Wednesday, December 16, 2009

Universal Coverage

Despite all other criticism, the Patient Protection And Affordable Care Act, fashioned by Rahm Emanuel, Harry Reid, and Joe Lieberman, provides for universal health insurance. Finally, the United States, in mandating coverage for every legal citizen, joins the rest of the industrialized world in ensuring that no one dies because of lack of health care. Salon's Thomas Schaller summarizes the opinions of health reform analysts, finding:

Jonathan Cohn, acknowledged health care expert at The New Republic, says so:

Is health care reform without a public option still worth passing? Unequivocally, unambiguously yes.

The case for is simple and straightforward: 30 million additional people, maybe more, will have health insurance.

Paul Starr, co-founder of The American Prospect, says so:

None of this, however, affects the central provisions of the legislation, which would extend health coverage to an estimated 33 million of the uninsured....

Ezra Klein, who has faithfully and famously been following the health care debate for The Washington Post, says so:

The core of this legislation is as it always was: $900 billion, give or take, so people who can't afford health-care insurance suddenly can....

You can choose your estimate. The Institute of Medicine's methodology says 22,000 people died in 2006 because they didn't have health-care coverage. A recent Harvard study found the number nearer to 45,000. Since we talk about the costs of health-care reform over a 10-year period, may as well talk about the lives saved that way, too. And we're looking, easily, at more than a hundred thousand lives, to say nothing of the people who will be spared bankruptcy, chronic pain, unnecessary impairment, unnecessary caretaking, bereavement, loss of wages, painful surgeries, and so on.


Oops. Just when a child, an adult, most likely an elderly person needs it the most

A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.

The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.

As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not "unreasonable." The bill does not define what level of limits would be allowable, delegating that task to administration officials.

Adding to the puzzle, the new language was quietly tucked away in a clause in the bill still captioned "No lifetime or annual limits."


Consumer Reports cites the clause and adds a comment:

‘‘(a) IN GENERAL.—A group health plan and a health-insurance issuer offering group or individual health insurance coverage may not establish—(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or ‘‘(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary."

Apparently, according to this clause, insurers can set “reasonable” annual caps on coverage, just not “unreasonable” ones. But what’s a “reasonable” limit? The bill doesn’t say.

And that’s not the only problem with this text. See where it says “dollar value”? This is a loophole that would let insurers limit certain types of care, such as physical rehabilitation sessions or mental-health counseling
.

Still, although this gives insurance companies a great opportunity to cut off (catastrophic) coverage when your needs are greatest and their costs are the hightest, at least no one will lose coverage under any other circumstance.

Oops. Insurance companies will be able to drop you when they object to your claim, as noted, ironically, on the website of the Senate Democrats as an "immediate benefit":

Protection from Rescissions of Existing Coverage
 The Patient Protection and Affordable Care Act will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact.


It's (almost) unfortunate that General Motors has stopped production on the Hummer- you could have driven that baby right through that loophole. On Daily Kos, math4barack explains

That's not really a ban on rescissions. "Fraud and intentional misrepresentation of material fact" are precisely the excuses that the insurance companies are using when rescinding policies. Does the Senate actually believe that the insurance companies are telling people that their policy is rescinded because they got sick? No way.

They always claim that it's due to fraud or misrepresentations. For example, one of the many horror stories involves a woman's policy being rescinded because she didn't report a prior case of acne. Her insurance company interpreted this as fraud and rescinded the policy. Fraud! The ban on rescissions is supposed to prevent this.


And these are the benefits of the health care legislatin, aside from closing the doughnut hole in Medicare prescription drug coverage and other incremental reforms. This is without even considering the impact on insurance premiums when the industry picks up tens of millions of additional customers with no Medicare expansion, public option, or any innovation that provides competition.

We will learn more about the legislation as it (presumably) passes the Senate, goes to the House, and (presumably) eventually to conference. In the meantime, you will be forgiven if you, too, observe as has the Kos blogger

This bill is an indirect transfer of wealth from Americans and their taxes to the private insurance industry. It is subsidizing their largesse. It is a bailout of the private insurance industry.

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