U.S. healthcare revamp to require medical coverage

Source: Reuters

WASHINGTON (Reuters) - U.S. lawmakers plan far-reaching insurance market reforms, and would require that businesses and individuals purchase medical coverage as they seek to overhaul the U.S. healthcare system, an early draft of Senate legislation said on Saturday.

The legislation seeks to provide health coverage for all Americans and would prohibit insurance companies from refusing to cover anyone because of health history. It also would outlaw annual or lifetime limits on coverage.

The bill would require individuals and businesses to purchase insurance. The business community is likely to raise strong objections to the employer requirement in the measure, being drafted by the Senate Health, Education, Labor and Pensions Committee headed by Senator Edward Kennedy.

<snip>

To help small businesses and individuals without employer-provided insurance, the Kennedy committee bill would establish government operated "gateways" for them to purchase affordable medical coverage. The gateway, or insurance exchange as some have called it, would act as a clearinghouse that would help customers compare plans and prices.

Read more: http://www.reuters.com/article/newsOne/idUSTRE55514G20090606

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The article also states that the bill would provide for subsidies to help some people purchase insurance. Medicaid would be extended to additional people in addition to those now covered.

This article is about the Kennedy bill only. No mention is made of what may be in the Baucus bill.

..and these IDIOTS think that people who are watching their livelihood evaporate should be forced into buying medical insurance?

They need to quit politics and get a real job.

:sarcasm:

Oh wait. Did they legislate that they have it for life?

does not mean it will be affordable. We need a public option - end of story.

'Cuz that's what they'll do - sure they'll be made to accept you into "coverage", but that won't mean they'll actually PAY for jack shit.

And that's our party putting this crap forward. I'm so disgusted. Now insurance companies can raise their rates at will. The people will be forced to pay higher and higher premiums while the government will funnel more money to the insurance companies, too. When it fails, the conservatives will then use it as proof that government programs don't work.

We can't let this pass. We have to tell them to go back to the drawing board and give us fully publicly paid, single-payer medicine. Accept no bullshit, especially when it plays into Republican's hands.

Unless Congress gets off their ass and seriously reforms the insurance industry. If insurance is mandated, they must be heavily regulated. No denial of claims, no denial of coverage, caps on profit.

Public option does not mean government paid. All it inherently requires is a government managed plan. It does not require the government to foot the bill (and to my knowledge that has not even been suggested by Dean or Obama). It does not necessarily require that premiums be unrelated to your health. It does not necessarily require that the plan be subsidized so it is affordable to lower income people. It does necessarily prevent the private companies from cherry picking the healthiest client.

Specifically, a public option (as promoted by Dean's petition and Obama's statement) did not expressly require that private insurance be accessible to everyone. This bill requires that both public AND private be accessible to everyone. That means the private companies cannot cherry pick the healthiest people leaving the public plan to care for all those who cannot get insurance (which would have driven up the cost of the premiums for the public option).

A public option(as promoted by Dean and Obama) did not expressly limit the cost of the plan (which would be higher for the public option than the private insurance plans if the first condition, above, was not included). This bill limits the cost of all plans (public or private). The limits are yet to be worked out - but there are limits.

A public option (as promoted by Dean and Obama) did not expressly include income based premiums or subsidies for lower income individuals. This one does for folks making up to 500% of poverty.

Is it what I want? absolutely not. I want single payer. Is there a chance in hell I'm going to get what I want this time around? - no. I was not willing to support the vague concepts of public option promoted by Obama and Dean because there were too many factors I view as mandatory that their petition and statement were silent on. This bill is not silent. It does not go as far as I want, but it is substantive change in the right direction which will guarantee access to insurance to all and lower premiums to those with lower incomes.

and we're not forced into some lackey plan , where we'll go bankrupt anyway. We'd rather have no reform.

to be legal, but if something happens they will not cover.

They try to deny everything. I'm fighting with them over a colonoscopy right now.

As always, the devil is in the details coming out of committee. Not any where near Medicare for all (leaves insurance middle men in place), yet this seems to be the likely compromise this year. If so, I hope Congress sets adequate subsidies, ensures no denial for pre-existing conditions and requires covered conditions/procedures to meet Medicare standards at a minimum. (disclaimer - I'm on Medicare, have never had anything denied, from routine to specialist, save dental care.)
:shrug: ~ pinto



Senate Committees (Dem)

HEALTH
Kennedy, Edward M. (MA) , Chairman
Dodd, Christopher J. (CT)
Harkin, Tom (IA)
Mikulski, Barbara A. (MD)
Bingaman, Jeff (NM)
Murray, Patty (WA)
Reed, Jack (RI)
Sanders, Bernard (VT)
Brown, Sherrod (OH)
Casey, Robert P. (PA)
Hagan, Kay R. (NC)
Merkley, Jeff (OR)
Whitehouse, Sheldon (RI)

FINANCE
Baucus, Max (MT) , Chairman
Rockefeller, John D. (WV)
Conrad, Kent (ND)
Bingaman, Jeff (NM)
Kerry, John F. (MA)
Lincoln, Blanche L. (AR)
Wyden, Ron (OR)
Schumer, Charles E. (NY)
Stabenow, Debbie (MI)
Cantwell, Maria (WA)
Nelson, Bill (FL)
Menendez, Robert (NJ)
Carper, Thomas R. (DE)

http://www.senate.gov/general/committee_assignments/assignments.htm

I am a married lesbian. My marriage is recognized in CA but not by the federal government. My spouse is the major breadwinner and I have a small income from a part-time home business which basically just covers my share of the rent and utilities. I am not insured because we cannot afford the extra $500 a month my spouse's company would charge for her to put me on her plan. So where am I in the federal plan? As the federal government does not recognize my marriage, am I eligible for the sliding scale? If so, how much will it cost me -- honestly, at my age with my medical history (I am partially disabled), I suspect that even on a sliding scale, I will not be able to afford this *mandatory* insurance. So what if I can't afford it? Do I go to jail for failing to carry the required insurance? This so-called health care reform is really bullshit -- it's forcing people like me who make only enough to pay basic living expenses to pay money I do not have nor want to to the greedy insurance companies. And to add insult to injury, the medical insurance my spouse has through her employer is NOW, as Obama is considering, going to be taxed as a benefit. So it looks like this "reform" is going to make both the feds and the insurance companies richer and leave us even more destitute than we already are.

It is still too early to know what, exactly, will be forced on us. It will be interesting.

I am disabled and on both Medicare and my employer's group insurance. The way Baucus want it, I would expect to have to pay taxes on the group plan. Since I have no income to deduct it from, then I would have to mail checks to my employer to cover the taxes. I currently have to do that for my employer provided life insurance. That would cause an extreme hardship on us. I do have private disability insurance as well as Social Security.

They may well make changes to Social Security and Medicare to help pay for the health "reform". That could also hurt us.

In 5 years, when I turn 65, we will lose my group policy leaving my wife without insurance. Under this plan, then we will have to find some insurance for her. That likely will also cause us some pain. At that time, having lost the private disability insurance, she may qualify for subsidies. However, if no affordable, realistic public plan is available, I don't know that her coverage would really help. If it is just private insurance, I have my doubts as to what it will cover.

I have grave concerns about what we will end up with.

prisoners have a constitutional right to medical treatment.

and then refused to follow the instructions to do the things (stop smoking, take anti-rejection drugs) to keep the body from rejecting the new heart. This guy was not a model prisoner by any stretch of the word; he was a true hardened criminal. He got the heart because his name was next on the list (probably added by the prison doctor). The prisoner was dead within a year, and (1) a good citizen on the long waiting list for a heart transplant had to wait even longer, (2) the organ was essentially wasted, and (3) the taxpayers got stuck with a very, very expensive hospital bill.

Something is wrong here.

That said, whatever the situation, the guy was a human needing health care.

His punishment for his crime was incarceration, not denial of health care.

If he chose to refuse the advice of medical personnel, he did what millions of other people have done, in and out of prison. And will continue to do.

Yeah, we paid for it. I'll give you that. We pay for ER visits for uninsured / underinsured "good" citizens all the time. I'm OK with it all.

individuals making under $54,000 would qualify. And yeah, I hear you, right now they would see you as an individual, not a married partner. That's how you'd have to enroll.

Have you looked into MediCal? Or Soc Sec Disability? SSDI eligibility rules are fairly stringent, MediCal less so. Yet there is no consideration of sexuality in a determination. I'm gay, disabled, covered by both. Check out your options, as far as health care goes. :thumbsup:

And because I'm married, my spouse's income would be considered as part of my income which puts us way over the limit (but still we make barely enough money to get by here in Silicon Valley).

I'm on as an individual. If you and your wife are recognized as legally married in CA, they'll likely count her income. Those limits will be somewhat higher. I used to be a benefits counselor but I'm out of ideas - save this:

Apply for everything you can. MediCal, SSDI, whatever. And soon.
Take care. ~ pinto

...by going without medical insurance, but have no choice due to lack of money. It pains me to see the kind of free or nearly free medical coverage countries like Canada, U.K., France, Australia and elsewhere provide ALL their citizens, regardless of income, station or status, and yet I live in the (self-proclaimed) wealthiest, most advanced nation in the world which fucks over its poor, unemployed, self-employed and "non-insurable" citizens wrt health care. Every minute of every day I live in fear of getting injured, ill or in an accident because I do not have health insurance. Before I left the workplace, I HAD company-provided insurance through Blue Cross Blue Shield. My boss brought the flu to work and infected 60% of his workforce, me included. The flu settled into my chest and developed into bronchitis making it hard for me to breathe. One night, my lungs had nearly closed up due to the infection and my spouse took me to the nearest hospital's emergency. I was there less than one hour and received a breathing treatment to open up my bronchial tubes. The cost was over $3,000 and fucking Blue Cross Blue Shield refused to pay because they maintained my condition was a result of my prior history of asthma (info they gleaned from my insurance application documents), i.e., a pre-existing condition. Never mind that I hadn't had any treatment or medical care for asthma for over 20 years prior to that. I tried fighting BCBS who continued to withhold payment to the hospital, so the hospital sent the bill to collections which in turn ruined my credit. It took me a year to pay off the hospital the $3,000 plus interest. BCBS never did pay a dime toward that. So much for having insurance...

sorry to babble, but I'm so disgusted with insurance companies and this country's "leaders" who've sold themselves to the corporate slime that have no regard to humanity. They don't care how many people suffer or die so long as they make their obscene profits and their CEOs get their absurdly huge bonuses. If I had the money, I would leave this country tomorrow...alas, I cannot.

your premium should be considerably less than $500 a month. Because your marriage is not recognized, your income alone would be the test - and subsidies go up to 500% of poverty level. (My daughter was on Medicaid for the same reason until she was 8 - my spouse was the breadwinner, but since the governments refused to recognize her relationship to my spouse the government could not include her income/assets in determining whether she was eligible. On the one hand I felt guilty because as a family we could have afforded a reasonable premium - but because our family was not recognized we were denied access to my spouse's insurance and neither my daughter or I were insurable except through the high risk pool. Since we were in the pickle because of the lack of recognition of our family, I didn't feel too guilty.)

Your premium cannot be based on your health. It is community and age based (and perhaps a couple of other factors - but NOT health). The percentages are not filled in in the bill, at this point. In addition, your co-pays are also limited based on income (I don't think that benefit goes to 500% of poverty - perhaps 250% of poverty).

The plan proposed by Kennedy does not tax medical benefits.

If you don't purchase insurance (and do not qualify for an income based exemption) there will be a penalty assessed that is big enough to induce participation (that's pretty much the language of the bill).

you have to pay a fine. This is how it works in Massachusetts, I believe. It's possibly the stupidest thing I've ever heard.

insurance companies would save enough to pay for insurance. What happened to this?

for workers.

and flay the insurance company executives.

a period of wage and price controls. Large firms started offering a health insurance "fringe benefit" co-payment as a way to by-pass wage controls and attract employees. Gradually became the norm for large companies and a routine bargaining issue between labor unions and management.

Now, more and more large employers are scaling back their contribution to health insurance for employees. I think it's inevitable that the federal government will have to step in to replace that safety net. Maybe in fits and starts, but they need to step in.

I, too, would like to see insurers out of the equation eventually. Maybe not flayed, but sent packing. They can go back (scale down) to what they started doing, insuring things, not health care.

where's their skin in this game? What is it that they'll be forced to offer here? Greater oversight? (For how long?) No exclusions for pre-existing conditions (you know they'll find a way)?

I'm just not seeing enough being asked of this sector in return for what, for them, looks like Christmas come early to me.

Now you'll hear states saying the Constitution does not require health insurance so you cannot force people to 'buy it' as it is a sovereignty issue - the ONE case where I think these states will have a legal foothold to opposed forced-pay insurance.

Maybe this round of fighting and in-fighting will create enough willpower for single payer to get brought in by all parties who are now going to be footing the bill for insurance and health corporations who are running the table on their profits from sick Americans.

This is much similar to the Massachusetts Health Insurance plan. I still have to pay health insurance premiums or pay for medical bills. And I doubt I'll get a job when I graduate, if any. What they did was they're applying the already failed compulsory health insurance plan from Massachusetts nationwide. It will not work.

A pox on the lot of them!
--------------------------------

"The legitimate object of government is to do for a community of people whatever they need to have done, but cannot do at all, or cannot do so well, for themselves, in their separate and individual capacities,"
--Abraham Lincoln

The vampires are sucking us dry.

a pre existig condition. Pre existing could be stretched to include menstruation.

time for our leadership(?)to step up and deliver.

Single Payer National Health Plan.

There would be no alternatives to this plan. All government workers from the bottom to the top(including the administration,the congress, and so on would be included in the plan--no exceptions.

There should be only one plan to cover everybody in the country.

you file a major claim "discover" that you had some preexisting condition. It may be totally unrelated to your condition which requires treatment, but they can deny your treatment based on it.

I've never considered private (non-group) insurance worth considering for that reason. I hope that this "feature" of private insurance is removed. I suspect that it won't be. I would imagine that if you failed to mention that you had a minor back injury, for example, that they would use that injury as an excuse to not cover your brain cancer. I don't trust the for-profit insurance companies.

be waivers for certain low income individuals and small businesses available. Baucus and Kennedy, on the other hand, are for coverage for all.

I think that to work, everyone should be covered. But, there should be a viable, affordable public option (or single payer).

All Obama has to say is he has 3 principles, I know I went to the meeting today and they had his personal marching orders...er I mean message to us. The 3 principles are:

1) reduces costs, 2) gives Americans the freedom to keep whatever doctor and health care plan they have or to choose a new doctor or health care plan if they want, and 3) makes quality, affordable healthcare available to all Americans.

I can translate if you wish, but #3, means everyone will have to buy insurance and if it's too costly you will have to fill out the paper work to verify your income and then be subsidized so you can buy insurance.

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/03/AR2009060303395.html?hpid=topnews

'"If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it," he wrote in a letter to top Senate Democrats. '

He said he could support mandates on both individuals and employers to contribute to the cost of health insurance if the bill provides protections to certain small businesses and poor people.

"If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it," he wrote in a letter to top Senate Democrats.

So does this mean poor people have no coverage, or that poor people get subsidized coverage, but mandates are on everyone else?

Which he didn't run on.


Hey, he didn't run on single payer either. Does that mean we can do that instead and the American people can get what we want? Or is health care reform all about forcing people to buy private health insurance.

who knows?

It doesn't really make sense since there would be subsidies to cover the poor and allow them to have insurance.

I take that to mean that there would be mandates on everyone else. Which, as you said, he didn't run on. He is responding to Baucus's insistence that everyone has mandated insurance.

Obama is insisting upon their being some kind of public plan. The Republicans are insistent that there NOT be one. It will be interesting to see what "reform" is ultimately passed.

would sign any bill that 1) reduces costs, 2) gives Americans the freedom to keep whatever doctor and health care plan they have or to choose a new doctor or health care plan if they want, and 3) makes quality, affordable healthcare available to all Americans.

No where in the message to the volunteers today did he mention anything about a public pool.

Thanks for the information.

tossed under the bus late last Fall/early Winter

This whole reform is a top down initiative. While a lot was made of local public meetings, people were never even asked if the wanted a single payer system In fact in the report that Obama published they do mention that some people expressed preference for a single payer system, but they don't bother to say how many or what percentages.

And those people who expressed that did so of their own volition because they certainly weren't asked about it.

Then in Dec I went to a local meeting and their were organizers all downplaying talk of single payer saying it isn't politically feasible. But we were asked to read the Baucus white paper on health care reform and to support that.

In March at the big White House Health Care Summit single payer expert advocates weren't invited and a couple were only added at the last moment due to public outcry. After Baucus had doctors and nurses arrested for trying to give testimony to the Senate it became pretty clear that the exclusion was coordinated.

So it's top down change brought to us by the people who have been ripping us off forever.

I think Obama wants to get something passed just as long as the health care industrial complex lets him.

available and waivers for small business and poor people. Kennedy, if I remember correctly, is for mandates for everyone and a public plan to be available.

I would bet we end up with mandates for everyone and a half-assed public plan. I don't expect the public plan to be anything like Medicaid or Medicare.

This has me especially worried. Obama doesn't stand his ground very well.

...to campaign funds, Dems included. Obama and Hilary both received the largest contributions from Big Pharma during their campaigns of any candidates, McClain included.

The primary purpose of a company, health insurance companies included, is to their shareholder. They make money by denying health care. This proposal would make it illegal not to subsidize a health insurance company.

And this is called health care reform?

I've never really understood how you can make something like this mandatory. Do you fine them? Send them to jail? Or are they just engaged in an illegal act that is never prosecuted? Or is "illegal" the wrong word?

I'm a bit confused about this.

US manufacturing, autos for just one, are at a disadvantage against any manufacturer in a country with some form of national health insurance. Workers wages are squeezed back to stagnancy by health care costs. And individuals who have to "buy" health care will still have to somehow figure out which company they think will screw them a little less than the others. We'll still have the insane, unmanagable, bewildering, excessive paperwork and our doctors having to fight with the Profiteers to get treatment.

I expect better of Senator Kennedy.

I'm very very disappointed in this proposal. This is not the "medicare for all" that we were led to expect. This is so scred up in so many ways.

They are compromising our health and economic future in order to compromise with the insurance companies.

They are creating a process so complex no one will have anything but misery and frustration from it.

And worse, they are making SURE that anyone who can't afford the outrageous insurance rates is someone who will be forced to take CHARITY, and prove with endless documentation their unworthiness to call themselves self-reliant Americans.

At the moment we need to do the best we can, we're going to do the least we can.

At the moment we need to lift the burden of health care OFF our businesses so as to make them competitive with the rest of the First World countries (do we even dare to compete in that category anymore?), we add to the paperwork and the stress. No longer can a business survive by dodging the health care issue. It MUST offer health care and deal with every government requirement to obtain it, however second rate it may be.

What a gift they are giving us. They are forbidding the insurance companies to throw us to the wolves. What a generous compromise.

This is a patchwork MESS.

:sigh:

The "Gateways" appear to NOT involve a public plan.


This appears to be the exact OPPOSITE of "Medicare for All"

..which passed overwhelmingly in the MA legislature by both rethugs and dems and enthusiastically signed into law by Mitt Romney.

Yes, we are looking at a national health care model based on something MITT FUCKING ROMNEY enthusiastically supported.

'nuf said.

The U.S.A. is doomed.

It looks like our economy is going to die first, followed very shortly by the parasitic insurance corporations, and probably all the big U.S. corporations after that.

Then we'll get a single payer national health plan, at least those of us who survive...

It's a double-dip for the insurance companies. They'll get payed by the insured and by the taxpayer, who are largely the same people.

It's because the federal employees have great plans, paid for mostly by their employer (the taxpayer). And they don't want to lose it. So they are willing to screw over the millions of small business owners/employees and individuals in order to protect themselves. We will be screwed, too.

Why is there such a rush to pass something like this? I read that Obama said August?

Why can't we discuss it some more, have debates, and get more public participation? I want to see the rates, coverage, benefits and exclusions that the insurance companies are going to offer. It doesn't do crap for anyone if the cost of the plans keeps going up and people can't pay for the plans anyway.

I've got something at stake here. I am currently uninsurable. I live like a very poor person and save my money mostly for medicine and food and stuff like that. So you would think this would be good for someone like me, but it will be terrible. First, there's nothing to say that I get offered a group-rated plan. Second, I do have to use some pretty expensive medications to stay functional (neurological problem). It works for me, but no insurance company covers it. So are they really telling me that I have to pay $400 a month to an insurance company plus the $300 a month for my medication? Seriously?

Are we really going to make being chronically ill a crime in this country? I would much prefer the current benign neglect. Ten years ago I was blind, mostly paralyzed and a literal drooler. I couldn't talk very well, couldn't remember what I was doing from one moment to the next, etc. What I do works, and it makes me functional. I understand that it's not proven treatment, and I am not saying that everyone else should have to pay for it. But it's kind of cruel to mandate that I buy insurance that will not pay for the treatments that literally are keeping me alive and functional.

Now how can any insurance company sign a person like me on? I answer yes to every health question they have! My autonomic nervous system was mostly gone! There wasn't enough of it left to even keep me breathing. I'm on my second dog that just follows me around to make sure I don't pass out.

On an actuarial basis, they'd have to charge me something like 4K a month to expect to break even, and that's figuring some major exclusions, plus not paying for the treatment I am getting on my own. I can't pay 2K a month or 3K a month or 4K a month. So does that mean that other people are going to pay it? If so, the average person's insurance premium is going to rise quite a bit! I am not the only person out there with these risk factors.

If that's the way it's going to be, then I'm just going to opt out. Let them come and arrest me. If they try to tax me extra I won't pay it. Point of honor. The MA experiment was well-meant, but it hasn't worked that well. Why would we put basically the same plan in for the entire country as a rush job?

I just don't understand the rush and the relative secrecy. Oh, we can find out what's in the bills, but we don't know what that will mean in practice. We ought to know how this will actually work before they vote on it. To make a law that affects people's lives in such a fundamental way without knowing how it is going to work in practice is irresponsible.

Btw, I am very proud that I have never been on public assistance of any type. I am not on disability now. I don't want to be forced on to it either. If people like me are able to make their way in the world, we should be left to do so without undue government interference. Maybe I should just give up and go to Mexico. I've been thinking about it.

They need to understand that a lot of people are barely getting by in this country. You can't start slapping extra mandates on them. The real unemployment rate is over 10%. Times are tight and getting tighter.

it's more robbery, just like the freakin' bailouts, except this would be the heist that keeps on giving.

new suckers to big insurance on a solid gold platter. We need a revamp, but this isn't it. Every citizen needs to be issued a healthcare access card - that's universal coverage. They present it when going for care, no questions asked and no deductibles, no co-pays and no bankruptcies. It's paid for by - booga, booga, booga - taxes. Anything less is a waste of time and a waste of money.

auto insurance became mandatory-there was a proposition on the ballot, for an increase at the pump so everyone would be covered with minimum insurance, so that the working poor could still commute to work. If you wanted extra benefits, you went to your insurance company. The insurance industries spent millions of dollars to defeat the proposition. So, the working poor were forced to find other means of transportation or choose between eating or insurance.

I see the same thing happening with health insurance. Some of us have lost our good jobs and are working where we can find something. My hubby, who had a great position, lost his job (along with all the other fifty something managers), and now it's work where he can find it. He's too young to retire and our 401k is in the toilet. Right now, I trust no corporation. To me, they're nothing but greedy fekkin vampires. If they could take your money without offering a service, they'd find a way to do it.

You might say it was the final straw for my hubby, since he always believed in quality customer service, instead of shoving shite down consumers' throats. Today, it's the bottom line for most corporations, and they could care less about the customers.