Thursday, July 30, 2009

The House Health Care Bill: The First 100 Pages

Everyone (including myself) is going to think that I'm a huge loser for sitting around on a Wednesday night and reading 100 pages of Congressional legislation, but it gives me bragging rights over the folks in Washington who actually vote on it but cannot make the same claim of reading it. It also serves to inform you of what is really being discussed in Washington. Unlike our Congressional representatives, I deem the task of reading transformational legislation to be of the utmost importance. What I found is startling.

Page 15: "(b) REQUIREMENTS FOR QUALIFIED HEALTH BENEFITS PLANS.—On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved"
  • This section essentially says that insurance companies cannot issue plans unless they meet certain requirements set by the government. You will not decide what you get and pay for in your plan. The government will. This is an essential step in the crowding out of private insurance. The government tells the private companies what they have to offer, but then the government is able to offer it at a lower cost; this will lead to individuals dropping private coverage.
Page 16: "(1) LIMITATION ON NEW ENROLLMENT.— (A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1."
  • This section makes it illegal for private insurance companies to issue new private plans after the bill takes effect (read: no choice!). You can keep your current plan, but if you ever want to switch (which everyone will at some point due to changing jobs or otherwise) then you have to go on the public plan. This furthers the crowding out of private plans and will eventually eliminate private insurance entirely, leaving us with only the government "option."
Page 21: "(1) LIMITED AGE VARIATION PERMITTED.—By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1."
  • This essentially means that younger, healthier people are going to have to pay a much higher premium in order to pay for the care of older people who need more medical care but will be paying a much lower premium than they normally would. The Wall Street Journal, in a recent article, notes that the normal age-related premium ratio is 5 to 1. To put it simply, the 20 year old with zero health problems might be paying $50 per month when he should only be paying $20 per month. At the same time a 55 year old who requires more medical care solely because of age only pays $100/month when she should be paying $250 per month. This will only serve to force younger individuals onto the public plan, because they cannot afford private coverage, further exacerbating the crowding out factor.
Page 28: (starting on page 27) "(b) MINIMUM SERVICES TO BE COVERED....
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age."
  • Any readers see anything wrong with #7? For my male readers, how about #9? Back in fourth grade I learned that a uterus and a vagina were required to birth a child. I'm pretty sure that has not changed. I have neither a uterus or a vagina, so why am I going to pay and be covered for maternity care? For those of you who don't drink (much), smoke or otherwise put harmful substances into your body, #7 requires you to pay for substance abuse coverage even though you don't abuse anything. This only increases the cost of insurance for some people.
Page 42: "(3) INDIVIDUAL AFFORDABILITY CREDITS.— The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits."
  • Translation: another welfare program. "Affordability credit" is government-speak for "welfare." If you happen to be one of the politically favored, government-dependent individuals who work 51% less than the people who fend for themselves, you will receive even more government money than you were prior to the passage of this bill.

Page 71: "(ii) BUDGETARY IMPLICATIONS.— Amounts appropriated under clause (i), and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Trust Fund."
  • This might be the most deceitful thing that I read last night. It basically says that some of the costs incurred in the legislation will simply not be counted in the budget. If the legislation actually costs $1 trillion then it gives the politicians a chance to say "we just won't count $300 billion of it, and we can tell the American people that it only costs $700 billion, because we passed a law saying that we can do it." Now we have Congress actually passing laws that make it legal for them to lie to our faces and pull an Enron scheme on all of America.
I left out about 5 or 6 other gems that were included in the first 100 pages, like the one on Page 39 that is surely meant to protect illegal aliens by mandating that all health care plans, documentation and explanations of benefits must be able to be understood by people with "limited English proficiency." This was just the first 100 pages of a 1000+ page bill. I can't imagine what else is buried in it. Leave your comments below.

****** Revision 7/30/2009 ******

It has come to my attention, thanks to a great reader, that I read one of the provisions in the bill incorrectly. It is posted below, but I removed it from the main post, because I was incorrect in my assertion that the provision will let the government suspend someone's health plan. The provision simply states that an insurance company cannot keep issuing the same plan upon being notified by the government.

Page 44: "(1) IN GENERAL.—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2).....
(B) suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur;"
  • If you purchase a private insurance plan and the government deems it inadequate then the government can simply suspend your plan without you knowing it. This would leave you without health insurance even though you have paid for it.
Clarification to Pg. 16 commentary: while this clause does not entirely outlaw private insurance, it does force people into the national health insurance exchange, the body through which all private plans will be offered and regulated. This will, however, eventually lead to crowding out of private insurance, because they will be told by the government what they must offer and how much it will cost.


  1. Your Page 16 argument has been analyzed as false by many credible sources. Go check PolitiFact and search for "Limitation on new enrollment" to get the article.

    Page 42 establishes the ability of welfare-level people to enroll. We are already paying for this anyway when uninsured people go to an emergency room for care.

    Your other points MAY be accurate, I don't know at this point though. It's a VERY confusing and vague situation.

    Page 44 reads "suspension OF ENROLLMENT", not suspension of the plan... Big difference.

  2. By the way, I look forward to your further analysis. You are definitely hitting on some key points that are very valid problems.

  3. One thing I'd like to point out, and one thing I'd like some numbers for (Patrick) is regarding covering the uninsured.

    The uninsured get care already (outcome is only 15% dependant on coverage). So, an uninsured person goes to the ER, we spend $1K, $2K, whatever on this visit (we=the insured who pay higher premiums due to cost shifting, portion of property/sales taxes, etc...).

    So this amount is paid for by us. What I would like to know is what percentage of the uninsured actually go to the ER? I would imagine that number is quite low when compared with the total uninsured population. Is it cheaper to cover these people when the actually go for care, or is it cheaper to cover ALL of them with a basic policy whether they use it or not? I would think it would be much more expensive to cover everyone, but I'd like to know for sure.

  4. Patrick, on the question of maternity care, do you really think that it's not in the best interest of the whole country to take care of expecting mothers? You don't have any kids in school, but your taxes go to fund education, or do you think that education spending is also a waste of money? And fyi, I'm happy for my tax dollars to pay in part for male-only health-related issues: prostate cancer treatment, for example. As a woman, I have no problem with that because it is to the benefit of society as a whole. Sex discrimination should not have a place in health care.

    I know you probably think the NYT opinion page is a bunch of left wing crazies, but read Nick Kristoff's column from yesterday on the subject of maternity care. As he says, "If men had uteruses, 'paternity wards' would get resources, ambulances would transport pregnant men to hospitals free of charge, deliveries would be free, and the Group of 8 industrialized nations would make paternal mortality a top priority."


Note: Only a member of this blog may post a comment.