2074 Pages of Loopholes

With Thanksgiving weekend behind us all politically interested people can look forward to the Senate opening work on the healthcare bill. According to Senate Majority Leader Harry Reid:

. . . senators {will} work on weekends if necessary to hammer out compromises on thorny issues like a government-run insurance plan, abortion coverage and holding down costs.

“The next few weeks will tell us a lot about whether senators are more committed to solving problems or creating them,” Reid said.

I make no pretense that I have abandoned my day job and any semblance of a life to read through the entire 2074 pages of H.R. 3590 but I have read through the entire 13 page index of the bill and looked up a number of sections that either looked interesting or concerning to me. Of course my first question is how will this affect my health insurance situation (that may give some insight into the 12 sections I reviewed). The real question in this debate is whether there will be anyone who takes the time in the coming weeks (according to the story linked above we may expect up to 3 weeks of debate) to read the entire bill and break down what it actually means for consumers and the nation – going beyond the party-line soundbites that we will no doubt be subjected to constantly through the media for as long as the debate lasts.

After reading through my chosen sections I found seven that were interesting enough for me to write about them. (For anyone who is curious, there are approximately 350 sections to the bill – 50 times what I am doing today.) I will review them in the order they appear in the bill.

Section 1251

This section is the assurance to every satisfied consumer of health insurance that they can keep the coverage they already have. It sounds nice, but it means that if you like the insurance you already have through your employer you are even more tied to your employer than you were before because if you lose your employment you may not be able to get that coverage at your next employer.

Sections 1301 and 1302

Section 1301 claims to define what constitutes a qualified health plan – what it says is that a qualified health plan is any “certified” plan offered through a health insurance exchange by an insurance company in good standing with the state where you reside which provides the benefits outlines in section 1302. (See page 100 starting at line 6.) If you go read section 1302 (b)(1) (page 103) you find a couple of required benefits that will definitely drive up costs for those who do not need those benefits:

(D) Maternity and newborn care (line 13)

(F) Prescription drugs. (line 17)

(J) Pediatric services, including oral and vision care. (line 23 – I’m specifically concerned about the requirement of pediatric oral and vision care.)

Section 1302(b)(4)(E)(ii) also shouts “higher premiums” to me (page 106 starting at line 15):

if such services are provided out of-network, the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided in-network;

In other words, insurance companies are no longer able to increase their efficiency by defining coverage networks where they receive preferred rates from the facilities.

Sections 1321 and 1323

We have been promised that the public option would be optional and that states could opt out. Part (c) of this section says that if states do not opt in to having an exchange or the Secretary of Health and Human Services determines that they are not making adequate progress HHS can bypass the states and set up their own exchange within the states – nice opt-out. (page 165 starting at line 21) Section 1323 goes on to reiterate how all of this is perfectly voluntary on the part of states and individuals.

Section 1501

This is the individual mandate and it starts out with a four page explanation (starting at line 18 of page 320) of why Congress has the right to tell me what constitutes health insurance and to require me to purchase an approved plan. Part (b) of this section outlines what happens if I don’t agree with their definition of “approved” (starting at line 18 of page 324) – essentially for each month I would have to pay a penalty that can add up to nearly $200 per month (the max appears to be $2250 per year for a family) – this is what President Obama insists is not a tax despite the fact that it is levied on tax returns and overseen by the IRS.

Section 9002

The only section I looked at that might qualify as a positive reform was section 9002 where it says that the cost of employer sponsored coverage, minus employee contributions, is to be counted as income. (page 1996, line 4) On the downside that probably means a tax increase for those with employer sponsored coverage (companies will pass it on to their employees), but on the upside that should help to level the playing field between the group coverage insurance market and the individual insurance market.

If my senators are paying attention to this, let me remind you of what Senator Reid said (as quoted at the top of this post):

The next few weeks will tell us a lot about whether senators are more committed to solving problems or creating them

If you are committed to solving problems you will have to fight tooth and nail to eradicate the issue of an individual mandateĀ  not to mention the other issues that I have outlined in this review of 2% of the bill you will be working on – that will definitely require working on weekends.