HR3200 does have some good stuff, and perhaps if there was more about how this was going to be paid for and concerning tort reform this bill would be salvageable. Salvageable of not, the good warrants mentioning: Keep in mind these comments come straight from the blog and may be out of context. Refer to the blog for clarification.
- People will be allowed to purchase their own supplemental insurance to cover those things they want that are not covered by the exchange product.
- There is a provision that profits from exchange policies are to be returned to enrollees.
- The exchange will provide coverage for psychiatric disease and substance abuse programs, which is something we don’t see with Medicaid/Medicare.
- No yearly/lifetime caps on benefits.
- Preventive care recommendations will follow the US Preventive Services Task Force grade A & B recommendations
- The committee deciding coverage will have a public forum so that everyone can input on care.
- They (the committee) will not dictate what can and cannot be done, just what that program will pay for.
- The basic plan will cover about 75% of costs, enhanced=85%, premium 95%.
- The bill includes provisions mandating that all insurance providers return profits beyond a certain level to the enrollees.
- Provisions that mandate insurance companies must renew policies unless there is suspicion of fraud.
- Real time/in office determination of coverage and an individual’s component of the charges with claim adjudication. This is cool,
- Everyone is eligible to enroll in an exchange insurance unless you are already enrolled in acceptable insurance (guess you gotta quit first?) 78: once you’ve been accepted you can keep it forever till you quit or qualify for Medicare/Medicaid
- The public option will be operated the same as any other exchange insurance, including cost sharing and various tiers to pick from. It’s not necessarily a freebie if you don’t qualify for enough credits to offset its cost to you. ***THERE IS NO PROVISION TO FORCE EVERYONE TO BE INSURED UNDER ANY PROGRAM AND BUT CERTAIN INDIVIDUALS CAN BE AUTOMATICALLY ENROLLED *** THEY DO NOT HOWEVER AUTOMATICALLY GET CREDITS TOWARD A FREEBIE INSURANCE—THEY NEED TO BE APPLIED FOR.
- The Medicaid department will make credit determinations and in the process identify those who should be enrolled instead into Medicaid. I think this is part of an initiative to capture those who qualify for Medicaid but refuse to join.
- Penalties are set for those that misrepresent themselves in applying for credit.
- Employers offering exchange plans will pay >=72.5 % of individuals plans and 65% of family plans. Some employers pay 100% of plan premiums now.
- Part time employees are eligible for prorated coverage.
- The bill does force those with means to get insurance.
- Small business (based on their payroll) may qualify for credits towards insuring their employees—not including those being paid over a certain amount. The amount of credits applicable is phased out with increasing payroll/business size.
- Provision for providing payment for inpatient psychiatric care.
- Provision to increase reimbursement of non-therapeutic nursing home costs
- Medicare payments (esp to SNFs/NHs?) will be adjusted upward if the national rate of uninsured individuals decreases by 8% secondary to this reform.
- Provision to address potential excess costs by cancer hospitals relative to receiving similar treatments elsewhere.
- I agree with need to address excessive costs from non-compliance by patients in regard to their health care instructions
- Provisions that allow such activity in rural areas where something like that may be the only game in town. At the same time, they place provisions that attempt to discourage inappropriate use or growth of such a monopoly.
- Medicare Advantage reforms: I agree that bonus payments can be an incentive to providing quality care
- Provisions that participating drug companies rebate the government for the cost of some Medicare Part D medications.
- There are several provisions here to make Medicare more affordable for low-income individuals and to ease their enrollment.
- Now I like this, Medicare/caid may start reimbursing for the use of translators. They’ve demanded it in the past and the cost of a translator usually far exceeded the reimbursement of the patient’s visit to the office
- he next 10 pages deal with standardizing Advance Directives in the hospital setting. Please note that this portion of the bill is shorter than the provision that provides for translators. There is nothing different in here than what physicians are already doing when discussing end-of-life care/Advance Directives/DNR (do not resuscitate) plans. All this section does is set down uniform guidelines: who does it, when, how often, why, what form do we use… With all the real crap in this bill, this ain’t nothin’—we’ve been doing discussing this stuff half-hazardly for years and if you have ever had to deal with a distraught family whose terminal relative was put on life support because their wishes had not been known, you would know this is a good thing. All this says is that they are included in the decision making process. There are no provisions for herding old ladies into hospice. There are provisions that the doctors inform patients of the risks and benefits of the various options open to them.
- It’s nice to know the government has finally realized its cheaper to find and treat an aneurysm early than to take care of one emergently and subsequently. Eliminating the co-pay for preventive services is a good thing but keep in mind that the recommendations for screening for most diseases end about the age of 70-75 (ie, no one checks 80 year olds for cervical cancer—or at least they shouldn’t). This provision will be tangible for those under 70 in an insurance exchange program that follows Medicare rules.
- Establishment of an organization to determine what areas of medicine should be researched in order to determine the direction of health care initiatives. I thought this was the job of NIH (National Institute of health). The proposed organization is a multidisciplined panel that will also weigh in of what works and what doesn’t work in medical practice. While independent medical research does a lot of this, much of this research is supported by pharmaceutical companies—which are understandably only interested in researching areas of future profit (its America! That’s the way it works here comrade.) An organization like this may be beneficial in steering medical research into under served areas (ie treatment of chronic/recurrent celiac plexus pain in people who have had certain abdominal surgeries/illnesses). Something like this could be funded by redirected cancer research or maybe a small tax on insurance premiums, or alcohol, or big macs…
