Post by unlawflcombatnt on Jan 3, 2010 17:00:01 GMT -6
Many of the claims about what the Senate health bill will actually do are false. The bill is rifled with major distortions and outright lies.
The most glaring is the "No Lifetime or Annual Limits" on health coverage.
This is actually the title of a section, which goes on to state the following ( page 16 ):
"Unreasonable?" So that means that "reasonable" limits CAN be placed on annual coverage.
Which means limits on annual coverage ARE allowed by the bill. It's simply amazing that the section has "no annual limits" in its title, and then goes right ahead and allows them in the legislative language."
There is no actual ban on Rescissions. An insurer can simply claim that there was misinformation on the original application, declare it "fraudulent," and rescind coverage. This can be seen from the following wording in the bill ( page 16 ):
This further gives lie to claims that pre-existing condition exclusions have been eliminated. If pre-existing condition exclusions actually were eliminated, there'd be no way to commit "fraud" on the application. If a pre-existing medical condition was not mentioned in the enrollment application, it would be immaterial if pre-existing condition exclusions were disallowed. Since the omission of that information would be immaterial, it would not be grounds for a fraud claim. But clearly they are material in the new health plan, or there'd be no reason for their omission to be considered fraud.
Other clauses further debunk the myth of "no pre-existing condition exclusions." Though the language claims there are no pre-existing condition exclusions, it does not say enrollees can't be charged more for insurance. In fact, there will be a high-risk pool that can charge 4x the amount of premium as it does for others. And the major factor putting a person in the "high risk" category is...a preexisting condition.
Here is the language regarding the high risk pool ( page 42 ):
(B) provides health insurance coverage....
(C) ensures that with respect to the premium rate charged for health insurance coverage offered to eligible individuals through the high risk pool, such rate shall--....
(ii) vary on the basis of age by a factor of not greater than 4 to 1....
(d) Eligible Individual- An individual shall be deemed to be an eligible individual for purposes of this section if such individual--
(1) is a citizen or national of the United States or is lawfully present in the United States....
(3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.
[/ul]
Thus those in the high-risk pool can be charged 4x as much. And if you have a pre-existing condition, the insurer can automatically put you in the high risk pool and charge you 4x as much.
So if you have a rotator cuff tear, asthma, depression, acne, or jock itch--you can be charged 4x as much.
Those not in the high-risk pool can be charge 3x as much based on a number of factors. This can be seen in the following passage from the bill ( page 80 ):
Thus those with health problems can easily be charged more for premiums. Those in the normal risk pool can be charged 3x as much as others.
But the premium and cost variations are worse than that. There's also the spurious enrollment in "wellness" programs, which allows the insurer to charge 30% less for selected enrollees. Though this is done under the guise of wellness program enrollment, it can be used to effectively lower the rates among less risky individuals by 30%. This effectively allows a variation in premiums of 4.2-to-1 for "normal" risk patients. For those in the high-risk pool, it is an effective rate variation of 5.7-to-1. ( page 87 )
A reward may be in the form of a discount or rebate of a premium or contribution, a waiver of all or part of a cost-sharing mechanism (such as deductibles, copayments, or coinsurance), the absence of a surcharge, or the value of a benefit that would otherwise not be provided under the plan.[/ul]
But there's still more. The Secretary of Health is allowed to increase the discount to wellness enrollees up to 50%. This would give a rate variation of 6-to-1 for regular enrollees. And it would create an 8-to-1 ratio between wellness enrollees and high-risk pool enrollees (page 88 ).
The high-risk pool will likely be unaffordable, at 6-8 times the cost of the lowest cost health care. And again, anyone with a pre-existing condition will fall into that pool.
Forget about limitations on medical loss ratios, like the false claim that 85% of the health care dollar must be spent on health care. That claim is an outright lie. In fact, health insurers will be permitted to spend as little as 75% of their premium income on health care. This can be seen from the following excerpts from the bill ( page 30 ):
`(A) with respect to a health insurance issuer offering coverage in the group market, 20%, or such lower percentage as a State may by regulation determine; or
`(B) with respect to a health insurance issuer offering coverage in the individual market, 25%[/ul]
The current Senate Health Care Bill is a scam. It's was written by insurers through their agents in Congress. And anything of any benefit in the Congressional bill--like the Public Option--has already been stripped out.
The most glaring is the "No Lifetime or Annual Limits" on health coverage.
This is actually the title of a section, which goes on to state the following ( page 16 ):
"Unreasonable?" So that means that "reasonable" limits CAN be placed on annual coverage.
Which means limits on annual coverage ARE allowed by the bill. It's simply amazing that the section has "no annual limits" in its title, and then goes right ahead and allows them in the legislative language."
There is no actual ban on Rescissions. An insurer can simply claim that there was misinformation on the original application, declare it "fraudulent," and rescind coverage. This can be seen from the following wording in the bill ( page 16 ):
This further gives lie to claims that pre-existing condition exclusions have been eliminated. If pre-existing condition exclusions actually were eliminated, there'd be no way to commit "fraud" on the application. If a pre-existing medical condition was not mentioned in the enrollment application, it would be immaterial if pre-existing condition exclusions were disallowed. Since the omission of that information would be immaterial, it would not be grounds for a fraud claim. But clearly they are material in the new health plan, or there'd be no reason for their omission to be considered fraud.
Other clauses further debunk the myth of "no pre-existing condition exclusions." Though the language claims there are no pre-existing condition exclusions, it does not say enrollees can't be charged more for insurance. In fact, there will be a high-risk pool that can charge 4x the amount of premium as it does for others. And the major factor putting a person in the "high risk" category is...a preexisting condition.
Here is the language regarding the high risk pool ( page 42 ):
(B) provides health insurance coverage....
(C) ensures that with respect to the premium rate charged for health insurance coverage offered to eligible individuals through the high risk pool, such rate shall--....
(ii) vary on the basis of age by a factor of not greater than 4 to 1....
(d) Eligible Individual- An individual shall be deemed to be an eligible individual for purposes of this section if such individual--
(1) is a citizen or national of the United States or is lawfully present in the United States....
(3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.
[/ul]
Thus those in the high-risk pool can be charged 4x as much. And if you have a pre-existing condition, the insurer can automatically put you in the high risk pool and charge you 4x as much.
So if you have a rotator cuff tear, asthma, depression, acne, or jock itch--you can be charged 4x as much.
Those not in the high-risk pool can be charge 3x as much based on a number of factors. This can be seen in the following passage from the bill ( page 80 ):
Thus those with health problems can easily be charged more for premiums. Those in the normal risk pool can be charged 3x as much as others.
But the premium and cost variations are worse than that. There's also the spurious enrollment in "wellness" programs, which allows the insurer to charge 30% less for selected enrollees. Though this is done under the guise of wellness program enrollment, it can be used to effectively lower the rates among less risky individuals by 30%. This effectively allows a variation in premiums of 4.2-to-1 for "normal" risk patients. For those in the high-risk pool, it is an effective rate variation of 5.7-to-1. ( page 87 )
A reward may be in the form of a discount or rebate of a premium or contribution, a waiver of all or part of a cost-sharing mechanism (such as deductibles, copayments, or coinsurance), the absence of a surcharge, or the value of a benefit that would otherwise not be provided under the plan.[/ul]
But there's still more. The Secretary of Health is allowed to increase the discount to wellness enrollees up to 50%. This would give a rate variation of 6-to-1 for regular enrollees. And it would create an 8-to-1 ratio between wellness enrollees and high-risk pool enrollees (page 88 ).
The high-risk pool will likely be unaffordable, at 6-8 times the cost of the lowest cost health care. And again, anyone with a pre-existing condition will fall into that pool.
Forget about limitations on medical loss ratios, like the false claim that 85% of the health care dollar must be spent on health care. That claim is an outright lie. In fact, health insurers will be permitted to spend as little as 75% of their premium income on health care. This can be seen from the following excerpts from the bill ( page 30 ):
`(A) with respect to a health insurance issuer offering coverage in the group market, 20%, or such lower percentage as a State may by regulation determine; or
`(B) with respect to a health insurance issuer offering coverage in the individual market, 25%[/ul]
The current Senate Health Care Bill is a scam. It's was written by insurers through their agents in Congress. And anything of any benefit in the Congressional bill--like the Public Option--has already been stripped out.