon general... There would be SOME overlap of members of this panel into that president's first term. But then he/she would be able to appoint new members of that panel whose politics are closer to him/her. I could see this panel being highly politicized and making health care even a more politicized and divisive issue than it already is.

In Subtitle D - Additional Consumer Protections: Sec. 131 Requiring fair market practices by health insurers (p. 37)...

I'm hoping to stumble upon something about the fair marketing practices of pharmaceutical companies later in the bill. I still believe that we can drive down the cost of pharmaceuticals by offering tax incentives to pharmaceutical companies that choose to divert their marketing dollars to lower the cost of their medicines to make them more affordable to a larger percentage of the population rather than advertise on TV, radio, & print and rather than splurging on expensive lunches for doctors (it's essentially pharmaceutical payola-- something that was deemed illegal for the music industry to be practicing-- so why are we still letting pharmaceutical companies get away with it?)

Oh and I just read another laugh out loud part...

SEC. 135. TIMELY PAYMENT OF CLAIMS. A QHBP offering entity shall comply
with the requirements of section 1857(f) of the Social Security Act with respect
to a qualified health benefits plan it offers in the same manner an Medicare
Advantage organization is required to comply with such requirements with respect
to a Medicare Advantage plan it offers under part C of Medicare.

This would imply that Medicare actually pays doctors and providers in a timely manner. There are a lot of doctors out there who refuse to deal with Medicare due to either slow or non-payment of claims. So I got a good chuckle out of that bit.

Then I got to the other committee (p. 41 for those of you following along at home):

(a) IN GENERAL.—There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration (in this division referred to as the ‘‘Administration’’).
(b) COMMISSIONER.— IN GENERAL.—The Administration shall be headed by a Health Choices Commissioner (in this division referred to as the ‘‘Commissioner’’) who shall be appointed by the President, by and with the advice and consent of the

I thought the Commissioner was Michael Chiklis and I thought his show was canceled in the early-mid 90s.

"The Commish" will be responsible for:

(a) DUTIES.—The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS.—The establishment of
qualified health benefits plan standards under this title, including the
enforcement of such standards in coordination with State insurance
regu1lators and the Secretaries of Labor and the Treasury.
(2) HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.
(3) INDIVIDUAL AFFORDABILITY CREDITS.— The administration of individual affordability credits under subtitle C of title II, including determination of
eligibility for such credits.
(4) ADDITIONAL FUNCTIONS.—Such additional functions as may be specified in this division.
(1) IN GENERAL.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance
Exchange or outside of such Exchange.
(A) IN GENERAL.—The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance.
(B) RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such QHBP offering entities.
(c) DATA COLLECTION.—The Commissioner shall collect data for purposes of carrying out the Commissioner’s duties, including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the Secretary of Health and Human Services.
(1) IN GENERAL.—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2).
(2) REMEDIES.—The remedies described in this paragraph, with respect to a qualified health benefits plan offered by a QHBP offering entity, are—
(A) civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section 1857(g) of the Social Security Act;
(B) suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur;
(C) in the case of an Exchange-participating health benefits plan, suspension of payment to the entity under the Health Insurance Exchange for individuals enrolled
in such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely
to recur; or
(D) working with State insurance regulators to terminate plans for repeated failure by the offering entity to meet the requirements of this title.

*emphasis mine

The trouble I see with the sanctions (civil money penalties and suspension of enrollment) is the aforementioned potential politicization of both the Health Benefits Advisory Committee and the Health Choices Administration. I could see sanctions being waived for large donors to a sitting president and sanctions being unjustly levied against those who oppose the sitting administration. These fears are rooted in the increazing polarization of not just Washington but the country as a whole. And while our country may not yet be in a place where health care has the potential to be politicized, I believe we are headed in that direction, unfortunately.

I'll keep you all posted as I delve deeper into this riveting page turner.

1 comment:

classicrockforthesoul said...

First of all, you're my hero for actually sitting down with the bill and reading it. The people working for us (aka our Senators and Congressmen) don't even want to read it, but it thrills me that regular American citizens want to understand what exactly is in this bill.

Keep up the good work on this - I enjoy reading your comments on the various topics.