Government Regulation of the Health Care Quality of Hospitals & Doctors through Health Plans is Confusing and Distorts Roles
Posted by Nandan Kenkeremath in Regulating Medicine on January 21st, 2010
Subsection 1311(h) of the Reid bill provides that, beginning on January 1, 2015, a qualified plan may contract with certain hospitals or providers only if certain conditions are met. Hospitals with more than 50 beds must use a specific patient safety evaluation system. Providers must implement such mechanisms to improve health care quality as the Secretary may require by regulation.
While subsection 1311(h) is in the midst of a number of requirements that only appear to apply to Exchange participating plans, the text simply refers to a “qualified health plan.” This is in Subtitle D and, thus it is unclear what the relationship is to the grandfathering provision of section 1251. By its terms, section 1251 appears to apply only to Title I, Subtitles A and B. Subsection 1311(g) appears to have periodic reporting to Exchanges based on certain guidelines. However, 1311(h) is a restriction on contracts. Regardless, under the overall scheme, employers may utilize plans from the exchange and such employers must be concerned about the rationality of provisions that apply to exchange plans.
These provisions are applying a confusing set of standards to health plans. It may or may not be appropriate for HHS to directly regulate hospitals and providers on issues that border on the practice of medicine. Note that providers must implement specific mechanisms to improve quality of care determined by the Secretary. It is unclear on what basis the Secretary determines these requirements, or how close to regulating the practice of medicine this is. The penalty for failing to follow these rules is the inability of providers and insurers to contract.
Enforcement and interpretation of such requirements by health plans through contract is an even more confusing proposition. How can a health plan know whether a hospital or provider is in sufficient compliance with these new regulatory provisions? Is termination of the contract required where HHS or another party finds a violation? Is the health plan liable for the failure of the provider? What is the consequence for having a contract with a hospital or provider that does not meet the standard? Does the contract remain valid? Would it be illegal to provide reimbursements in that context?
To be clear, group health plans often set out conditions for provider participation. The point here is that the government is seeking to implement policy by working through insurance contracts instead of direct regulations. This confuses the roles of the parties.
Same Sham Budget Tricks Under the House and Senate Bills
Posted by Nandan Kenkeremath in Health Care Costs on November 19th, 2009
After a while, you start to see the patterns. You can’t ensure 31 million people for free. According to CBO, under the Reid bill in 2019 the Federal costs for providing subsidies for such insurance is 83 billion dollars in premium and cost sharing subsidies, 24 million dollars in reinsurance and risk adjustment payments, and 87 billion dollars in expanded Medicaid payments. (I like the 2019 snapshot for evaluation because the ramp and different time frames for taxes make the 10 year totals very deceptive.) So, in the 2019 snapshot you get about 194 billion dollars in outlays. For comparison sake, a ten year operating window you have about $2 trillion dollars in new outlays.
For the 2019 snapshot CBO notes offset of 47 billion dollars in reductions in Medicare annual updates to FFS Payment rates, 22 billion dollars in reductions in Medicare Advantage, 10 billion dollars in reductions payments to certain types of hospitals and 21 billion dollars of other Medicare savings. There are also new taxes. Of course savings to Medicare should have gone to Medicare. Medicare is going broke. Why do you take “savings” and use them for a different entitlement. Some costs were in the House bill but simply taken off as a budget trick. This trick is prominently mentioned by CBO:
“For example, the sustainable growth rate (SGR) mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments, and legislation to do so again is currently under consideration in the Congress.” CBO is referring to what the House was originally provide as $247 billion in new spending over ten years to address these payments.
CBO certainly does not try to hide its skepticism over the cuts to Medicare spending per beneficiary. They are not really authorized to explicitly say this is a sham. They simply note that Medicare spending per beneficiary would increase substantially less than what history has provided. They know this is unsustainable. The Medicare actuaries, in evaluating the House bill were even more explicit in to pointing to this sham.
Because of the bill’s severe cuts to Medicare, “providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and might end their participation in the program (possibly jeopardizing access to care for beneficiaries).”
Because Medicare cuts would likely have to be reduced to avoid jeopardizing access to care for seniors, the provisions “will likely result in significantly smaller actual savings” than assumed. Beyond the Medicare cuts, the other provisions designed to reduce the rate of growth in health care costs would have “a relatively small savings impact.”
Because of the increased demand for health care, “supply constraints might interfere with providing the services desired by the additional 34 million insured persons.” The result could be “some of this demand being unsatisfied,” meaning that people would not have access to care. Additionally, providers would negotiate for higher rates, meaning that health care costs and premiums would increase.
Again these statements of the Medicare actuaries are about the House bill, but it seems like the same issues that are in the Senate bills.
What that means is the obvious — the trillions in new spending are real. The purported savings to offset the new spending are not. Same sham. Apparently, Congressional leaders do not believe Americans are particularly astute about material like this. And public reporting has been fairly weak in explaining the point.
Diagram of Regulation of Health Plans Under H.R. 3962
Posted by Nandan Kenkeremath in Downloadable Bills, Materials, Charts, Diagrams, Effect on Health Plans and Employees on November 6th, 2009
Here is a diagram of the effect of H.R. 3962 on health plans and a related diagram which would show existing regulatory programs. Leading Edge Policy and Strategy was commissioned by the U.S. Chamber of Commerce to provide diagrams to illustrate the differences in government regulation of health plans under current law as well as under the House Health Care Reform Bill.
Diagram of Regulation of Health Plans under HR 3962
Diagram of Regulation of Health Plans without House Health Care Reform Bill
Please also see the Primer on the the House Plan The primer reflects H.R. 3200 not H.R. 3962. Things have only gotten worse for employers and health plans. The biggest thing is the ability of State Attorney Generals to sue over what is complies as a qualified health benefit plans. More liabilities, more enforcers, more confusion, more burden. Not good for employer sponsored plans.
Requirements for Certain Insurers to Provide End of Life Information in the House Healthcare Reform Bill
Posted by Nandan Kenkeremath in Uncategorized on November 6th, 2009
Look, if it is so important to get end of life planning info out to Americans, just mail it out. Or put it on some Federal website. Or have the exchanges provide it. Why is it so important to for qualified health benefit entities to provide this in the context of enrollment on the new health exchange. Is this a special warning or something about the exchange? I am glad that such entities “shall not promote suicide, assisted suicide or mercy killings.” And then again, its great that the brochures will make sure that Americans understand that none of this is about providing “palliative or hospice care or use an item, good, benefit, or service furnished for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason.” Certainly nothing should presume anything. And look, pursuant to section 304(b) this should all be culturally and linguistically appropriate. Just what we need for a sensitive issue like end of life planning — Washington speak.
Why make these private sector folks dance on this as the governments errand runners. No one can parse through this jumble of rules of construction, prohibitions, and mandates. Do this if you want to be on the exchange, but don’t do you dare do it in a way that looks like that. Have the exchanges provide the info if its so important. We don’t need 100s of interpetations of confusing law working through laws on insurers who really don’t need to get embroiled in public debates over the right language. I provide the section below for your edification:
SEC. 240. DISSEMINATION OF ADVANCE CARE PLANNING INFORMATION.
(a) In General- The QHBP offering entity –
(1) shall provide for the dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating health benefits plans offered through the Exchange;
(2) shall present such individuals with–
(A) the option to establish advanced directives and physician’s orders for life sustaining treatment according to the laws of the State in which the individual resides; and
(B) information related to other planning tools; and
(3) shall not promote suicide, assisted suicide, euthanasia, or mercy killing.
The information presented under paragraph (2) shall not presume the withdrawal of treatment and shall include end-of-life planning information that includes options to maintain all or most medical interventions.
(b) Construction- Nothing in this section shall be construed–
(1) to require an individual to complete an advanced directive or a physician’s order for life sustaining treatment or other end-of-life planning document;
(2) to require an individual to consent to restrictions on the amount, duration, or scope of medical benefits otherwise covered under a qualified health benefits plan; or
(3) to promote suicide, assisted suicide, euthanasia, or mercy killing.
(c) Advanced Directive Defined- In this section, the term `advanced directive’ includes a living will, a comfort care order, or a durable power of attorney for health care.
(d) Prohibition on the Promotion of Assisted Suicide-
(1) IN GENERAL- Subject to paragraph (3), information provided to meet the requirements of subsection (a)(2) shall not include advanced directives or other planning tools that list or describe as an option suicide, assisted suicide, euthanasia, or mercy killing, regardless of legality.
(2) CONSTRUCTION- Nothing in paragraph (1) shall be construed to apply to or affect any option to–
(A) withhold or withdraw of medical treatment or medical care;
(B) withhold or withdraw of nutrition or hydration; and
(C) provide palliative or hospice care or use an item, good, benefit, or service furnished for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason.
(3) NO PREEMPTION OF STATE LAW- Nothing in this section shall be construed to preempt or otherwise have any effect on State laws regarding advance care planning, palliative care, or end-of-life decision-making.
Special Provisions in the House Healthcare Reform Bill for Certain Perpetrators of Child Sexual Abuse
Posted by Nandan Kenkeremath in Regulating Medicine on November 6th, 2009
You can’t make this stuff up. Most of the time people argue about things using terms that are not really in the bill. You know, like the term “death panels” is not in the bill. But taxpayer money for “perpetrators of child sexual abuse”, that is in the House bill in Subdivision D.
Here are the provisions.
`SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.
`(a) Establishment- The Secretary, acting through the Service, shall establish, consistent with section 701, in every Service Area, programs involving treatment for–
`(1) victims of sexual abuse who are Indian children or children in an Indian household; and
`(2) perpetrators of child sexual abuse who are Indian or members of an Indian household.
`(b) Use of Funds- Funding provided pursuant to this section shall be used for the following:….
`(3) To develop prevention and intervention models which incorporate traditional health care practices, cultural values, and community involvement.
`(4) To develop and implement culturally sensitive assessment and diagnostic tools for use in Indian communities and Urban Centers.
`(5) To identify and provide behavioral health treatment to Indian perpetrators and perpetrators who are members of an Indian household–
`(A) making efforts to begin offender and behavioral health treatment while the perpetrator is incarcerated or at the earliest possible date if the perpetrator is not incarcerated; and
`(B) providing treatment after the perpetrator is released, until it is determined that the perpetrator is not a threat to children.
SEC. 714. on DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND TREATMENT has somewhat similar provisions.
So here are my concerns. First, is it just me who thinks its creepy to have the perpetrators of child sexual abuse on an even footing for Federal tax payer treatment with the victims?
Second, do we really need “traditional health care practices” for these perpetrators or just a very long time in jail? What is the evidence for “traditional health care practices” for something this important.
There is a thesis among some that perpetrators simply have a medical illness and simply need behavioral therapy. In the case of the House healthcare bill, the perpetrator seems to have a right to treatment “until it is determined that the perpetrator is not a threat to children.” This is my third concern. Determined by who? A doctor? A bureaucrat? Some of us might say a convicted child molester is always a threat to children. And what if a doctor doesn’t even believe a treatment is helpful or working? The language does not seem to acknowledge that as possibility.
Finally, since perpetrators of child sexual abuse seems to be a category in the House bill, one can only point out that they have a financial advantage over others. I suppose this is true of many in jail, but at least they are in jail. One would think that we should drain any extra income or assets above a basic level for the perpetrator of child sexual abuse before you would have taxpayers pick up the tab for them. I have noted that The Senate and House Bills Are Unfair to Low & Moderate Income Workers in Companies Offering Health Insurance and that Most All Working Union Brothers and Sisters are not Eligible for Subsidies under the House and Senate Bills. Those posts point out that the over $600 billion in new subsidies are not available to workers whose employers offer health insurance. Those workers and taxpayers are paying for their coverage and treatment. Not so for certain perpetrators of child sexual abuse.
Bureaucrats Dictating the Practice of Medicine — Culturally and Linguistically Appropriate Healthcare
Posted by Nandan Kenkeremath in Regulating Medicine on November 6th, 2009
When you go behind closed doors with liberal Congressional staff and stakeholders you end up with some fascinating provisions. I have already noted how the House bill has Bureacrats Dictating the Practice of Medicine. Let me point out a different kind of example. This one would work through health insurers. Section 304(b)(8) requires that entities offering insurance or health plans on the new Exchange must “provide for culturally and linguistically appropriate communication and health services.” I have tried to figure out how this works. Insurers don’t tend to provide health services. They do communicate. They do tend to pay for health services. One reading seems to be that insurers and health plans must place requirements in contracts with doctors, nurses, and hospitals. In other words, as a condition of reimbursment or participation with a health plan a healthcare provider must provide culturally and linguistically health services. Otherwise, its a little hard to know what the point of this clause is.
It seems like Congress is asking hundreds of insurers to each define an approach to “provide for culturally and linguistically appropriate health services.” So what will satisfy this requirement. Do doctors have to have translators. Can junior now go get a soy latte while Nana who does not speak English is in with the doctor? How many cultures and languages must a doctor be proficient in? Who is going to define this term? I guess it starts with the new, all powerful, Health Choices Commissioner. The Commish will decide whether people offering insurance are in compliance. That will mean he will review whether payment policies or contracts provide of culturally and linguistically appropriate health services. Generally, I think it would culturally appropriate if the doctor does a good job diagnosing and treating an illness. But if he can name all of the various ethnic and religious holidays, perhaps that is even better.
So with hundreds of different interpretations of how to approach this from hundreds of insurers how will providers deal with the different standard. I mean if Congress wants to require providers to provide “culturally and linguistically appropriate health services” why work through the insurers? Why bless the notion that they should regulate whether and how doctors provide culturally and linguistically appropriate health services. Doesn’t that mean hundreds of conflicting interpretations. Does this vary by setting. Some places have several immigrants with different language capabilities. Other places do not. Would this vary by number or location?
I know Medicare does something like this. I’ve talked to a number of doctors about how that works. I’ve got news for the Washington bureaucrats. The doctors think its ridiculous stuff and a waste. At some point realize that you cannot regulate everything. Please.
Bureaucrats Dictating the Practice of Medicine
Posted by Nandan Kenkeremath in Regulating Medicine on November 5th, 2009
In Congress, Members frequently say they do not want Federal law to regulate the practice of medicine. But the health care reform bills do. I want to start by focusing on section 252 of the H.R. 3962 the House health care bill. Here it is:
SEC. 252. PROHIBITING DISCRIMINATION IN HEALTH CARE.
(a) In General- Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
(b) Implementation- To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.
Let me point out a few things. First, this is not limited to health plans or health insurance coverage. All health care covered by the Act is subject to these requirements. This Act is the whole health care reform bill which applies to health care providers (doctors, nurses, hospitals, emergency transportation, etc). So the regulations in this section apply to that group. So, BTW, if you are employer with a clinic, you are probably covered by this. This would be “whether directly or through contractual, licensing, or other arrangements.” So this regulation has broad applicability to doctors, nurses, and other health care providers in virtually all settings.
Second, what is “personal characteristics” ? Seems to me this includes health status, medical information, genetic information, weight, sex, etc. It seems hard to provide medical services without regard to personal characteristics. The whole point of medical diagnostics and services is pay careful attention to such personal characteristics. So what were the authors thinking? Musical taste? I guess that would be “extraneous to the provision of high quality health care.”
Finally, having established that all personal health status and medical information would appear to be a personal characteristic we have one thing left. The Secretary of Health and Human Services must save us by defining “high quality health care.” Do people understand this authority. There is no limitation. If the Secretary says it is not high quality health care then you can’t use the medical information.
Note that we already have extensive and sophisticated regulations regarding use of health information by insurers and use of health information for non-medical purposes under the extensive regulations of the Health Insurance Portability and Accountability Act.
This is new authority. It would override existing laws and directly regulate doctors. It specifically places the definition of high quality care in the hands of a bureaucrat and not doctors. How extensive will these regulations be? Employers worried about wellness programs might observe that behavioral incentives or risk assessments to support behavioral incentives may or may not qualify as “high quality health care.” Doctors, nurses, and health care providers better pay careful attention to the power of this regulatory authority.
Patients and families– your doctors will have to follow a whole range of regulations by a government bureaucracy that defines high quality medicine. They will not want to violate these regulations made by Washington bureaucrats. There are stiff penalties and liabilities. Imagine when your doctor has to call to get clarifications on these regulations. Up for waiting? Ever have a condo association or some other functionary say he or she would like to help but… Who do you trust more?
The Current Bills Lack a Focus on Real Reductions in National Health Care Spending
Posted by Nandan Kenkeremath in Uncategorized on October 30th, 2009
As I have mentioned, Forcing Some Americans to Pay More for the Health Care Coverage of Other Americans does not Lower the Cost of Health Care. So are there real areas we could reduce National health care costs? The Congressional Budget Office has indicated in a letter that a certain package of medical liability reforms could reduce both National health care spending and the deficit. These are different numbers. The number for the deficit is $54 billion over ten years. But that is just savings to Federal programs and increased tax revenues. Private sector savings would be more than that. National implementation of a package of proposals similar to the preceding list would reduce total national premiums for medical liability insurance by about 10 percent. CBO estimates that the direct costs that providers will incur in 2009 for medical malpractice liability—which consist of malpractice insurance premiums together withsettlements, awards, and administrative costs not covered by insurance—will total approximately $35 billion, or about 2 percent of total health care expenditures. CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That would be well over $110 billion over ten years.
Southeastern Consultants (SEC) has performed and presented to the Institutes of Medicine a recent analysis of nine million Medicaid only and Medicaid/Medicare dually enrolled patients in five large states. See more information. They found a group patients and systems exhibiting patterns of extreme uncoordinated care. Variables with high significance included using excessive numbers of prescriptions, high numbers of different prescribing and treating physicians, utilizing a high number of different pharmacies, accessing the ER frequently and/or for non-emergent care, all of which contribute to unnecessary costs due to resulting usage of therapeutically duplicative drugs, inappropriate drug usage, drug compliance problems, frequently changing drug therapies, excessive and duplicative lab and diagnostic tests, excessive office visits and excessive and inappropriate utilization of all types of services. According to the study, if health reform efforts aimed at these uncoordinated care patients and systems are developed now and phased in, the average savings in the period 2010-2018 are estimated at $240.1 billion per year or an average of 8.8% of the total annual expenditures for direct care services. That would be over $2.4 trillion for a decade.
Price Waterhouse Cooper found an even greater amount. Their research found that wasteful spending in the health system has been calculated at up to $1.2 trillion of the $2.2 trillion spent in the United States, more than half of all health spending. Defensive medicine, such as redundant, inappropriate or unnecessary tests and procedures, was identified as the biggest area of excess, followed by inefficient healthcare administration and the cost of care necessitated by conditions such as obesity, which can be considered preventable by lifestyle changes.
“60 Minutes” did an exposé Sunday on Medicare fraud. The program cited costs of an estimated $60 billion a year in such fraud. As Kroft warned viewers in the segment’s teaser, “We caution you that this story may raise your blood pressure, along with some troubling questions about our government’s ability to manage a medical bureaucracy”
The point is that there are large baskets of waste and preventable costs. The problem with these health care reform bills is (a) that they do little in these areas and (b) many of the requirements will distract everyone’s time for a decade on to massive new bureaucracies, new entitlements, and new opportunities for scams. We force some Americans to pay for the cost of health care for other Americans. And we also also force them to pay for the same old defensive medicine, needless litigation, uncoordinated care, and medicare and other program fraud. Pretty much for every dollar of winner there is a dollar of loser. Cost savings in these area may be difficult to work on, but we need to do it. We need to change focus.
The House Bill will Undermine Employer-Sponsored Wellness Programs
Posted by Nandan Kenkeremath in Effect on Health Plans and Employees on October 24th, 2009
Perhaps this is not clear to the supporters but the House health care reform bill makes the situation worse for health plan wellness programs. This is not consistent with the President’s strong support of the Safeway wellness program as an example of success.
Many wellness programs use health information to help employees. Some create financial incentives to participate or to achieve certain objectives. Existing law regulates the amount of incentives that can be tied to achieving health or fitness objectives. The House bill would appear to seriously undermine existing wellness programs. Section 152 of the House bill requires that all health care and related services (including insurance coverage and public health activities) be provided without regard to personal characteristics extraneous to the provision of high quality care or related services. The Secretary of HHS must issue new regulations. This requirement would appear to be enforceable against health care providers, health plans, employers, and federal programs.
“Personal characteristics” would probably be read to include health status or medical information. This raises numerous problems since health information and status is obviously central to the provision of care. If an insurer or health care provider believes consideration of a personal characteristic is relevant to the provision of high quality health care, including in a wellness program, would such regulation prohibit such consideration under penalty of law? Wellness program would need to consider personal characteristics to tailor objectives for each participants. Unfortunately, under the House bill, not only will employers need to follow the current limitation under current law but a whole new suite of regulations from HHS. This provision also opens the door widely for the bureaucracy to regulate providers on what is “high quality care.”
Section 114 provides: a qualified health benefits plan shall comply with standards established by the Commissioner to prohibit discrimination in health benefits or benefit structures. In this case there are new regulations issued by the new Health Care Commissioner — a new and extremely powerful super bureuacrat — on essentially the same topic as existing law.
Subsection 121 (c) the bill states that a qualified health benefits plan may not impose any limit (other than cost-sharing) unrelated to clinical appropriateness on the coverage of health care items or services. Again, could incentives based on objectives in a wellness program for a group health plan be regulated by this provision. At the very least, this is another set of rules would appear to require changes to insurance design and raise questions about wellness programs.
Proof of these problems came when HHS recently issued a proposed rule to help implement Title I of the Genetic Information Nondiscrimination Act (GINA). That act prohibits requesting genetic information for underwriting purposes. Like the provisions above, GINA seeks to prohibit discrimination based on a type of health information or status. GINA includes family history as genetic information — a typical question that might be asked in a wellness program. In their proposed rule HHS has defined incentives in health plan wellness programs to be under the definition of “underwriting purposes.” This would mean they could not ask for family medical history and a useful piece of medical information would essentially be made illegal. As stupid as this is, the provisions in the House bill would be worse. All health status information would appear to be covered.
What we have is regulation over and over and over again — each of which will apply to wellness programs and some of which will directly regulate doctors. To be complete the vision under the House bill includes (1) existing regulations by the Department of Labor; (2) existing restrictions under the Health Insurance Portability and Accountability Act; (3) new restrictions under GINA; (4) new restrictions on discrimination issued under section 152 by the Secretary of HHS; (5) new restrictions under section 114 on discrimination issued by a new bureacracy by a new Health Choices Commissioner; and (6) new restrictions under section 121(c) that would appear to restriction flexibility in incentives and benefit design for wellness programs. Those who have been operating under the current exception under HIPAA for wellness program need to understand that such exception will not apply under items 3-6 above. This all moves in the opposite direction of the Presidents professed support for the Safeway type program. It’s another gap between the rhetoric in the debate and what the bills actually do.
The Bills Would Break the President’s Commitment that, If You Like Your Plan, You Can Keep Your Plan
Posted by Nandan Kenkeremath in Health Care Costs on October 16th, 2009
I’ve been trying to weed through the possible titles for this post and this point. Politicians like to promise things. They don’t mind breaking such promises when confronted with the complexities of policy. They don’t mind claiming they are not breaking a commitment when they are. So I have been following for some time the President’s statements in multiple fora —
“…if you like your health care plan you will be able to keep your health care plan. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.,,”
The President seemed like a straightforward, ordinary guy — you know, the kind you might arrange to have a beer with along with the Vice President and a Harvard University professor. So I continue to ponder his insistence at this statement in the face of contrary facts.
Does it all depend on what “keep” is? I recognize that there are forces outside of the health care reform bills that will either raise the costs of health insurance or reduce benefits. In that sense, no one can really keep the same health insurance they have now five years from now. But the bills make this worse for some Americans.
If you tax higher cost plans that exist today and tax health care services addressed by such insurance, the cost of those plans have to go up. That would happen under the Baucus bill. As CBO states with respect to additional fees under Baucus:
“…Those fees would increase costs for the affected firms, which would be passed on to purchasers and would ultimately raise insurance premiums by a corresponding amount..”.
Under the Baucus bill, higher priced employer plans, would be subject to a new tax. This would get passed on to employees. Either that means employers will change plans to lower benefits or get lower salary increases.
Both the House and Senate bills tighten ratings bands. This would mean an insurer cannot offer a plan to either a person in a higher age group or higher priced geographic area that is more than a certain ratio above what you charge a younger individual or someone in a lower-priced geographic area. This means, at the very least, younger Americans would pay more to subsidize Americans who are 45-55.
CBO has a similar assessment for Medicare Advantage plans. The budget office’s director, Douglas Elmendorf, has said that as a result of the proposed 100 billion in cuts, the extra benefits Medicare Advantage recipients receive would be halved over the next decade.
Under the House and Senate reform bills, many Americans can’t just keep the same plan they would have had at the same prices or the the same benefit design they would have had. Maybe it depends on what “you” means? I assume “you” would not “like” it if you were forced to pay more for your health plan than what you would have without the legislation. And if the massive new regulatory schemes force broad benefit design changes, you may or may not like the result. What if you liked the plan you had before the massive array of new design requirements?