DIVISION A—AFFORDABLE HEALTH CARE CHOICES

“The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending”. This is a line straight out of HR 3200, it can be found on Page 4; the link is included at the end of this article. The division is real but it is not the one that was intended.

I dedicated 2 days to reading this resolution and I need to dedicate countless more to actually understand all the legal jargon that is in there. Yet I don’t need any more time to understand the division that the health care debate is creating throughout the America. Legal speak is complicated and difficult to understand, and I want to make clear that the way I read this may not be the only way to interpret what is in the resolution, But as an American citizen the way I read this deserves to be addressed before it is voted on just like every other American who has questions.

Here are a few issues, all somewhat related that I have heard over and over being denied and corrected and spun to death. So I decided to put the actual words used and what it seems to say to me out there, and while I admit there is much more that I am not covering, these are the issues that most struck me. And yes they are all in the first 30 Pages of the resolution, I have many other issues later on, but this article would be almost as large as the resolution so I will save them for later.

1- Will I get to keep my current Health care plan?

It has been said that you will not be effected if you like your plan, yet the way I read this resolution is that you Yes you will allowed to keep your current plan IF-

A. Your situation doesn’t change.

“GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘‘grandfathered health insurance coverage’’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met………. Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.” Pg. 16

So you can keep your current health care plan, yet you can’t modify, change or update that plan at all. This feels like a very high pressure sales tactic to me to try to get people into the Public option. However in the interest of fairness there is a clause that will allow you to add a dependant to a current health care plan.

B. Your plan meets the requirements that are set out by LAW or by the Commissioner.

“REQUIREMENTS FOR QUALIFIED HEALTH BENEFITS PLANS.—On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved”. Pg15

In order to qualify as an appropriate health care plan it has to meet strict guidelines set forth by the “Commissioner”. So yes you will get to keep your plan as long as it qualifies with what the government says it should be.

2- Will this force employer’s to change current plans/Will this effect small business?

“Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable agencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers.” Pg 22-23

Taking this in context with 1A and 1B, the wordage does not force an employer or individual to change plans yet it certainly does not help him stay with the plan he is happy with. One of the arguments I heard recently for the quick passage of the health care legislation is that the economic recovery would be greatly benefited, which may or may not be true. This wordage might not be referring to monetary “Incentives”, but if someone can think of a scenario where this is a positive for a small business or the individual who is happy with his plan I am all ears. Paragraph (1) is included under issue # 3 below.

3- What is the hurry?

This Resolution requires a study to be conducted over the 18 months to make sure that businesses will not be adversely affected, For example;

“The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:

(A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure.

(B) The similarities and differences between typical insured and self-insured health plans.

(C) The financial solvency and capital reserve levels of employers that self-insure by employer size.

(D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent.

(E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and mid size employers to self-insure” Pg 22-23

We have spent trillions on economic stimulus in the last few months, and while it might not have been focused on health care should we not take the time to ask these questions BEFORE we pass legislation?

Even if economic stimulus is not a factor in passing this legislation, if the possibility that these issues could adversely affect small business is that not something we should know before hand, especially in the midst of a recession where economic recovery is top on the priority list?

I don’t think there would be much, if any, push back on reform if it was easy to understand and there was no wiggle room on its impact to the average American. Putting all of the verbal judo and legal mumbo jumbo aside, the biggest sticking point for me is the attitude with which it is being approached, For example this statement from President Obama.

"So make no mistake. The status quo on health care is no longer an option for the United States of America…….We are going to get this done. Inaction is not an option. And for those naysayers and cynics who think that this is not going to happen, don't bet against us,"

The previous president once made a statement that was so polarizing that he is still taking heat for, 1 and a half terms term and 7 yrs later, perhaps you heard it.

“If you are not with us, you are against us.”

When pres bush made this statement I was cheering, and I couldn’t understand why people were pushing back. Years later I am willing to admit I was wrong to question their motives. I still support President BushPresident Bush’s policies yet I understand now why people did not like the sentiment.

I am not against health care for the masses, nor am I against reform but I am very much against broad, undefined and confusing legislation that stems from elitist attitudes that assume we don’t know what is best for us and should just bow down to what we are told is for the greater good.

I admitted in the beginning of this article that there are possibly more than 1 way these things can be taken, but that is the way I read it, if you read it another way please feel free to point it out. But keep in mind, and this is the very point I want to make with this article, before ANY Resolution is passed it should not be open to 2 completely different interpretations.

If a resolution could be drafted that addressed these issues in a clear and concise manner then most of the opposition would probably disappear. You cannot make everyone happy, but you can make them less confused and angry.

Maybe we should all go to the Whitehouse for a beer.

Sources: http://energycommerce.house.gov/Press_111/20090714/aahca.pdf