‘‘Patient Protection and Affordable Care Act’’ Part I

So lets get started. The actual meat of the Senate version of the health care bill starts on page 16. Pages 2-15 are an “index” of section numbers, much like page numbers but with specific reference to certain portions of the text and not an actual page number, per se. My review is based on page numbers; mostly because it’s easier for me. If a section crosses page numbers, I’ll complete that section and pick up the remainder of the page in another post. If you would like to follow along as we review together, here is the link to the bill from the democratic senators website.

The first section tells us that insurers are not allowed to establish lifetime limits of coverage or set “unreasonable” annual limits on beneficiaries, but fails to tell us what “unreasonable” is. If a service is not part of the basic essential package of benefits required, insurers may impose lifetime and individual limits for those services. This section also says that an insurer cannot rescind a members benefits once enrolled, unless that person commits fraud or makes an act of intentional misrepresentation. But they can cancel your insurance with prior notice, as permitted under section 2702(c) or 2742 (b). So in effect, they can cancel you with prior notice.

This next section is even better. Instead of paraphrasing it, I decided to include it in it’s entirety so everyone can see just how ridiculous this is. I’m also including the link to the Task Force they mention. You definitely need to read that. Look through the list and pick a disease or diseases that you or someone you know may be concerned about. Check the recommendations for screening. Wow!

SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES. ‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for—
‘‘(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;
‘‘(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and ‘‘(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

‘‘(b) INTERVAL.— ‘‘(1) IN GENERAL.—The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline. ‘‘(2) MINIMUM.—The interval described in paragraph (1) shall not be less than 1 year.

The previous section is saying that any new recommendation made by the task force must wait at LEAST one year before being included as a covered, no “cost sharing”, benefit. By that time the research and literature will have likely changed and we’ll all be receiving a free benefit that covers an outdated treatment or recommendation. It could actually be found to be harmful. Thanks!


Wow! Really big words that mean that all of the insurers are going to be forces to provide members or insureds (you) with a complete, concise summary of benefits and coverage, that is culturally appropriate, not smaller than 12pt type, contain insurance and medical definitions, description of coverages including those requiring cost sharing, deductibles, copays, renewals and only be four pages long. The bill took almost four pages to say what had to be contained in the four pages and didn’t go into any detail. It also states that it must be culturally appropriate and able to be understood by a typical plan participant.

They cant tell the insurers what to do in less space than they want the insurers to do it, with much greater detail and under penalty of law or prohibiting them from participation. What the hell are they thinking?

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.


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