HR 3200 Sec, 113, 114, 115, 116

Sec.113 INSURANCE RATING RULES

a) allows for limited variations in rates QHBPs charge enrollees
b)1) requires a study of large groups, self-insured employers vs. those with a bought plan, including solvency issues for the self-insured.
b)2) requires a report on this study to with recommendations to make sure that there are no incentives for smaller employers to self-insure, or which will "create adverse selection in risk polls of large group insureres of self insured employers". Is this adverse selection adverse to the insurers or the insured?


Sec. 114 Nondiscrimination in benefits.

a) To understand this properly you have to look us sec 702 ERISA 1974, Sec 2702 Public Health Services Act, and Sec 9802 of the Internal Revenue Code of 1986. Which I haven't got to yet.
b) requires parity in mental health and substance abuse benefits, making the provisions of Sec 2705 of the PHSA applicable to all plans, both individual and group, as long as they are not superceded by or inconsistent with Subtitle C.


Sec. 115 ENSURING ADEQUACY OF PRIVIDER NETWORKS.

a) QHBPS areto have enough profiders in their networks that their enrollees can actually get the covered services. What happens if no QHBPs in a geographic area can get enough folks to accept their plans?
Transparency in the cost-share differential between in network and out-of-network is required. Every plan I've ever had had this in the enrollment book and printed on the insurance cards.


Sec. 116 ENSURING VALUE AND LOW PREMIUMS

a) seems to basically mean that if a QHBP takesi n more than a pre-set % of what it pays out it must rebate the excess to enrolees. The term medical loss ratio is used, which seems to mean the portion of premiums taken in that is used to cover enrollees claims.
b) the Commissioner is to use HHS methodology to set the MLR. It must be high enough to get insurers to participate. Though if the MLR is what they pay out, it would seem that they mean setting the percentage of premiums NOT spent on enrollee claims high enough.

John Conyers is an ass.

John Conyers actually has the nerve to say there is no reason for our legislators to read the bills put before them. Since the health care bill would take two days and two lawyers to understand, they shouldn't bother.

Patronizing is one of the nicer terms I can think of. I mean, us poor stupid voters, how can we think that our representatives ought to know what they're doing when they vote on something?

Here is the news item, with a video clip :http://www.cnsnews.com/public/content/article.aspx?RsrcID=51610&print=on

Edited on Friday, July 31st to add:
I've been told that what he was saying was that there was no point in reading the current version of the bill because it was that long and complex and was going to be changed in committee anyway.

However.... it will probably be easier to understand the changes if one understands what was there to be changed, and if they had come up with a bill out of committee on Wednesday, I'd be willing to bet that they'd still expect the House to vote on it by today, even if the members hadn't had the two days and two lawyers to help them out.

HR 3200, Sec. 100, 101, 102, 111, 112.

OK, I started reading this thing and taking notes on it yesterday.

Text in red is directly from the GPO pdf of the bill.

Dr. Who is much more interesting.

DIVISION A - AFFORDABLE HEALTH CARE CHOICES

Sec. 100 PURPOSE; TALBLE OF CONTENTS OF DIVISION; GENERAL DEFINITIONS

a)1) The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending.
Will the bill ever address how you can increase the number of people utilizing our health care system without increasing the amount you need to spend?
a)2) actually uses the word "broken" to describe aspects of the health care system.
a)3) discusses how the bill will reform health insurance.
a)4) Entitled HEALTH DELIVERY REFORM
First the snarky question - how do you deliver health? Second - similar question to a1, how do you increase quality of health care to more people while spending less per person?
b) the table of contents
c) general definitions used throughout the bill, with many references to ERISA 1974
c)25) Y1 ... and similar subsequently numbered terms, mean 2013 and subsequent years, respectively.
Do most folks who are pushing for this realize that it won't help anyone for at least 4 years?

Now we get to the actual TITLE I of the bill - PROTECTIONS AND STANDARDS FOR QUALIRIED HEALTH BENEFITS PLANS.

Subtitle A - General Standards

Sec. 101 REQUIREMENTS REFORMING HEALTH INSURANCE MARKETPLACE

That is an exact quote from the GPO copy of the bill. Does anyone out there know what it means? Otherwise the section is actually comprehensible, at least to someone with a postgraduate level of education.

Sec. 102 PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE

a) defines grandfathered coverage. If I'm reading this right, only individual plans (not group, or employer plans) can be grandfathered. However, per b)1) there is a 5 year transition period for group plans.
a)1) beginning with day 1 of Y1, no new enrollees in existing plans, except for adding dependents.
a)2) NOTHING about a plan can change except for the premiums or other changes required by law.
a)3) defines the premium increase rules.

b)1) by the beginning of Y6, all employment based plans must meet requirements of Sec 101 for QHBPs, i.e., unless your plan already met the requirements on Day 1, Y1, YOU CAN NO LONGER KEEP YOUR
PLAN
b)2) beginning with Day1, Y1, the only individual plans for new enrollees must be QHBPs and must be Exchange participating.


Subtitle B - Standards Guaranteeing Access to Affordable Coverage

Sec. 111 PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS
A short section, only one paragraph, which prohibits QHBPs from imposing pre-existing condition exclusions or limits.

Sec. 112 GUARANTEED ISSUE AND RENEWAL FOR INSURED PLANS

This is a little unclear on initial reading, partly because it references sections 2711 and 2712 of the Public Health Service Act, but it sounds like once someone is in a plan, as long as they pay their premiums they can never be dropped, for any reason. As a reasonable person, I would read this section to say that a) an insured can never be dropped unless they fail to pay their premiums, and b) as long as a single insured wishes to keep their plan, the insurer MUST keep insuring them.

Does this mean that once a plan is offered the insurance company can never stop offering it? i.e., if BigInsCo decides they no longer want to offer group plans, they must continue for as long as a single
client wishes to use that plan?

HR 3200

So I'm starting to read this 1000+ page monstrosity. Lets see if I can make any sense of it....