Tag Archives: Internet Portals

In need of health care myself

I’ve fallen back off the posting wagon, due to illness in the youngest son, and myself. We had to enjoy some fine health care – which, thankfully, we have. The next sections of the PPACA are actually quite interesting. They discuss the Exchanges, or the private market compromise so as not to have government provided health care (except for the Armed Forces, the VA, Medicaid, and Medicare of course) once everyone is required to buy health care insurance.

Sec 1311 gives money to the states to set up these Exchanges, which most likely due to insurance laws are run through the States. They have to be set up starting in 2014, and money won’t be available after January 1, 2015.

The Exchanges themselves are to “facilitate the purchase of qualified health plans” and assist small businesses in doing the same, which under the PPACA are now required to offer health insurance in finding appropriate plans. These are separate goals, although states can choose to offer a single Exchange to achieve them both. There are some restrictions placed on advertising, so as not to scare off people with high medical needs, ensure provider choice, assistance for low income people in finding health insurance, meet certain quality standards and plans for improving quality, and share information with those people who would choose to enroll in these plans.

The plans would be rated, by a system developed by the states, to make decision making easier on the prospective enrollees. These ratings, and all of the other information, would be available by the aforementioned Internet Portals (Portals!!). The Exchanges would have open enrollment periods similar to the ones that current health insurances have. There are special provisions that say that stand-alone dental plans can be offered, even though they don’t offer any of the previously described qualifying health benefits.

The states retain the right to add benefits to the plans in their Exchanges, above and beyond the Federal minimum, but these costs must be borne by the state.

So, to sum up, the Exchanges will certify health plans, operate a toll-free number where you can ask for assistance, operate the Internet Portal, rate the health plans, present the details of the health plans in a standardized format, tell people when they are eligible for Medicaid, CHIP, or any state assistance program for health care, provide a calculator that tells people how much their insurance actually costs after the tax credits (that we haven’t gotten to) are applied, grant certifications that people are exempt from the penalty for not purchasing insurance (we’ll get to that soon), tell the employers who ceases to have insurance each year, and establish something called the Navigator program (explained at the end of this post).

The Exchanges have to be self-sustaining, they must consult with the relevant stakeholders, and they must publish their costs. The Exchanges also ask the health plans to justify any rate increases they wish to implement, and then use this information in deciding whether the plan can be offered in the Exchange. It also requires the insurance plans to increase their transparency of costs. They must also implement methods to improve health care quality such as patient-centered education, reduction of medical errors, wellness and health activities, and reduction of disparities.

The final part of this section provides grants for Navigators, or entities that have previously established relationships with employers and employees, consumers, or the self-employed, that could be used to facilitate those groups’ purchases of the health plans available from the Exchanges.

So – there you have it – one of the more controversial sections of the PPACA. The only one more controversial is the section that provides for the penalties if you don’t buy a health plan. We shall press on and try to get to that one quickly.

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And we move faster, faster through time and space, well, just the PPACA, really

Moving into Subtitle B – Immediate Action to Preserve and Expand Coverage (I can see why Scalia didn’t want to read this thing – it’s boring!)

Section 1101 – Immediate Access to Insurance for Uninsured Individuals with a Pre-existing condition  isn’t the section that requires that health insurance companies cover people with pre-existing conditions. That’s a later provision which could bankrupt the entire insurance industry, without the companion provision to ensure that healthy people buy insurance.

What is does, though, is create a high-risk insurance pool, with higher administrative costs than are allowed for normal insurance (read, larger profits are allowed) and where premiums can be higher, although still subject to some standards and rules. You have to be a U.S. citizen or national, have a pre-existing condition, and not be covered under other coverage for at least 6 months. So, if you lose your group insurance, you still have to wait a few months to apply for this coverage.

The section attempts to prevent insurance companies from ‘dumping’ insurees by imposing sanctions. Although that doesn’t necessarily eliminate dumping, if the sanctions are low enough.

It also appropriates $5,000,000,000 to pay any claims in these pools that the insurance companies can’t pay out of premiums. This high risk pool ends when the Exchange systems starts on January 1, 2014.  Then people with pre-existing coverage are allowed to buy into the high-risk pools created by the Exchange system. Or when the Secretary decides they are spending too much money, and stops accepting people. In short then, if you have no access to group coverage, you aren’t completely hosed by your pre-existing conditions like you are now, just mostly.

Section 1102 – Reinsurance for Early Retirees

This section creates a pot of money to pay back money to employer based helath plans that cover early reitrees (at least 55, but younger than the Medicare eligibility level – you Internet billionaires who retired at 35 – pay for your own health care!) They are paid back for claims that are over $15,000 (at a rate of 80%) but less than $90,000. They are supposed to use these costs to lower the cost of the insurance, specifically in regards to chronic conditions. There is another $5,000,000,000 for this.

Section 1103 – Internet Portals to SPAAAACE! Or Information about Affordable Coverage Options. The first one sounds more fun.

Creates an Internet website (as opposed to some other kind of website?) that gives information on health care eligibility, premium rates, cost sharing, ratios of health care expenditures to administrative expenses.

Section 1104 – Administrative Simplification!!!

Specifically of HIPPA (Health Insurance Portability and Protection Act), about electronic funds transfers between health care providers and insurers. It is 5 pages long. That’s the simplification. Feel free to read it – nothing very exciting there.

Section 1105 – Effective Date – my favorite section. Effective Date of the day the Act was passed (March 23, 2010). Administrative Simplification is ours!!!

 Now that’s progress!

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