in america, health care reforms YOU

It’s that time again.  For cake? you are inquiring hopefully.  Sadly, no.  Put down those forks, and prepare yourself for another installment about HEALTH CARE REFORM, the hot button issue that has all the young people buzzing about what they’re going to do w/ Grandma’s jewelry once the death panels put her down.

Today we are going to discuss the remainder of Title I, and also Title II, in all its glory.

Subtitle F starts off by making reference to the well-known Public Health Service Act of 1946.  Unfortunately, your humble and barely-literate author was unfamiliar w/ this document, and had to google it in order to figure out wtf they were talking about.  Basically, Subtitle F is a disclaimer stating that H.R. 3200 doesn’t override any of the stupilations set forth in the Public Health Service Act, specifically section 22 (about providing care to people w/ AIDS), and section 27, called “lifespan respite care.”

I pondered the word respite.  Respite?  FROM LIFE?  OMG, DEATH PANELS.  I had finally found it!  Or wait…no.  Here’s what the bill actually defines “lifetime respite care” as: “a coordinated system of accessible, community-based respite care services for family caregivers of children or adults with special needs.”

Well that was more anti-climactic than the swine flu pandemic.  Moving on.

The subtitle goes on to set down some anti-discrimination guidelines, and also includs a sort of Good Samaritan clause, wherein employees who identify malpractice are protected from retaliation from irate employers.

Subtitle F ends talking about “Severability,” or as I like to call it, “ass-covering,” saying: “If any provision of this Act, or any application of such provision to any person or circumstance, is held to be unconstitutional, the remainder of the provisions of this Act and the application of the provision to any other person or circumstance shall not be affected.

The last subtitle of Title I deals w/ an amendent to the now-infamous section 22 of the Public Health Service Act.  Basically, it states that if coverage falls below a certain “medical loss ratio” (to be est. by the Health Secretary), than insurance issuers have to give their customers rebates to make up for it; this applies to both groups and individuals.

Quite a bit is devoted to crafting a law to make sure that insurance companies are bound from rescinding their services unexpectedly.  Anyone who has received a near-incomprehensible letter from their insurance company, stating that they “won’t pay gyrate termites niggle piggle pants poo, YOU ARE NOW UNINSURED; you can appeal but you know that won’t help frigid middle vanaduous” knows what I’m talking about.  The only case in which an insurance company can dump someone is if there is clear evidence of insurance fraud, which must be verified by a third party review panel.

In order to make transmission of data more efficient, there are plans to cut down on the amount of paper, and increase use of electronic communication.

The bill also plots to provide retirees w/ “health benefits,” or “medical, surgical, hospital, prescription drug, and such other benefits as shall be determined by the Secretary, whether self-funded or delivered through the purchase of insurance or otherwise.”

This is to make sure that old people (defined as over 55.  I know, I know, you still FEEL young) who aren’t eligible for Medicare and whose employers didn’t contribute to a retirement account (or perhaps just squandered it in an attempt to get rich quick) are still taken care of.  The retirees get to have a trust (or “reinsurance”) fund set up to cover these medical expenses, which is capped at $10 billion.

Title II is called “Health Insurance Exchange and Related Provisions.”  The govn. wants to est. something called a “Health Insurance Exchange…in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.”  It then defines who is eligible to participate (pretty much everyone, although enrollment is spaced out over a period of 3 yrs.).  And once you’re in, you’re in.

The bill then covers what kind of plans issuers can offer under contract w/ the Health Commissioner.  There will still be co-pays, but not for the “basic services” (covered in our last entry).  The Commissioner will accept bids of coverage plans from insurance companies, so long as the companies meet certain criteria (e.g. data reporting, enrollment accepting, affordable, offering culturally and linguistically appropriate service to cilents).

The next section, 205, deals w/ employer-employee rltnshps.  Employers will hold open enrollment periods so people can sign up for insurance plans.  People who aren’t eligible for Medicaid are automatically enrolled in an Exchange-program.  If you ARE eligible, you’re automatically enrolled in Medicaid.  Either way, you’re covered.

Gentlefriends, I know I promised you all of Title II today…but alas, the clock is ticking, and even though I would like nothing more than to spend the rest of my day hacking through this dense underbrush of legal language in search of troves of meaning, I cannot.  I still have a lot of packing to do and errands to run before I leave on Tuesday.  That said, I hope you will continue your own foray into the world of H.R. 3200.

Perhaps I will be able to finish this up while it’s still relevant…but I can’t make any promises.  Do come back for fascinating tales of living and teaching in Namibia, though!


One thought on “in america, health care reforms YOU

  1. Thank you for deciphering some of that. I haven’t had the balls to try yet, but I probably should considering I’ve already gotten into several health care arguments with republicans here. Btw, “won’t pay gyrate termites niggle piggle pants poo, YOU ARE NOW UNINSURED; you can appeal but you know that won’t help frigid middle vanaduous”–well said. You always manage to make me laugh; I almost swallowed my gum.

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