As you read this, consider the government’s management and/or impending insolvency of Social Security, Medicaid, Medicare, Dept. of Education, Fannie Mae/Freddie Mac, the Postal Service, etc. Sorry, but I have a hard time believing THIS TIME they’ll get it right, managing an industry which is over 15% of our entire economy.
Also…when you learn who has the most control in appointing the various heads of these new regimes and you see the time frames for adoption of policy and standards, you can easily understand President Obama’s unrelenting determination to get this done immediately in the event he is not re-elected in 2012.
SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.
SEC. 124. PROCESS FOR ADOPTION OF RECOMMENDATIONS; ADOPTION OF BENEFIT STANDARDS.
SEC. 131. REQUIRING FAIR MARKETING PRACTICES BY HEALTH INSURERS.
SEC. 132. REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS.
SEC. 141. HEALTH CHOICES ADMINISTRATION; HEALTH CHOICES COMMISSIONER.
SEC. 201. ESTABLISHMENT OF HEALTH INSURANCE EXCHANGE; OUTLINE OF DUTIES; DEFINITIONS.
SEC. 207. HEALTH INSURANCE EXCHANGE TRUST FUND.
SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.
SEC. 222. PREMIUMS AND FINANCING.
HEALTH BENEFITS ADVISORY COMMITTEE
Classic backroom politics are at work here. Of the maximum 26 possible committee members, 17 are appointed by the President and 9 are appointed by the Comptroller General of the United States. Interesting thing here is this: the Comptroller is usually appointed by the President for a 15 year term, but the current Comptroller was actually appointed by the previous Comptroller, appointed by Clinton, who announced an early retirement in 2008. The current President, President Obama, gets to nominate the new Comptroller…hmmm. Seems like the President sure has a lot of sway in determining the makeup of this board, eh?
Purpose is to recommend covered benefit standards including treatments, items, services and cost-sharing for essential, enhanced, and premium plans. Per Sec. 131, the commission even dictates “uniform marketing standards”…whatever that means. Per Sec 132, the Commissioner will establish standards for appeals and grievances which providers must abide by as well as a yet undefined “external review process” for denied claims.
Per Sec.124 Initial recommendations must be given to the Secretary of Health and Human Services within 1 year and the Secretary then has 45 days to decide whether to propose for adoption. Oh, BTW…the Secretary was also appointed by President Obama.
Sec. 141: HEALTH CHOICES ADMINISTRATON
This administration is headed by a Health Choices Commissioner appointed by…the President.
The Commissioner is responsible for establishment of qualified health benefits plan standards, establishment and operation of a Health Insurance Exchange, and the administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits. The Commissioner is also authorized to do random audits, to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audits of such QHBP offering entities and may assess fines and penalties, suspend enrollment of new plan participants and suspend payments to entities in the Health Insurance Exchange. This Commissioner even has the power to provide standards for the actual definitions of terms used in health insurance coverage. Commissioner also appoints a Qualified Health Benefits Plan Ombudsman…a high profile paper pusher basically.
THE HOLY GRAIL: HEALTH INSURANCE EXCHANGE AND TRUST FUND
A bureaucrat’s dream…the bill creates a government run marketplace for health care which allows it to “establish standards for, accept bids from, and negotiate and enter into contracts with, QHBP offering entities for the offering of health benefits plans through the Health Insurance Exchange, with different levels of benefits required under section 203, and including with respect to oversight and enforcement”. It also has an extensive section which determines which employers and individuals are eligible to participate in the Exchange and when. Oh and BTW…as if a Social Security Trust Fund, which has been so regularly plundered for the last few decades that it now contains IOU’s instead of any cash, wasn’t a deterrent, this Exchange will institute a new government Trust Fund.
PUBLIC OPTION, YES OR NO?
Here’s one to watch…Sec. 221 is one of the sections that blew my mind when I came across it. Despite all the assurances that the Public Option was off the table, it seems to have been slipped into the bill. This public option will be just that, one option, not a mandate, among the many private options offered on the Exchange. However, I dare predict this “option” will inevitably become a mandate in future generations as government will dictate the pricing for this and lacking the need to be efficient and profitable, it will likely be cheaper while offering incentives for individuals to migrate into this plan slowly ….then one day, mark my words…the regulation and pricing will create other consequences which slowly cripple the private market and government will then make some cure all using the existing pubic option.
Am I just paranoid? Well, the best proof of the anti-competitive advantages this pubic option will have is in Sec.222 entitled PREMIUMS AND FINANCING. The Commission dictates a range of acceptable premiums for private providers….how and if those private providers remain profitable complying with those standards is their problem. On the other hand, the bill allows the Secretary to make and change premiums at any levels it deems necessary to fully cover all administrative and health expenditure costs.
Mark my word…just as Social Security benefits have been reduced while the retirement age increased, one day, when the pool of public option beneficiaries is large enough and private options are weeded out, the premiums here will be dramatically raised as well. Also note, this public option allows for the Secretary to determine payment rates on services, products and drugs…again, once it has a substantial base of beneficiaries and resulting expense issues, the government will wield its big stick in “negotiating” prices.