Tag Archives: pre-existing conditions

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!