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October 21st, 2009 11:27 am
A Bill of Requirements, Not Choice
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Proponents of ObamaCare have couched their language in terms familiar to conservatives and libertarians: choice, option and freedom.  We’ve been told that a ‘Public Option’ will be available to compete with private health care companies.  White House officials want Americans to forget that more than 88 million patients could lose their private health care and be forced into the government option.

Peering into Harry Reid’s newest health care incarnation, which you can read here (with our commentary here), the new Senate health care bill is all about force, not choice.  In the first 100 pages alone, there are dozens of examples of “requirements” on doctors, patients, states and the federal government.

Here is a brief snippet of what to expect.  Of course, this represents just over 6% of the new mandates and regulations contained in the 1,502 page bill.  Unfortunately, most of the language below is completely unintelligible.

1) Requiring that all new health benefits plans offered to individuals and employees in the individual and small group markets be qualified health benefits plans.

2) SEC. 2201. GENERAL REQUIREMENTS: New plans must be qualified health benefits plans. Each State shall provide that each health benefits plan which is offered in the individual or small group market within the State shall be a qualified health benefits plan.

3) An offeror of a plan shall not be treated as meeting the requirements of this subsection unless the plan also accepts, renews, or continues in force coverage of an individual who is eligible for enrollment in the plan by reason of their relationship to the named insured under the plan.

4) Each offeror of a health benefits plan shall establish annual and special enrollment periods meeting the requirements of section 2236(d)(2).

5) Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this title.

6) The contribution amount for any plan year may be based on the percentage of revenue of each offeror or on a specified amount per enrollee and may be required to be paid in advance or periodically throughout the plan year.

7) An employment based plan meets the requirements of this paragraph if the plan—provides benefits appropriate for individuals between the ages described in subsection (a)(2)(C) and that are certified as so appropriate by the Secretary; implements programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions; and provides documentation of the actual cost of medical claims involved and for which reimbursement is sought under this section.

8 ) Each State shall phase in the application of the insurance reform requirements under subpart 1 to grandfathered health benefits plans offered in the small group market within the State.

9) SPECIAL RULE FOR RATING REQUIREMENTS — A State law shall not be treated as offering more protection to consumers than the protection offered by such requirements if the State law imposes ratios that are greater than the ratios specified in section 2204(b).

10) Each State shall — require each offeror of a qualified health benefits plans offered through an exchange — to provide an internal claims appeal process; to provide notice in clear language and in the enrollee’s primary language of available internal and external appeals processes and the availability of the ombudsman established under section 2229(a) to assist them with the appeals processes.

11) PLAN REQUIREMENTS — An offeror meets the requirements of this subsection with respect to a qualified health benefits plan if the plan offers a benefits package that is uniform in each State in which the plan is offered and meets the requirements set forth in paragraph (3) the offeror is licensed in each State; the offeror meets all requirements of this title with respect to a qualified health benefits plan, including the requirement to offer the silver and gold levels of the plan in each exchange in the State for the market in which the plan is offered; and the offeror determines the premiums for the plan in any State on the basis of the ratings rules in effect in that State for the ratings areas in which it is offered.

12) The State provides that the amount of the monthly premium an eligible individual is required to pay for coverage under the standard health plan for the individual and the individual’s dependents.

13) The amount of the monthly premium an individual is required to pay under either the standard health plan or the applicable second lowest cost silver plan shall be determined after reduction for any premium credits and premium subsidies allowable with respect to either plan.

14) The Secretary shall each year conduct a review of each State program to ensure compliance with the requirements of this section.

15) INFORMATION REQUIRED TO BE PROVIDED BY APPLICANTS: An applicant for enrollment in a qualified health benefits plan offered through an exchange shall provide the information required by any of the following paragraphs that is applicable to an enrollee.

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