I don't understand this congress passed hea;thcare bill much at all

[blues90]

I kept hearing a mandate is a gift to the insurance companies sort of a trade of where the insuance companies get 45 million more people and the insurance companies will look the other way on pre-existing conditons and can't cancel people if they become an expense suddenly.

What's to stop the insurance comps from raising rates? I don't see any number given to "affordable".

I know this still has to go through the senate.
I don't know when the mandate deal takes affect. I would be nice to know so I know how much longer I will have to choose between a roof and food.

One would think they would regulate the costs the ins companies can charge. Plus hospitals and doctors. I find it difficult to believe that the un-insured using emergency services are to sole reason everything cost so damn much not when the med ins companies are rolling in money and making 20 to 30% profits.

I'm not saying I have a better way or ideas , but at a time when the un-employment rate is 17%+ how on earth can people be forced to buy insurance. To many this is buy or die.

I don't know when this mandate kicks in , I have heard a few thing will kick in soon.

[tabatha]

1. Here is some help - look at 8 and 9

TOP 14 PROVISIONS THAT TAKE EFFECT IMMEDIATELY

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE ­ Reduces the donut hole by $500 and institutes a 50%
discount on brand-name drugs, effective January 1, 2010.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) ­ Creates a
temporary insurance program until the Exchange is available for individuals who have been uninsured for several
months or have been denied a policy because of pre-existing conditions.

3. BANS LIFETIME LIMITS ON COVERAGE ­Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS ­Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for
benefits, except in the case of fraud.

5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE­ Requires health
plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.

6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE­ Eliminates co-payments for preventive
services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES­Improves the low-income protection programs in
Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE­ Prohibits Medicare Advantage plans from
charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

9. IMMEDIATE SUNSHINE ON PRICE GOUGING­ Discourages excessive price increases by insurance companies through
review and disclosure of insurance rate increases.

10. CONTINUITY FOR DISPLACED WORKERS­Allows Americans to keep their COBRA coverage until the Exchange is in
place and they can access affordable coverage.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM ­Creates a long-term care insurance
program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

12. HELP FOR EARLY RETIREES ­Creates a $10 billon fund to finance a temporary reinsurance program to help offset the
costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

13. COMMUNITY HEALTH CENTERS­ Increases funding for Community Health Centers to allow for a doubling of the
number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS ­ Provides new investment in training programs to increase the
number of primary care doctors, nurses, and public health professionals.

PREPARED BY OFFICE OF SPEAKER PELOSI – OCTOBER 29, 2009

[backscatter712]

2. Here's the theory of the mandate.

There are two economic models for insurance. One is experience-rated insurance, and the other is community-rated insurance.

Our current broken-ass system is experience-rated. In other words, everyone who wants insurance is evaluated for the risk they will make claims. That means they go through your medical records, factors like age, gender, smoking, etc. etc. etc., crunch the numbers using the actuarial tables, figure out how much you'll cost, add in administrative costs and profits, and there's your premium. If your risk is too high, you either get priced out of being able to buy insurance, or the insurer will refuse to do business with you.

As everyone here on DU well knows, this model has flaws - it throws the sick, hurt and disabled under the bus so they can't get health coverage at all, even though they're the ones that need it most.

The other model is community rating. Here, the general idea is that everyone pays the same. Whether you're rich, poor, sick, healthy, male, female, high-risk or low-risk, you pay the same, and the insurer cannot exclude anyone. The problem is that then you get what's known as a moral hazard. In other words, healthy, young people won't be motivated to pay into the system until they need it, and you get adverse selection, which causes costs to spiral upwards.

The remedy for the adverse selection problem is mandates. In other words, not only is everyone allowed to get in paying the same rate, everyone is REQUIRED to pay in. That way, the risk is spread around evenly, and nobody gets to freeload, and nobody gets stiffed.

That's the theory at least.

Personally, I think the individual and employer mandates are necessary, for the reasons I laid out above, but at the same time, the insurers absolutely need to be put on a leash. The public option is necessary - to give the insurers more competition, and give people a way to give the entire industry the finger if they won't treat people fairly. So is revocation of the insurer's anti-trust exemption, as is outright laws requiring community rating, banning pre-existing conditions clauses, rescissions of sick people, and other abuses. At least the current legislation that just passed the House gives us most of that.

And as Hello_Kitty mentioned, if you can't afford health coverage, you should be getting help - part of the health care bill is sliding-scale subsidies to help health care become affordable.

[Hello_Kitty]

3. If you're in a position between choosing between a roof and food.

You should qualify for Medicaid or substantial subsidies under the plan. The problem IMO is that the thing has to be "revenue neutral", which means that subsidies will be reduced if costs go up. So it will help you in the beginning but may bleed you as time goes on. Or it may not. Depends on what your income is going forward and how well this thing works.

And you're right about the uninsured not being the sole cause of high health care costs. The most generous estimates have the uninsured adding 8% to the average premium. 8% isn't nothing but it's hardly cause to demonize them a la welfare queens and not a reason to think that mandates to buy private insurance are the magical cure to affordability for everyone.

[blues90]

5. What really gets me is this.

It's true in all cases when you pay for insurance whether car insurance or health or dental. You don't see what the actual cost of the care was compared to the profit above that. You don't see this with anything even a home repair. But you can with auto body repair get estimates which is required , at least it was and submit them to the ins company. At least you have a choice of price or to do nothing at all.

With this thick healthcare bill there is nothing stating what the cost will be just that they will save X amount over the next 10 years , Based on WHAT?

I worked for auto dealerships in the repair end and I know for a fact that techs recommend more work than needed and the service adviser sells all they can. Yet you can shop around. I was honest with customers and either when I was a manager told the writer this is what you remove and tell the customer down the road you may need this or that and when I was a writer I knew what they needed because I was a tech for many years before and sold them only that and said , these other things may need attention and explain why but lets look next time you come in to be certain.

I was told when I had my job with insurance I was told what my end was but never knew what percentage the company I worked for paid . When I lost my job I got cobra form and from that it looked like I was paying full pop for the crappy dental.

[sandnsea]

4. 85% of premiums must be paid out in health coverage

Consequently they can't just raise the rates infinitely unless they start paying more for services, or for more services, or both.

And, they have to keep the insurance at a 2:1 ratio, so they can't charge older people significantly more than younger people so young people will always be paying attention to the health care issue.

Furter, if the subsidies cause us to have to raise taxes, again, people will start complaining which will again reduce premiums.

There are mechanisms in there to control premiums, but we do have to pay attention to them.

[blues90]

6. I don't see how anyone can keep on top of the ins companies

All these years they have gotten away with murder. No one payed attention when these damn HMO's were shoved down our throats and that is how they grew to the point they are now.

At what price is it that we say enough . We will need an entire set of buildings and low paid employees just to over see the health ins companies so add that in or subtract that for the so called savings over the 10 years they claim we will see.

With most of both political parties in the pockets of the ins companies as well as wallstreet and the banks and the war machine how are we as the little people supposed to trust any bit of this , it's all projection.

See you in the camps.

[optimator]

7. subsidies should be paid to doctors not insurance criminals

that would bring costs down.
this insurance bill only shifts and shuffles the burden of unchanged costs.