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Landy
08-18-2009, 06:26 PM
OK, a lot of people have said "I haven't seen or read the bill", etc. so I have hit a few high areas of the bill and put them here--You got a few minutes?? lol

I also couldn't help but put my opinion after certain parts of the bill. Please know that I haven't read the whole thing either!

Let's try to keep this civilized so it's not locked...I've spent a lot of time putting this baby together, you know! lol

Feel free to tell me if you think I've interpreted it incorrectly or pose an opposing view.

Here are some key items of HC 3200

Link to bill: <a target=_blank class=ftalternatingbarlinklarge href="http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf">HC3200</a>

<b>Page 21, line 23:</b>
Basically states that the Gov't will audit books of large ins companies & employers that offer self-insurance:

<i>"STUDY-The commissioner, in coordination with the Sec of Health & Human Serv and the Sec or Labor shall conduct a study of the large group insured and self-insured employer health care markets...."</i>

One phrase I found interesting from page 22, Line 23
<i>"Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mis-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers."</i>

Does anyone else read this as the gov't doesn't want it to be a desirable option for employer's to offer/purchase employer sponsored ins?

<b>Page 30, Line 13 </b>
Tells of the committee that decides covered benefits, etc...

<i>"In General - There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans..."</i>

It then goes on to see who will be on this committee. How many medical persons do you see listed on the committee?? Will all CFs be treated under the same cookie-cutter recommendations?

<b>Page 50, Line 21&24</b>
Addresses Illegal Immigrant Coverage??

"<i>PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."</i>

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces?

<b>Page 58, Line 5</b>
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

<i>"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."</i>

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly?

<b>Starting at page 72, </b>
as I understand it, the bill explains how you can exchange your current Employee Sponsored or Private Insurance to be in line with/combined? with the Public Option (Health Insurance Exchange). It sounds like they will try to match what plan you currently have.

It's too long to quote anything here, but there are goals the gov't has for (pg 74, line 19) Year 1, Year 2, Year 3, etc.

<b>Page 84</b>
talks of Benefit Package Levels...

Some say all of this is the Gov't plan to eventually be the only insurance plan available. Another point, as I read into page 86, it looks like the Public Ins option will be billed accordingly to income. I sure hope they will hold into account the money we spend for OTC products, fuel used to travel to our numerous appts, etc before just charging an 8% of income type fee/tax.

<b>Page 121, Line 11</b>
Basically states that payment rates to doctors will be based on rates "for similar services and providers under Parts A&B of Medicare."
It goes on to explain rate exceptions; many exceptions are for items not currently covered under Medicare or Medicaid.

<b>Page 149, Line 14</b>
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)?

<b>Page 167, Line 20</b>
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?

See Tax <b>Exceptions - page 169, Line 19</b>
1) Dependents
2) Non Resident Aliens---Hmm...could this be Illegal Immigrants that have exception to the 2.5% tax???
3) Individuals residing outside US
There are others mentioned if you care to read them.

Not being an attorney or well versed in reading these bills, there are certain parts where I just say "Huh?", and here is an example of such item:
<b>Page 203, Line 14[/B<i>]"The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes...."</i></b>


<b>Page 280</b>
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission.


<b>Page 317</b>
deals with Prohibition of Physician Owned Hospitals

We have a local heart hospital that is physician owned and is really one of the best cardiac centers in the whole area. Under this part of the bill, they will be heavily regulated on what they can & cannot do. So much for their physician freedom...


<b>Page 333 Quality Bonus Payments
Page 335 Establishment of Outcome-Based Measures</b>
Neither may be a bad thing, IMO. The only thing I fear, as a CF, is that hospitals won't take high-risk situations so their outcome results aren't skewed.

<b>Page 424 </b>
Advance Care Planning Consultation a.k.a. The Death Panel

Basically, for anyone on Medicare, every 5 years (page 425, line 11), they will have a "consultation" to make a game plan with things such as advanced directives, living wills, durable power of atty, etc.

<b>Page 426</b> explains end of life services.
<b>Page 429 </b>would/could apply to us CFs re: end of life options

The fear (unfounded or not) is that this is all a way for us to sign off on life saving type procedures.
From a CF view-point, what if you signed a DNR, got a transplant & needed to be on the vent immediately afterwards for a day or 2. Well, you actually had signed a DNR during a consultation 2 years ago---is it going to be an issue to be vented for a short period of time because someone in Washington shows you signed a DNR 2 years ago, and won't OK the vent?
Yes, you could sign a DNR right now and this could apply, but from my understanding, your INS company doesn't know you signed a DNR, so they are not going to be withholding the vent based on that, so your doctor and your family could deviate away from the DNR under certain circumstances when being on the vent would only be temporary and insurance would cover it.

<b>Page 468-479 </b>talks of Community Based Medical Homes. If you read this section, the phrase "chronic illness" is often used. I'm not sure if this means Home Health Services, Hospice, or if both fall under the umbrella of CBMH?

Also, what's your take on page 472, line 8? It explains how 2 payments are made for your in home care. Is Community Based Organization the company that provides home service and the Primary or Principal Care Practice the doctor?

<b>Page 489</b>
Excluding Clinical Social Worker Services from Coverage under the Medicare skilled nursing facility prospective payment system & consolidated payment.

This most likely does not apply to our social workers.

<b>Page 646</b> is where Pharmaceutical lingo starts/exists. I'm getting tired, so will let someone else look at this section, if they even want to.


I will report more as time allows and/or it seems relevant.

Landy
08-18-2009, 06:26 PM
OK, a lot of people have said "I haven't seen or read the bill", etc. so I have hit a few high areas of the bill and put them here--You got a few minutes?? lol

I also couldn't help but put my opinion after certain parts of the bill. Please know that I haven't read the whole thing either!

Let's try to keep this civilized so it's not locked...I've spent a lot of time putting this baby together, you know! lol

Feel free to tell me if you think I've interpreted it incorrectly or pose an opposing view.

Here are some key items of HC 3200

Link to bill: <a target=_blank class=ftalternatingbarlinklarge href="http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf">HC3200</a>

<b>Page 21, line 23:</b>
Basically states that the Gov't will audit books of large ins companies & employers that offer self-insurance:

<i>"STUDY-The commissioner, in coordination with the Sec of Health & Human Serv and the Sec or Labor shall conduct a study of the large group insured and self-insured employer health care markets...."</i>

One phrase I found interesting from page 22, Line 23
<i>"Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mis-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers."</i>

Does anyone else read this as the gov't doesn't want it to be a desirable option for employer's to offer/purchase employer sponsored ins?

<b>Page 30, Line 13 </b>
Tells of the committee that decides covered benefits, etc...

<i>"In General - There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans..."</i>

It then goes on to see who will be on this committee. How many medical persons do you see listed on the committee?? Will all CFs be treated under the same cookie-cutter recommendations?

<b>Page 50, Line 21&24</b>
Addresses Illegal Immigrant Coverage??

"<i>PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."</i>

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces?

<b>Page 58, Line 5</b>
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

<i>"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."</i>

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly?

<b>Starting at page 72, </b>
as I understand it, the bill explains how you can exchange your current Employee Sponsored or Private Insurance to be in line with/combined? with the Public Option (Health Insurance Exchange). It sounds like they will try to match what plan you currently have.

It's too long to quote anything here, but there are goals the gov't has for (pg 74, line 19) Year 1, Year 2, Year 3, etc.

<b>Page 84</b>
talks of Benefit Package Levels...

Some say all of this is the Gov't plan to eventually be the only insurance plan available. Another point, as I read into page 86, it looks like the Public Ins option will be billed accordingly to income. I sure hope they will hold into account the money we spend for OTC products, fuel used to travel to our numerous appts, etc before just charging an 8% of income type fee/tax.

<b>Page 121, Line 11</b>
Basically states that payment rates to doctors will be based on rates "for similar services and providers under Parts A&B of Medicare."
It goes on to explain rate exceptions; many exceptions are for items not currently covered under Medicare or Medicaid.

<b>Page 149, Line 14</b>
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)?

<b>Page 167, Line 20</b>
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?

See Tax <b>Exceptions - page 169, Line 19</b>
1) Dependents
2) Non Resident Aliens---Hmm...could this be Illegal Immigrants that have exception to the 2.5% tax???
3) Individuals residing outside US
There are others mentioned if you care to read them.

Not being an attorney or well versed in reading these bills, there are certain parts where I just say "Huh?", and here is an example of such item:
<b>Page 203, Line 14[/B<i>]"The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes...."</i></b>


<b>Page 280</b>
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission.


<b>Page 317</b>
deals with Prohibition of Physician Owned Hospitals

We have a local heart hospital that is physician owned and is really one of the best cardiac centers in the whole area. Under this part of the bill, they will be heavily regulated on what they can & cannot do. So much for their physician freedom...


<b>Page 333 Quality Bonus Payments
Page 335 Establishment of Outcome-Based Measures</b>
Neither may be a bad thing, IMO. The only thing I fear, as a CF, is that hospitals won't take high-risk situations so their outcome results aren't skewed.

<b>Page 424 </b>
Advance Care Planning Consultation a.k.a. The Death Panel

Basically, for anyone on Medicare, every 5 years (page 425, line 11), they will have a "consultation" to make a game plan with things such as advanced directives, living wills, durable power of atty, etc.

<b>Page 426</b> explains end of life services.
<b>Page 429 </b>would/could apply to us CFs re: end of life options

The fear (unfounded or not) is that this is all a way for us to sign off on life saving type procedures.
From a CF view-point, what if you signed a DNR, got a transplant & needed to be on the vent immediately afterwards for a day or 2. Well, you actually had signed a DNR during a consultation 2 years ago---is it going to be an issue to be vented for a short period of time because someone in Washington shows you signed a DNR 2 years ago, and won't OK the vent?
Yes, you could sign a DNR right now and this could apply, but from my understanding, your INS company doesn't know you signed a DNR, so they are not going to be withholding the vent based on that, so your doctor and your family could deviate away from the DNR under certain circumstances when being on the vent would only be temporary and insurance would cover it.

<b>Page 468-479 </b>talks of Community Based Medical Homes. If you read this section, the phrase "chronic illness" is often used. I'm not sure if this means Home Health Services, Hospice, or if both fall under the umbrella of CBMH?

Also, what's your take on page 472, line 8? It explains how 2 payments are made for your in home care. Is Community Based Organization the company that provides home service and the Primary or Principal Care Practice the doctor?

<b>Page 489</b>
Excluding Clinical Social Worker Services from Coverage under the Medicare skilled nursing facility prospective payment system & consolidated payment.

This most likely does not apply to our social workers.

<b>Page 646</b> is where Pharmaceutical lingo starts/exists. I'm getting tired, so will let someone else look at this section, if they even want to.


I will report more as time allows and/or it seems relevant.

Landy
08-18-2009, 06:26 PM
OK, a lot of people have said "I haven't seen or read the bill", etc. so I have hit a few high areas of the bill and put them here--You got a few minutes?? lol

I also couldn't help but put my opinion after certain parts of the bill. Please know that I haven't read the whole thing either!

Let's try to keep this civilized so it's not locked...I've spent a lot of time putting this baby together, you know! lol

Feel free to tell me if you think I've interpreted it incorrectly or pose an opposing view.

Here are some key items of HC 3200

Link to bill: <a target=_blank class=ftalternatingbarlinklarge href="http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf">HC3200</a>

<b>Page 21, line 23:</b>
Basically states that the Gov't will audit books of large ins companies & employers that offer self-insurance:

<i>"STUDY-The commissioner, in coordination with the Sec of Health & Human Serv and the Sec or Labor shall conduct a study of the large group insured and self-insured employer health care markets...."</i>

One phrase I found interesting from page 22, Line 23
<i>"Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mis-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers."</i>

Does anyone else read this as the gov't doesn't want it to be a desirable option for employer's to offer/purchase employer sponsored ins?

<b>Page 30, Line 13 </b>
Tells of the committee that decides covered benefits, etc...

<i>"In General - There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans..."</i>

It then goes on to see who will be on this committee. How many medical persons do you see listed on the committee?? Will all CFs be treated under the same cookie-cutter recommendations?

<b>Page 50, Line 21&24</b>
Addresses Illegal Immigrant Coverage??

"<i>PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."</i>

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces?

<b>Page 58, Line 5</b>
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

<i>"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."</i>

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly?

<b>Starting at page 72, </b>
as I understand it, the bill explains how you can exchange your current Employee Sponsored or Private Insurance to be in line with/combined? with the Public Option (Health Insurance Exchange). It sounds like they will try to match what plan you currently have.

It's too long to quote anything here, but there are goals the gov't has for (pg 74, line 19) Year 1, Year 2, Year 3, etc.

<b>Page 84</b>
talks of Benefit Package Levels...

Some say all of this is the Gov't plan to eventually be the only insurance plan available. Another point, as I read into page 86, it looks like the Public Ins option will be billed accordingly to income. I sure hope they will hold into account the money we spend for OTC products, fuel used to travel to our numerous appts, etc before just charging an 8% of income type fee/tax.

<b>Page 121, Line 11</b>
Basically states that payment rates to doctors will be based on rates "for similar services and providers under Parts A&B of Medicare."
It goes on to explain rate exceptions; many exceptions are for items not currently covered under Medicare or Medicaid.

<b>Page 149, Line 14</b>
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)?

<b>Page 167, Line 20</b>
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?

See Tax <b>Exceptions - page 169, Line 19</b>
1) Dependents
2) Non Resident Aliens---Hmm...could this be Illegal Immigrants that have exception to the 2.5% tax???
3) Individuals residing outside US
There are others mentioned if you care to read them.

Not being an attorney or well versed in reading these bills, there are certain parts where I just say "Huh?", and here is an example of such item:
<b>Page 203, Line 14[/B<i>]"The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes...."</i></b>


<b>Page 280</b>
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission.


<b>Page 317</b>
deals with Prohibition of Physician Owned Hospitals

We have a local heart hospital that is physician owned and is really one of the best cardiac centers in the whole area. Under this part of the bill, they will be heavily regulated on what they can & cannot do. So much for their physician freedom...


<b>Page 333 Quality Bonus Payments
Page 335 Establishment of Outcome-Based Measures</b>
Neither may be a bad thing, IMO. The only thing I fear, as a CF, is that hospitals won't take high-risk situations so their outcome results aren't skewed.

<b>Page 424 </b>
Advance Care Planning Consultation a.k.a. The Death Panel

Basically, for anyone on Medicare, every 5 years (page 425, line 11), they will have a "consultation" to make a game plan with things such as advanced directives, living wills, durable power of atty, etc.

<b>Page 426</b> explains end of life services.
<b>Page 429 </b>would/could apply to us CFs re: end of life options

The fear (unfounded or not) is that this is all a way for us to sign off on life saving type procedures.
From a CF view-point, what if you signed a DNR, got a transplant & needed to be on the vent immediately afterwards for a day or 2. Well, you actually had signed a DNR during a consultation 2 years ago---is it going to be an issue to be vented for a short period of time because someone in Washington shows you signed a DNR 2 years ago, and won't OK the vent?
Yes, you could sign a DNR right now and this could apply, but from my understanding, your INS company doesn't know you signed a DNR, so they are not going to be withholding the vent based on that, so your doctor and your family could deviate away from the DNR under certain circumstances when being on the vent would only be temporary and insurance would cover it.

<b>Page 468-479 </b>talks of Community Based Medical Homes. If you read this section, the phrase "chronic illness" is often used. I'm not sure if this means Home Health Services, Hospice, or if both fall under the umbrella of CBMH?

Also, what's your take on page 472, line 8? It explains how 2 payments are made for your in home care. Is Community Based Organization the company that provides home service and the Primary or Principal Care Practice the doctor?

<b>Page 489</b>
Excluding Clinical Social Worker Services from Coverage under the Medicare skilled nursing facility prospective payment system & consolidated payment.

This most likely does not apply to our social workers.

<b>Page 646</b> is where Pharmaceutical lingo starts/exists. I'm getting tired, so will let someone else look at this section, if they even want to.


I will report more as time allows and/or it seems relevant.

Landy
08-18-2009, 06:26 PM
OK, a lot of people have said "I haven't seen or read the bill", etc. so I have hit a few high areas of the bill and put them here--You got a few minutes?? lol

I also couldn't help but put my opinion after certain parts of the bill. Please know that I haven't read the whole thing either!

Let's try to keep this civilized so it's not locked...I've spent a lot of time putting this baby together, you know! lol

Feel free to tell me if you think I've interpreted it incorrectly or pose an opposing view.

Here are some key items of HC 3200

Link to bill: <a target=_blank class=ftalternatingbarlinklarge href="http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf">HC3200</a>

<b>Page 21, line 23:</b>
Basically states that the Gov't will audit books of large ins companies & employers that offer self-insurance:

<i>"STUDY-The commissioner, in coordination with the Sec of Health & Human Serv and the Sec or Labor shall conduct a study of the large group insured and self-insured employer health care markets...."</i>

One phrase I found interesting from page 22, Line 23
<i>"Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mis-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers."</i>

Does anyone else read this as the gov't doesn't want it to be a desirable option for employer's to offer/purchase employer sponsored ins?

<b>Page 30, Line 13 </b>
Tells of the committee that decides covered benefits, etc...

<i>"In General - There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans..."</i>

It then goes on to see who will be on this committee. How many medical persons do you see listed on the committee?? Will all CFs be treated under the same cookie-cutter recommendations?

<b>Page 50, Line 21&24</b>
Addresses Illegal Immigrant Coverage??

"<i>PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."</i>

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces?

<b>Page 58, Line 5</b>
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

<i>"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."</i>

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly?

<b>Starting at page 72, </b>
as I understand it, the bill explains how you can exchange your current Employee Sponsored or Private Insurance to be in line with/combined? with the Public Option (Health Insurance Exchange). It sounds like they will try to match what plan you currently have.

It's too long to quote anything here, but there are goals the gov't has for (pg 74, line 19) Year 1, Year 2, Year 3, etc.

<b>Page 84</b>
talks of Benefit Package Levels...

Some say all of this is the Gov't plan to eventually be the only insurance plan available. Another point, as I read into page 86, it looks like the Public Ins option will be billed accordingly to income. I sure hope they will hold into account the money we spend for OTC products, fuel used to travel to our numerous appts, etc before just charging an 8% of income type fee/tax.

<b>Page 121, Line 11</b>
Basically states that payment rates to doctors will be based on rates "for similar services and providers under Parts A&B of Medicare."
It goes on to explain rate exceptions; many exceptions are for items not currently covered under Medicare or Medicaid.

<b>Page 149, Line 14</b>
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)?

<b>Page 167, Line 20</b>
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?

See Tax <b>Exceptions - page 169, Line 19</b>
1) Dependents
2) Non Resident Aliens---Hmm...could this be Illegal Immigrants that have exception to the 2.5% tax???
3) Individuals residing outside US
There are others mentioned if you care to read them.

Not being an attorney or well versed in reading these bills, there are certain parts where I just say "Huh?", and here is an example of such item:
<b>Page 203, Line 14[/B<i>]"The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes...."</i></b>


<b>Page 280</b>
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission.


<b>Page 317</b>
deals with Prohibition of Physician Owned Hospitals

We have a local heart hospital that is physician owned and is really one of the best cardiac centers in the whole area. Under this part of the bill, they will be heavily regulated on what they can & cannot do. So much for their physician freedom...


<b>Page 333 Quality Bonus Payments
Page 335 Establishment of Outcome-Based Measures</b>
Neither may be a bad thing, IMO. The only thing I fear, as a CF, is that hospitals won't take high-risk situations so their outcome results aren't skewed.

<b>Page 424 </b>
Advance Care Planning Consultation a.k.a. The Death Panel

Basically, for anyone on Medicare, every 5 years (page 425, line 11), they will have a "consultation" to make a game plan with things such as advanced directives, living wills, durable power of atty, etc.

<b>Page 426</b> explains end of life services.
<b>Page 429 </b>would/could apply to us CFs re: end of life options

The fear (unfounded or not) is that this is all a way for us to sign off on life saving type procedures.
From a CF view-point, what if you signed a DNR, got a transplant & needed to be on the vent immediately afterwards for a day or 2. Well, you actually had signed a DNR during a consultation 2 years ago---is it going to be an issue to be vented for a short period of time because someone in Washington shows you signed a DNR 2 years ago, and won't OK the vent?
Yes, you could sign a DNR right now and this could apply, but from my understanding, your INS company doesn't know you signed a DNR, so they are not going to be withholding the vent based on that, so your doctor and your family could deviate away from the DNR under certain circumstances when being on the vent would only be temporary and insurance would cover it.

<b>Page 468-479 </b>talks of Community Based Medical Homes. If you read this section, the phrase "chronic illness" is often used. I'm not sure if this means Home Health Services, Hospice, or if both fall under the umbrella of CBMH?

Also, what's your take on page 472, line 8? It explains how 2 payments are made for your in home care. Is Community Based Organization the company that provides home service and the Primary or Principal Care Practice the doctor?

<b>Page 489</b>
Excluding Clinical Social Worker Services from Coverage under the Medicare skilled nursing facility prospective payment system & consolidated payment.

This most likely does not apply to our social workers.

<b>Page 646</b> is where Pharmaceutical lingo starts/exists. I'm getting tired, so will let someone else look at this section, if they even want to.


I will report more as time allows and/or it seems relevant.

Landy
08-18-2009, 06:26 PM
OK, a lot of people have said "I haven't seen or read the bill", etc. so I have hit a few high areas of the bill and put them here--You got a few minutes?? lol
<br />
<br />I also couldn't help but put my opinion after certain parts of the bill. Please know that I haven't read the whole thing either!
<br />
<br />Let's try to keep this civilized so it's not locked...I've spent a lot of time putting this baby together, you know! lol
<br />
<br />Feel free to tell me if you think I've interpreted it incorrectly or pose an opposing view.
<br />
<br />Here are some key items of HC 3200
<br />
<br />Link to bill: <a target=_blank class=ftalternatingbarlinklarge href="http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf">HC3200</a>
<br />
<br /><b>Page 21, line 23:</b>
<br />Basically states that the Gov't will audit books of large ins companies & employers that offer self-insurance:
<br />
<br /><i>"STUDY-The commissioner, in coordination with the Sec of Health & Human Serv and the Sec or Labor shall conduct a study of the large group insured and self-insured employer health care markets...."</i>
<br />
<br />One phrase I found interesting from page 22, Line 23
<br /><i>"Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mis-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers."</i>
<br />
<br />Does anyone else read this as the gov't doesn't want it to be a desirable option for employer's to offer/purchase employer sponsored ins?
<br />
<br /><b>Page 30, Line 13 </b>
<br />Tells of the committee that decides covered benefits, etc...
<br />
<br /><i>"In General - There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans..."</i>
<br />
<br />It then goes on to see who will be on this committee. How many medical persons do you see listed on the committee?? Will all CFs be treated under the same cookie-cutter recommendations?
<br />
<br /><b>Page 50, Line 21&24</b>
<br />Addresses Illegal Immigrant Coverage??
<br />
<br />"<i>PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."</i>
<br />
<br />What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces?
<br />
<br /><b>Page 58, Line 5</b>
<br />Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.
<br />
<br /><i>"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."</i>
<br />
<br />So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly?
<br />
<br /><b>Starting at page 72, </b>
<br />as I understand it, the bill explains how you can exchange your current Employee Sponsored or Private Insurance to be in line with/combined? with the Public Option (Health Insurance Exchange). It sounds like they will try to match what plan you currently have.
<br />
<br />It's too long to quote anything here, but there are goals the gov't has for (pg 74, line 19) Year 1, Year 2, Year 3, etc.
<br />
<br /><b>Page 84</b>
<br />talks of Benefit Package Levels...
<br />
<br />Some say all of this is the Gov't plan to eventually be the only insurance plan available. Another point, as I read into page 86, it looks like the Public Ins option will be billed accordingly to income. I sure hope they will hold into account the money we spend for OTC products, fuel used to travel to our numerous appts, etc before just charging an 8% of income type fee/tax.
<br />
<br /><b>Page 121, Line 11</b>
<br />Basically states that payment rates to doctors will be based on rates "for similar services and providers under Parts A&B of Medicare."
<br />It goes on to explain rate exceptions; many exceptions are for items not currently covered under Medicare or Medicaid.
<br />
<br /><b>Page 149, Line 14</b>
<br />Explains Employer Contributions (i.e. tax) in Lieu of Coverage
<br />
<br />This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)?
<br />
<br /><b>Page 167, Line 20</b>
<br />If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?
<br />
<br />See Tax <b>Exceptions - page 169, Line 19</b>
<br />1) Dependents
<br />2) Non Resident Aliens---Hmm...could this be Illegal Immigrants that have exception to the 2.5% tax???
<br />3) Individuals residing outside US
<br />There are others mentioned if you care to read them.
<br />
<br />Not being an attorney or well versed in reading these bills, there are certain parts where I just say "Huh?", and here is an example of such item:
<br /><b>Page 203, Line 14[/B<i>]"The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes...."</i></b>
<br />
<br />
<br /><b>Page 280</b>
<br />Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission.
<br />
<br />
<br /><b>Page 317</b>
<br />deals with Prohibition of Physician Owned Hospitals
<br />
<br />We have a local heart hospital that is physician owned and is really one of the best cardiac centers in the whole area. Under this part of the bill, they will be heavily regulated on what they can & cannot do. So much for their physician freedom...
<br />
<br />
<br /><b>Page 333 Quality Bonus Payments
<br />Page 335 Establishment of Outcome-Based Measures</b>
<br />Neither may be a bad thing, IMO. The only thing I fear, as a CF, is that hospitals won't take high-risk situations so their outcome results aren't skewed.
<br />
<br /><b>Page 424 </b>
<br />Advance Care Planning Consultation a.k.a. The Death Panel
<br />
<br />Basically, for anyone on Medicare, every 5 years (page 425, line 11), they will have a "consultation" to make a game plan with things such as advanced directives, living wills, durable power of atty, etc.
<br />
<br /><b>Page 426</b> explains end of life services.
<br /><b>Page 429 </b>would/could apply to us CFs re: end of life options
<br />
<br />The fear (unfounded or not) is that this is all a way for us to sign off on life saving type procedures.
<br />From a CF view-point, what if you signed a DNR, got a transplant & needed to be on the vent immediately afterwards for a day or 2. Well, you actually had signed a DNR during a consultation 2 years ago---is it going to be an issue to be vented for a short period of time because someone in Washington shows you signed a DNR 2 years ago, and won't OK the vent?
<br />Yes, you could sign a DNR right now and this could apply, but from my understanding, your INS company doesn't know you signed a DNR, so they are not going to be withholding the vent based on that, so your doctor and your family could deviate away from the DNR under certain circumstances when being on the vent would only be temporary and insurance would cover it.
<br />
<br /><b>Page 468-479 </b>talks of Community Based Medical Homes. If you read this section, the phrase "chronic illness" is often used. I'm not sure if this means Home Health Services, Hospice, or if both fall under the umbrella of CBMH?
<br />
<br />Also, what's your take on page 472, line 8? It explains how 2 payments are made for your in home care. Is Community Based Organization the company that provides home service and the Primary or Principal Care Practice the doctor?
<br />
<br /><b>Page 489</b>
<br />Excluding Clinical Social Worker Services from Coverage under the Medicare skilled nursing facility prospective payment system & consolidated payment.
<br />
<br />This most likely does not apply to our social workers.
<br />
<br /><b>Page 646</b> is where Pharmaceutical lingo starts/exists. I'm getting tired, so will let someone else look at this section, if they even want to.
<br />
<br />
<br />I will report more as time allows and/or it seems relevant.

jrotier
08-19-2009, 02:07 AM
It's great to see people really looking into this stuff to try and see how it may impact us. I've been researching alot too, even tried to read some of the bill (got lost pretty quickly though, but did come across alot of what you mentioned. Just to add a few comments, points of view, ect....

<i>Page 50, Line 21&24
Addresses Illegal Immigrant Coverage??

"PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces? </i>

I found a Newsweek article that addresses 7 myths about the plan, and this was one of them. Basically, it also has a provision to not allow federal affordibility credits to undocumented aliens. I think this means they cannot receive assistance to purchase insurance, but just as now, would probably still receive emergency coverage if they came to a hospital with a life threatening condition. A hospital (I believe) cannot turn someone away with a life threatening emergency if they cannot afford or do not have insurance to pay.

Here is a link to the newsweek article <a target=_blank class=ftalternatingbarlinklarge href="http://www.newsweek.com/id/211981/page/1
">http://www.newsweek.com/id/211981/page/1
</a>
<i>Page 58, Line 5
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly? </i>

Kind of vague, they way they state it, but it could also mean that via the internet or phone, providers can look up benefit information (not bank account) to determine amounts of copays and/or dedictibles due at time of service, and if they have been met. Because it talks about elegibility and services, it leads me to beleive they are talking about access to benefit information, not bank account information. Major insurance companies already have this, but it may not be real time because not everything is completely electronic. The machine readable card would be just like an insurance card, but scannable instead of having to call a phone number or get on the internet. It does not specifically state that it is linked to a bank per se. (Again, just my interpretation)

Just to address the public option, no reliable or quotable resources, but it is looking more and more like that might be scrapped as many see that that hallmark of socialized medicine.

<i>Page 149, Line 14
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)? </i>

I think the idea behind this is that the government option is supposed to be more affordable than private insurance. If a small business can afford private insurance, they won't have to do the governement option, so it's not that they can't have a private insurance option, it's that many small businesses cannot afford it (which is why many small businesses do not offer health insurance to employees). This is a huge area of debate I think, because many say that the government option may not be affordable either. Not sure what will happen to the tax idea if they scrap the government option though.

<i>Page 167, Line 20
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?</i>

Many people who are healthy choose to not have health insurance because "it won't happen to me". I remember reading (again, can't recall where) that the number of uninsured is not necessarily because they can't afford it or it is not offered, it's that they choose not to. Affordibility is an issuse, but as a 20-something, many of my friends simple choose to spend their money on other things. Because one of the ideas for insurance reform includes making sure no one is excluded because of a preexisting condition, it makes sense (in theory) to mandate that healthcare is purchased by everyone. Of course, affordability is an issue, but if everyone waited until they got sick, because they couldn't be excluded, healthcare costs might continue to skyrocket. Note: Mandating everyone purchase healthcare is NOT in the reforms.

<i>Page 280
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission</i>

This is one of the ideas that concerns me the most. Common sense would say that if a person is "stable" when discharged, that the hospital/doctor shouldn't be penalized. I think the key idea might be whether or not something is preventable. I don't have alot of experience with hemoptysis, but it seems like that is something that just happens, and aside from an embolyzation (sp?) there is no real treatment for it, except monitoring, removing the factors that contribute, and treating the infection, all which should be done before a CF patient leaves (I would think?) I don't think they would start mandating embolyzations for all episodes, because it sounds like there is a criteria that is followed to determine if that is necessary.

The idea of payment based on outcomes rather than fee for service also concerns me. This idea did not jump out at me when reading the reforms, but Obama talks about it alot. I understand the idea, we don't want to reward doctor or hospitals for ordering tests and making sure that tests are not duplicated, but what about specialties where the end result is not as positive. Take oncologists, especailly those who deal with agressive cancers with a low survial rate. And even CF, we can be 100% compliant, but still get sicker. I want to know how they are going to address those issues.

Anyways, I've rambled on long enough, but the Newsweek article also address the "death committee" myth.

So again, just my interpretation of some of the points the OP made and I too hope this remains civil as I think we are all struggling to see how this will impact us, and society in general.

jrotier
08-19-2009, 02:07 AM
It's great to see people really looking into this stuff to try and see how it may impact us. I've been researching alot too, even tried to read some of the bill (got lost pretty quickly though, but did come across alot of what you mentioned. Just to add a few comments, points of view, ect....

<i>Page 50, Line 21&24
Addresses Illegal Immigrant Coverage??

"PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces? </i>

I found a Newsweek article that addresses 7 myths about the plan, and this was one of them. Basically, it also has a provision to not allow federal affordibility credits to undocumented aliens. I think this means they cannot receive assistance to purchase insurance, but just as now, would probably still receive emergency coverage if they came to a hospital with a life threatening condition. A hospital (I believe) cannot turn someone away with a life threatening emergency if they cannot afford or do not have insurance to pay.

Here is a link to the newsweek article <a target=_blank class=ftalternatingbarlinklarge href="http://www.newsweek.com/id/211981/page/1
">http://www.newsweek.com/id/211981/page/1
</a>
<i>Page 58, Line 5
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly? </i>

Kind of vague, they way they state it, but it could also mean that via the internet or phone, providers can look up benefit information (not bank account) to determine amounts of copays and/or dedictibles due at time of service, and if they have been met. Because it talks about elegibility and services, it leads me to beleive they are talking about access to benefit information, not bank account information. Major insurance companies already have this, but it may not be real time because not everything is completely electronic. The machine readable card would be just like an insurance card, but scannable instead of having to call a phone number or get on the internet. It does not specifically state that it is linked to a bank per se. (Again, just my interpretation)

Just to address the public option, no reliable or quotable resources, but it is looking more and more like that might be scrapped as many see that that hallmark of socialized medicine.

<i>Page 149, Line 14
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)? </i>

I think the idea behind this is that the government option is supposed to be more affordable than private insurance. If a small business can afford private insurance, they won't have to do the governement option, so it's not that they can't have a private insurance option, it's that many small businesses cannot afford it (which is why many small businesses do not offer health insurance to employees). This is a huge area of debate I think, because many say that the government option may not be affordable either. Not sure what will happen to the tax idea if they scrap the government option though.

<i>Page 167, Line 20
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?</i>

Many people who are healthy choose to not have health insurance because "it won't happen to me". I remember reading (again, can't recall where) that the number of uninsured is not necessarily because they can't afford it or it is not offered, it's that they choose not to. Affordibility is an issuse, but as a 20-something, many of my friends simple choose to spend their money on other things. Because one of the ideas for insurance reform includes making sure no one is excluded because of a preexisting condition, it makes sense (in theory) to mandate that healthcare is purchased by everyone. Of course, affordability is an issue, but if everyone waited until they got sick, because they couldn't be excluded, healthcare costs might continue to skyrocket. Note: Mandating everyone purchase healthcare is NOT in the reforms.

<i>Page 280
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission</i>

This is one of the ideas that concerns me the most. Common sense would say that if a person is "stable" when discharged, that the hospital/doctor shouldn't be penalized. I think the key idea might be whether or not something is preventable. I don't have alot of experience with hemoptysis, but it seems like that is something that just happens, and aside from an embolyzation (sp?) there is no real treatment for it, except monitoring, removing the factors that contribute, and treating the infection, all which should be done before a CF patient leaves (I would think?) I don't think they would start mandating embolyzations for all episodes, because it sounds like there is a criteria that is followed to determine if that is necessary.

The idea of payment based on outcomes rather than fee for service also concerns me. This idea did not jump out at me when reading the reforms, but Obama talks about it alot. I understand the idea, we don't want to reward doctor or hospitals for ordering tests and making sure that tests are not duplicated, but what about specialties where the end result is not as positive. Take oncologists, especailly those who deal with agressive cancers with a low survial rate. And even CF, we can be 100% compliant, but still get sicker. I want to know how they are going to address those issues.

Anyways, I've rambled on long enough, but the Newsweek article also address the "death committee" myth.

So again, just my interpretation of some of the points the OP made and I too hope this remains civil as I think we are all struggling to see how this will impact us, and society in general.

jrotier
08-19-2009, 02:07 AM
It's great to see people really looking into this stuff to try and see how it may impact us. I've been researching alot too, even tried to read some of the bill (got lost pretty quickly though, but did come across alot of what you mentioned. Just to add a few comments, points of view, ect....

<i>Page 50, Line 21&24
Addresses Illegal Immigrant Coverage??

"PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces? </i>

I found a Newsweek article that addresses 7 myths about the plan, and this was one of them. Basically, it also has a provision to not allow federal affordibility credits to undocumented aliens. I think this means they cannot receive assistance to purchase insurance, but just as now, would probably still receive emergency coverage if they came to a hospital with a life threatening condition. A hospital (I believe) cannot turn someone away with a life threatening emergency if they cannot afford or do not have insurance to pay.

Here is a link to the newsweek article <a target=_blank class=ftalternatingbarlinklarge href="http://www.newsweek.com/id/211981/page/1
">http://www.newsweek.com/id/211981/page/1
</a>
<i>Page 58, Line 5
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly? </i>

Kind of vague, they way they state it, but it could also mean that via the internet or phone, providers can look up benefit information (not bank account) to determine amounts of copays and/or dedictibles due at time of service, and if they have been met. Because it talks about elegibility and services, it leads me to beleive they are talking about access to benefit information, not bank account information. Major insurance companies already have this, but it may not be real time because not everything is completely electronic. The machine readable card would be just like an insurance card, but scannable instead of having to call a phone number or get on the internet. It does not specifically state that it is linked to a bank per se. (Again, just my interpretation)

Just to address the public option, no reliable or quotable resources, but it is looking more and more like that might be scrapped as many see that that hallmark of socialized medicine.

<i>Page 149, Line 14
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)? </i>

I think the idea behind this is that the government option is supposed to be more affordable than private insurance. If a small business can afford private insurance, they won't have to do the governement option, so it's not that they can't have a private insurance option, it's that many small businesses cannot afford it (which is why many small businesses do not offer health insurance to employees). This is a huge area of debate I think, because many say that the government option may not be affordable either. Not sure what will happen to the tax idea if they scrap the government option though.

<i>Page 167, Line 20
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?</i>

Many people who are healthy choose to not have health insurance because "it won't happen to me". I remember reading (again, can't recall where) that the number of uninsured is not necessarily because they can't afford it or it is not offered, it's that they choose not to. Affordibility is an issuse, but as a 20-something, many of my friends simple choose to spend their money on other things. Because one of the ideas for insurance reform includes making sure no one is excluded because of a preexisting condition, it makes sense (in theory) to mandate that healthcare is purchased by everyone. Of course, affordability is an issue, but if everyone waited until they got sick, because they couldn't be excluded, healthcare costs might continue to skyrocket. Note: Mandating everyone purchase healthcare is NOT in the reforms.

<i>Page 280
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission</i>

This is one of the ideas that concerns me the most. Common sense would say that if a person is "stable" when discharged, that the hospital/doctor shouldn't be penalized. I think the key idea might be whether or not something is preventable. I don't have alot of experience with hemoptysis, but it seems like that is something that just happens, and aside from an embolyzation (sp?) there is no real treatment for it, except monitoring, removing the factors that contribute, and treating the infection, all which should be done before a CF patient leaves (I would think?) I don't think they would start mandating embolyzations for all episodes, because it sounds like there is a criteria that is followed to determine if that is necessary.

The idea of payment based on outcomes rather than fee for service also concerns me. This idea did not jump out at me when reading the reforms, but Obama talks about it alot. I understand the idea, we don't want to reward doctor or hospitals for ordering tests and making sure that tests are not duplicated, but what about specialties where the end result is not as positive. Take oncologists, especailly those who deal with agressive cancers with a low survial rate. And even CF, we can be 100% compliant, but still get sicker. I want to know how they are going to address those issues.

Anyways, I've rambled on long enough, but the Newsweek article also address the "death committee" myth.

So again, just my interpretation of some of the points the OP made and I too hope this remains civil as I think we are all struggling to see how this will impact us, and society in general.

jrotier
08-19-2009, 02:07 AM
It's great to see people really looking into this stuff to try and see how it may impact us. I've been researching alot too, even tried to read some of the bill (got lost pretty quickly though, but did come across alot of what you mentioned. Just to add a few comments, points of view, ect....

<i>Page 50, Line 21&24
Addresses Illegal Immigrant Coverage??

"PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."

What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces? </i>

I found a Newsweek article that addresses 7 myths about the plan, and this was one of them. Basically, it also has a provision to not allow federal affordibility credits to undocumented aliens. I think this means they cannot receive assistance to purchase insurance, but just as now, would probably still receive emergency coverage if they came to a hospital with a life threatening condition. A hospital (I believe) cannot turn someone away with a life threatening emergency if they cannot afford or do not have insurance to pay.

Here is a link to the newsweek article <a target=_blank class=ftalternatingbarlinklarge href="http://www.newsweek.com/id/211981/page/1
">http://www.newsweek.com/id/211981/page/1
</a>
<i>Page 58, Line 5
Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.

"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."

So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly? </i>

Kind of vague, they way they state it, but it could also mean that via the internet or phone, providers can look up benefit information (not bank account) to determine amounts of copays and/or dedictibles due at time of service, and if they have been met. Because it talks about elegibility and services, it leads me to beleive they are talking about access to benefit information, not bank account information. Major insurance companies already have this, but it may not be real time because not everything is completely electronic. The machine readable card would be just like an insurance card, but scannable instead of having to call a phone number or get on the internet. It does not specifically state that it is linked to a bank per se. (Again, just my interpretation)

Just to address the public option, no reliable or quotable resources, but it is looking more and more like that might be scrapped as many see that that hallmark of socialized medicine.

<i>Page 149, Line 14
Explains Employer Contributions (i.e. tax) in Lieu of Coverage

This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)? </i>

I think the idea behind this is that the government option is supposed to be more affordable than private insurance. If a small business can afford private insurance, they won't have to do the governement option, so it's not that they can't have a private insurance option, it's that many small businesses cannot afford it (which is why many small businesses do not offer health insurance to employees). This is a huge area of debate I think, because many say that the government option may not be affordable either. Not sure what will happen to the tax idea if they scrap the government option though.

<i>Page 167, Line 20
If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?</i>

Many people who are healthy choose to not have health insurance because "it won't happen to me". I remember reading (again, can't recall where) that the number of uninsured is not necessarily because they can't afford it or it is not offered, it's that they choose not to. Affordibility is an issuse, but as a 20-something, many of my friends simple choose to spend their money on other things. Because one of the ideas for insurance reform includes making sure no one is excluded because of a preexisting condition, it makes sense (in theory) to mandate that healthcare is purchased by everyone. Of course, affordability is an issue, but if everyone waited until they got sick, because they couldn't be excluded, healthcare costs might continue to skyrocket. Note: Mandating everyone purchase healthcare is NOT in the reforms.

<i>Page 280
Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission</i>

This is one of the ideas that concerns me the most. Common sense would say that if a person is "stable" when discharged, that the hospital/doctor shouldn't be penalized. I think the key idea might be whether or not something is preventable. I don't have alot of experience with hemoptysis, but it seems like that is something that just happens, and aside from an embolyzation (sp?) there is no real treatment for it, except monitoring, removing the factors that contribute, and treating the infection, all which should be done before a CF patient leaves (I would think?) I don't think they would start mandating embolyzations for all episodes, because it sounds like there is a criteria that is followed to determine if that is necessary.

The idea of payment based on outcomes rather than fee for service also concerns me. This idea did not jump out at me when reading the reforms, but Obama talks about it alot. I understand the idea, we don't want to reward doctor or hospitals for ordering tests and making sure that tests are not duplicated, but what about specialties where the end result is not as positive. Take oncologists, especailly those who deal with agressive cancers with a low survial rate. And even CF, we can be 100% compliant, but still get sicker. I want to know how they are going to address those issues.

Anyways, I've rambled on long enough, but the Newsweek article also address the "death committee" myth.

So again, just my interpretation of some of the points the OP made and I too hope this remains civil as I think we are all struggling to see how this will impact us, and society in general.

jrotier
08-19-2009, 02:07 AM
It's great to see people really looking into this stuff to try and see how it may impact us. I've been researching alot too, even tried to read some of the bill (got lost pretty quickly though, but did come across alot of what you mentioned. Just to add a few comments, points of view, ect....
<br />
<br /><i>Page 50, Line 21&24
<br />Addresses Illegal Immigrant Coverage??
<br />
<br />"PROHIBITING DISCRIMINATION IN HEALTH CARE....(line 24) ... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality care or related services."
<br />
<br />What the heck does personal characteristics mean?? Skin color, disfiguration, smiley faces? </i>
<br />
<br />I found a Newsweek article that addresses 7 myths about the plan, and this was one of them. Basically, it also has a provision to not allow federal affordibility credits to undocumented aliens. I think this means they cannot receive assistance to purchase insurance, but just as now, would probably still receive emergency coverage if they came to a hospital with a life threatening condition. A hospital (I believe) cannot turn someone away with a life threatening emergency if they cannot afford or do not have insurance to pay.
<br />
<br />Here is a link to the newsweek article <a target=_blank class=ftalternatingbarlinklarge href="http://www.newsweek.com/id/211981/page/1
">http://www.newsweek.com/id/211981/page/1
</a><br />
<br /><i>Page 58, Line 5
<br />Speaks of "real time" determination of an individuals financial responsibility. I assume this is what people are talking about when they say the gov't will have access to our bank accts and financial information.
<br />
<br />"(D) enable the real-time (or near real time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card..."
<br />
<br />So, if I understand this correctly, they will have real time access to my bank accts thru an ID card, so if it's the day before payday and I was to see my Pulmonary Specialists that day, I may have to see a GP because I only have $10 in my bank acct that day - not enough to pay the $50 co-pay to see the specialist? OR, say it is pay day & I have $850 in the bank, then will my co-pay be charged accordingly? </i>
<br />
<br />Kind of vague, they way they state it, but it could also mean that via the internet or phone, providers can look up benefit information (not bank account) to determine amounts of copays and/or dedictibles due at time of service, and if they have been met. Because it talks about elegibility and services, it leads me to beleive they are talking about access to benefit information, not bank account information. Major insurance companies already have this, but it may not be real time because not everything is completely electronic. The machine readable card would be just like an insurance card, but scannable instead of having to call a phone number or get on the internet. It does not specifically state that it is linked to a bank per se. (Again, just my interpretation)
<br />
<br />Just to address the public option, no reliable or quotable resources, but it is looking more and more like that might be scrapped as many see that that hallmark of socialized medicine.
<br />
<br /><i>Page 149, Line 14
<br />Explains Employer Contributions (i.e. tax) in Lieu of Coverage
<br />
<br />This one is hard to understand, but how I take it is...if a Small Employer (payroll 400K or less a year) does not offer the Govt Health Care as an option, they will pay a tax up to 8% of their yearly payroll. (chart on page 150, line 13). I guess my question is, what if they offer private health ins, but don't participate in the Gov't program, then they pay their share of the employee's insurance policy & also pay the tax for non-participation in the Gov't program? Essentially they are penalized for not offering Govt plan? If this is the case, then will Small Employers even offer private insurance any longer - what would be the incentive, and is this the Gov't goal (private ins snubbed out)? </i>
<br />
<br />I think the idea behind this is that the government option is supposed to be more affordable than private insurance. If a small business can afford private insurance, they won't have to do the governement option, so it's not that they can't have a private insurance option, it's that many small businesses cannot afford it (which is why many small businesses do not offer health insurance to employees). This is a huge area of debate I think, because many say that the government option may not be affordable either. Not sure what will happen to the tax idea if they scrap the government option though.
<br />
<br /><i>Page 167, Line 20
<br />If individuals choose not to have any insurance, they will pay a tax of 2.5% of wages. I don't think this would apply to us CFs (I would think we would all choose to have insurance) and if the Gov't plan is reasonably priced, then I don't know why someone, CF or not, would choose not to have coverage?</i>
<br />
<br />Many people who are healthy choose to not have health insurance because "it won't happen to me". I remember reading (again, can't recall where) that the number of uninsured is not necessarily because they can't afford it or it is not offered, it's that they choose not to. Affordibility is an issuse, but as a 20-something, many of my friends simple choose to spend their money on other things. Because one of the ideas for insurance reform includes making sure no one is excluded because of a preexisting condition, it makes sense (in theory) to mandate that healthcare is purchased by everyone. Of course, affordability is an issue, but if everyone waited until they got sick, because they couldn't be excluded, healthcare costs might continue to skyrocket. Note: Mandating everyone purchase healthcare is NOT in the reforms.
<br />
<br /><i>Page 280
<br />Explains about how hospitals will be penalized for readmissions. While I get the fact that they don't want people dismissed too soon, I wonder if this means that us CFs will no longer get any say on being discharged to do IVs at home for a period of time, just on the off-chance that we may have complications at home (i.e. blood clots, hemoptysis, etc) that may result in a readmission</i>
<br />
<br />This is one of the ideas that concerns me the most. Common sense would say that if a person is "stable" when discharged, that the hospital/doctor shouldn't be penalized. I think the key idea might be whether or not something is preventable. I don't have alot of experience with hemoptysis, but it seems like that is something that just happens, and aside from an embolyzation (sp?) there is no real treatment for it, except monitoring, removing the factors that contribute, and treating the infection, all which should be done before a CF patient leaves (I would think?) I don't think they would start mandating embolyzations for all episodes, because it sounds like there is a criteria that is followed to determine if that is necessary.
<br />
<br />The idea of payment based on outcomes rather than fee for service also concerns me. This idea did not jump out at me when reading the reforms, but Obama talks about it alot. I understand the idea, we don't want to reward doctor or hospitals for ordering tests and making sure that tests are not duplicated, but what about specialties where the end result is not as positive. Take oncologists, especailly those who deal with agressive cancers with a low survial rate. And even CF, we can be 100% compliant, but still get sicker. I want to know how they are going to address those issues.
<br />
<br />Anyways, I've rambled on long enough, but the Newsweek article also address the "death committee" myth.
<br />
<br />So again, just my interpretation of some of the points the OP made and I too hope this remains civil as I think we are all struggling to see how this will impact us, and society in general.

kayleesgrandma
08-19-2009, 02:12 PM
Great idea, hope this stays civil, and I think it will--no SEIU unions to keep us out! We will have to discuss it here because most of our congress people do not want to face us in town halls, and I will admit that some of the town halls have been loud, and rude! So I hope that the discussion here will be thought-provoking.

I just worry that it won't make any difference what we read NOW--when it goes to the floor, they can add amendments like they did for the Porkulus Bill, and the Crap and Trade Bill. What will we be able to do if they add like 300 pages, like they did at 3AM for the Cap and Trade?

I also think that if anyone thinks there won't be rationing of care--then they are being unrealistic--it will HAVE to happen. I worry about what that will mean for Kaylee, and all of you, and since I'm getting "older"--I am on the list also.

I guess they took the "flag" site down on the Whitehouse site, so we don't have to worry about getting flagged for opposing the plan. (Of course, I already "flagged" myself--and told them what they could do with their site...I am waiting for the black helicopters to arrive at any time...)

kayleesgrandma
08-19-2009, 02:12 PM
Great idea, hope this stays civil, and I think it will--no SEIU unions to keep us out! We will have to discuss it here because most of our congress people do not want to face us in town halls, and I will admit that some of the town halls have been loud, and rude! So I hope that the discussion here will be thought-provoking.

I just worry that it won't make any difference what we read NOW--when it goes to the floor, they can add amendments like they did for the Porkulus Bill, and the Crap and Trade Bill. What will we be able to do if they add like 300 pages, like they did at 3AM for the Cap and Trade?

I also think that if anyone thinks there won't be rationing of care--then they are being unrealistic--it will HAVE to happen. I worry about what that will mean for Kaylee, and all of you, and since I'm getting "older"--I am on the list also.

I guess they took the "flag" site down on the Whitehouse site, so we don't have to worry about getting flagged for opposing the plan. (Of course, I already "flagged" myself--and told them what they could do with their site...I am waiting for the black helicopters to arrive at any time...)

kayleesgrandma
08-19-2009, 02:12 PM
Great idea, hope this stays civil, and I think it will--no SEIU unions to keep us out! We will have to discuss it here because most of our congress people do not want to face us in town halls, and I will admit that some of the town halls have been loud, and rude! So I hope that the discussion here will be thought-provoking.

I just worry that it won't make any difference what we read NOW--when it goes to the floor, they can add amendments like they did for the Porkulus Bill, and the Crap and Trade Bill. What will we be able to do if they add like 300 pages, like they did at 3AM for the Cap and Trade?

I also think that if anyone thinks there won't be rationing of care--then they are being unrealistic--it will HAVE to happen. I worry about what that will mean for Kaylee, and all of you, and since I'm getting "older"--I am on the list also.

I guess they took the "flag" site down on the Whitehouse site, so we don't have to worry about getting flagged for opposing the plan. (Of course, I already "flagged" myself--and told them what they could do with their site...I am waiting for the black helicopters to arrive at any time...)

kayleesgrandma
08-19-2009, 02:12 PM
Great idea, hope this stays civil, and I think it will--no SEIU unions to keep us out! We will have to discuss it here because most of our congress people do not want to face us in town halls, and I will admit that some of the town halls have been loud, and rude! So I hope that the discussion here will be thought-provoking.

I just worry that it won't make any difference what we read NOW--when it goes to the floor, they can add amendments like they did for the Porkulus Bill, and the Crap and Trade Bill. What will we be able to do if they add like 300 pages, like they did at 3AM for the Cap and Trade?

I also think that if anyone thinks there won't be rationing of care--then they are being unrealistic--it will HAVE to happen. I worry about what that will mean for Kaylee, and all of you, and since I'm getting "older"--I am on the list also.

I guess they took the "flag" site down on the Whitehouse site, so we don't have to worry about getting flagged for opposing the plan. (Of course, I already "flagged" myself--and told them what they could do with their site...I am waiting for the black helicopters to arrive at any time...)

kayleesgrandma
08-19-2009, 02:12 PM
Great idea, hope this stays civil, and I think it will--no SEIU unions to keep us out! We will have to discuss it here because most of our congress people do not want to face us in town halls, and I will admit that some of the town halls have been loud, and rude! So I hope that the discussion here will be thought-provoking.
<br />
<br />I just worry that it won't make any difference what we read NOW--when it goes to the floor, they can add amendments like they did for the Porkulus Bill, and the Crap and Trade Bill. What will we be able to do if they add like 300 pages, like they did at 3AM for the Cap and Trade?
<br />
<br />I also think that if anyone thinks there won't be rationing of care--then they are being unrealistic--it will HAVE to happen. I worry about what that will mean for Kaylee, and all of you, and since I'm getting "older"--I am on the list also.
<br />
<br />I guess they took the "flag" site down on the Whitehouse site, so we don't have to worry about getting flagged for opposing the plan. (Of course, I already "flagged" myself--and told them what they could do with their site...I am waiting for the black helicopters to arrive at any time...)

kayleesgrandma
08-19-2009, 02:17 PM
Why couldn't they -instead of trying to overhaul the whole thing? Why a government takeover of the whole system? The Post Office, Social Security, Medicare, Amtrack, are all going bankrupt in the next few years--what should make us think that the govenment getting it's hands on something that comprises 1/7 of our economy will be a good thing?

Also the wording--it's almost impossible to understand. It is created by lawyers, but no accounting OF the lawyers and TORT reform is in the bill. Makes me wonder...hmmm, our President is a lawyer...hmmm...

kayleesgrandma
08-19-2009, 02:17 PM
Why couldn't they -instead of trying to overhaul the whole thing? Why a government takeover of the whole system? The Post Office, Social Security, Medicare, Amtrack, are all going bankrupt in the next few years--what should make us think that the govenment getting it's hands on something that comprises 1/7 of our economy will be a good thing?

Also the wording--it's almost impossible to understand. It is created by lawyers, but no accounting OF the lawyers and TORT reform is in the bill. Makes me wonder...hmmm, our President is a lawyer...hmmm...

kayleesgrandma
08-19-2009, 02:17 PM
Why couldn't they -instead of trying to overhaul the whole thing? Why a government takeover of the whole system? The Post Office, Social Security, Medicare, Amtrack, are all going bankrupt in the next few years--what should make us think that the govenment getting it's hands on something that comprises 1/7 of our economy will be a good thing?

Also the wording--it's almost impossible to understand. It is created by lawyers, but no accounting OF the lawyers and TORT reform is in the bill. Makes me wonder...hmmm, our President is a lawyer...hmmm...

kayleesgrandma
08-19-2009, 02:17 PM
Why couldn't they -instead of trying to overhaul the whole thing? Why a government takeover of the whole system? The Post Office, Social Security, Medicare, Amtrack, are all going bankrupt in the next few years--what should make us think that the govenment getting it's hands on something that comprises 1/7 of our economy will be a good thing?

Also the wording--it's almost impossible to understand. It is created by lawyers, but no accounting OF the lawyers and TORT reform is in the bill. Makes me wonder...hmmm, our President is a lawyer...hmmm...

kayleesgrandma
08-19-2009, 02:17 PM
Why couldn't they -instead of trying to overhaul the whole thing? Why a government takeover of the whole system? The Post Office, Social Security, Medicare, Amtrack, are all going bankrupt in the next few years--what should make us think that the govenment getting it's hands on something that comprises 1/7 of our economy will be a good thing?
<br />
<br />Also the wording--it's almost impossible to understand. It is created by lawyers, but no accounting OF the lawyers and TORT reform is in the bill. Makes me wonder...hmmm, our President is a lawyer...hmmm...

Landy
08-19-2009, 10:29 PM
Jackie,

I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.

As for illegals...here is what was quoted in the Newsweek article:

<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
ALIENS.</b>
Nothing in this subtitle shall allow Federal payments
for affordability credits on behalf of individuals who are
not lawfully present in the United States.</i>

Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?
As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol

I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol

Good discussion...

Landy
08-19-2009, 10:29 PM
Jackie,

I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.

As for illegals...here is what was quoted in the Newsweek article:

<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
ALIENS.</b>
Nothing in this subtitle shall allow Federal payments
for affordability credits on behalf of individuals who are
not lawfully present in the United States.</i>

Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?
As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol

I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol

Good discussion...

Landy
08-19-2009, 10:29 PM
Jackie,

I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.

As for illegals...here is what was quoted in the Newsweek article:

<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
ALIENS.</b>
Nothing in this subtitle shall allow Federal payments
for affordability credits on behalf of individuals who are
not lawfully present in the United States.</i>

Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?
As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol

I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol

Good discussion...

Landy
08-19-2009, 10:29 PM
Jackie,

I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.

As for illegals...here is what was quoted in the Newsweek article:

<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
ALIENS.</b>
Nothing in this subtitle shall allow Federal payments
for affordability credits on behalf of individuals who are
not lawfully present in the United States.</i>

Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?
As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol

I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol

Good discussion...

Landy
08-19-2009, 10:29 PM
Jackie,
<br />
<br />I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.
<br />
<br />As for illegals...here is what was quoted in the Newsweek article:
<br />
<br /><i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
<br /> ALIENS.</b>
<br />Nothing in this subtitle shall allow Federal payments
<br />for affordability credits on behalf of individuals who are
<br />not lawfully present in the United States.</i>
<br />
<br />Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?
<br />As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol
<br />
<br />I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol
<br />
<br />Good discussion...

jrotier
08-20-2009, 12:35 AM
Good call...so disappointing how we have to read between the lines like this...and Terri's right....since this isn't a thing the public will vote on, they can add / delete whatever they want.

I agree Terri, my biggest fear is rationing of care. I work in a nursing home and see it already with HMO's.

Any thoughts on how this might affect research for new drugs / treatments?

jrotier
08-20-2009, 12:35 AM
Good call...so disappointing how we have to read between the lines like this...and Terri's right....since this isn't a thing the public will vote on, they can add / delete whatever they want.

I agree Terri, my biggest fear is rationing of care. I work in a nursing home and see it already with HMO's.

Any thoughts on how this might affect research for new drugs / treatments?

jrotier
08-20-2009, 12:35 AM
Good call...so disappointing how we have to read between the lines like this...and Terri's right....since this isn't a thing the public will vote on, they can add / delete whatever they want.

I agree Terri, my biggest fear is rationing of care. I work in a nursing home and see it already with HMO's.

Any thoughts on how this might affect research for new drugs / treatments?

jrotier
08-20-2009, 12:35 AM
Good call...so disappointing how we have to read between the lines like this...and Terri's right....since this isn't a thing the public will vote on, they can add / delete whatever they want.

I agree Terri, my biggest fear is rationing of care. I work in a nursing home and see it already with HMO's.

Any thoughts on how this might affect research for new drugs / treatments?

jrotier
08-20-2009, 12:35 AM
Good call...so disappointing how we have to read between the lines like this...and Terri's right....since this isn't a thing the public will vote on, they can add / delete whatever they want.
<br />
<br />I agree Terri, my biggest fear is rationing of care. I work in a nursing home and see it already with HMO's.
<br />
<br />Any thoughts on how this might affect research for new drugs / treatments?

ladybug
08-20-2009, 01:18 AM
Rationing of care is terrifying to me.

Being military, we have a plan that is as close to Obama's plan to cover everyone under a government-run plan as I've seen. And guess what? I have kept my own private insurance plan with BCBS that I pay out of pocket for every month (hundreds out of pocket just for the premium btw). I choose this over having to go to who the military says I can go to and jump through all of the hurdles that come with managed (dare I say socialized) care.

I also notice there is very little incentive in the military for specialized care. I worry if Obama's plan passes, what is going to be the incentive for people to even WANT to get into dealing with CF (or other progressive diseases)? If I were a doc, I would prefer to be a peds doc or someone that doesn't deal with old people or serious disease so I wouldn't even have to deal with the re-admission issue or other rationing of care based on how sick my patients are. So, I worry there will be less specialists for our population in general. And, I think we can all agree the one or two docs that specialize in CF in random big cities across the U.S. isn't necessarily a huge abundance of docs to begin with. As we as CFers age, we're going to need more multi-disciplinary care in more cities, not less.

With regard to being re-admitted after a "stable" discharge, I have had several allergic reactions to medications or worsening symptoms, often after I was getting significantly better in the hospital. I think these little "issues" arise when we least expect them, and the LAST thing I want is for a doc to either keep me in for the entire 3 weeks cause they're afraid to let me go home on IVs or not treat me when I'm readmitted cause its a mark on their record.

Anyway, that's just my two cents, and I apologize I haven't read over all the ins and outs of this bill... it gives me a headache (and honestly a good chuckle) to even read what was posted on here. But, based on the media attention this thing is getting and what I've heard, I wanted to add my opinion. <img src="i/expressions/face-icon-small-wink.gif" border="0">

ladybug
08-20-2009, 01:18 AM
Rationing of care is terrifying to me.

Being military, we have a plan that is as close to Obama's plan to cover everyone under a government-run plan as I've seen. And guess what? I have kept my own private insurance plan with BCBS that I pay out of pocket for every month (hundreds out of pocket just for the premium btw). I choose this over having to go to who the military says I can go to and jump through all of the hurdles that come with managed (dare I say socialized) care.

I also notice there is very little incentive in the military for specialized care. I worry if Obama's plan passes, what is going to be the incentive for people to even WANT to get into dealing with CF (or other progressive diseases)? If I were a doc, I would prefer to be a peds doc or someone that doesn't deal with old people or serious disease so I wouldn't even have to deal with the re-admission issue or other rationing of care based on how sick my patients are. So, I worry there will be less specialists for our population in general. And, I think we can all agree the one or two docs that specialize in CF in random big cities across the U.S. isn't necessarily a huge abundance of docs to begin with. As we as CFers age, we're going to need more multi-disciplinary care in more cities, not less.

With regard to being re-admitted after a "stable" discharge, I have had several allergic reactions to medications or worsening symptoms, often after I was getting significantly better in the hospital. I think these little "issues" arise when we least expect them, and the LAST thing I want is for a doc to either keep me in for the entire 3 weeks cause they're afraid to let me go home on IVs or not treat me when I'm readmitted cause its a mark on their record.

Anyway, that's just my two cents, and I apologize I haven't read over all the ins and outs of this bill... it gives me a headache (and honestly a good chuckle) to even read what was posted on here. But, based on the media attention this thing is getting and what I've heard, I wanted to add my opinion. <img src="i/expressions/face-icon-small-wink.gif" border="0">

ladybug
08-20-2009, 01:18 AM
Rationing of care is terrifying to me.

Being military, we have a plan that is as close to Obama's plan to cover everyone under a government-run plan as I've seen. And guess what? I have kept my own private insurance plan with BCBS that I pay out of pocket for every month (hundreds out of pocket just for the premium btw). I choose this over having to go to who the military says I can go to and jump through all of the hurdles that come with managed (dare I say socialized) care.

I also notice there is very little incentive in the military for specialized care. I worry if Obama's plan passes, what is going to be the incentive for people to even WANT to get into dealing with CF (or other progressive diseases)? If I were a doc, I would prefer to be a peds doc or someone that doesn't deal with old people or serious disease so I wouldn't even have to deal with the re-admission issue or other rationing of care based on how sick my patients are. So, I worry there will be less specialists for our population in general. And, I think we can all agree the one or two docs that specialize in CF in random big cities across the U.S. isn't necessarily a huge abundance of docs to begin with. As we as CFers age, we're going to need more multi-disciplinary care in more cities, not less.

With regard to being re-admitted after a "stable" discharge, I have had several allergic reactions to medications or worsening symptoms, often after I was getting significantly better in the hospital. I think these little "issues" arise when we least expect them, and the LAST thing I want is for a doc to either keep me in for the entire 3 weeks cause they're afraid to let me go home on IVs or not treat me when I'm readmitted cause its a mark on their record.

Anyway, that's just my two cents, and I apologize I haven't read over all the ins and outs of this bill... it gives me a headache (and honestly a good chuckle) to even read what was posted on here. But, based on the media attention this thing is getting and what I've heard, I wanted to add my opinion. <img src="i/expressions/face-icon-small-wink.gif" border="0">

ladybug
08-20-2009, 01:18 AM
Rationing of care is terrifying to me.

Being military, we have a plan that is as close to Obama's plan to cover everyone under a government-run plan as I've seen. And guess what? I have kept my own private insurance plan with BCBS that I pay out of pocket for every month (hundreds out of pocket just for the premium btw). I choose this over having to go to who the military says I can go to and jump through all of the hurdles that come with managed (dare I say socialized) care.

I also notice there is very little incentive in the military for specialized care. I worry if Obama's plan passes, what is going to be the incentive for people to even WANT to get into dealing with CF (or other progressive diseases)? If I were a doc, I would prefer to be a peds doc or someone that doesn't deal with old people or serious disease so I wouldn't even have to deal with the re-admission issue or other rationing of care based on how sick my patients are. So, I worry there will be less specialists for our population in general. And, I think we can all agree the one or two docs that specialize in CF in random big cities across the U.S. isn't necessarily a huge abundance of docs to begin with. As we as CFers age, we're going to need more multi-disciplinary care in more cities, not less.

With regard to being re-admitted after a "stable" discharge, I have had several allergic reactions to medications or worsening symptoms, often after I was getting significantly better in the hospital. I think these little "issues" arise when we least expect them, and the LAST thing I want is for a doc to either keep me in for the entire 3 weeks cause they're afraid to let me go home on IVs or not treat me when I'm readmitted cause its a mark on their record.

Anyway, that's just my two cents, and I apologize I haven't read over all the ins and outs of this bill... it gives me a headache (and honestly a good chuckle) to even read what was posted on here. But, based on the media attention this thing is getting and what I've heard, I wanted to add my opinion. <img src="i/expressions/face-icon-small-wink.gif" border="0">

ladybug
08-20-2009, 01:18 AM
Rationing of care is terrifying to me.
<br />
<br />Being military, we have a plan that is as close to Obama's plan to cover everyone under a government-run plan as I've seen. And guess what? I have kept my own private insurance plan with BCBS that I pay out of pocket for every month (hundreds out of pocket just for the premium btw). I choose this over having to go to who the military says I can go to and jump through all of the hurdles that come with managed (dare I say socialized) care.
<br />
<br />I also notice there is very little incentive in the military for specialized care. I worry if Obama's plan passes, what is going to be the incentive for people to even WANT to get into dealing with CF (or other progressive diseases)? If I were a doc, I would prefer to be a peds doc or someone that doesn't deal with old people or serious disease so I wouldn't even have to deal with the re-admission issue or other rationing of care based on how sick my patients are. So, I worry there will be less specialists for our population in general. And, I think we can all agree the one or two docs that specialize in CF in random big cities across the U.S. isn't necessarily a huge abundance of docs to begin with. As we as CFers age, we're going to need more multi-disciplinary care in more cities, not less.
<br />
<br />With regard to being re-admitted after a "stable" discharge, I have had several allergic reactions to medications or worsening symptoms, often after I was getting significantly better in the hospital. I think these little "issues" arise when we least expect them, and the LAST thing I want is for a doc to either keep me in for the entire 3 weeks cause they're afraid to let me go home on IVs or not treat me when I'm readmitted cause its a mark on their record.
<br />
<br />Anyway, that's just my two cents, and I apologize I haven't read over all the ins and outs of this bill... it gives me a headache (and honestly a good chuckle) to even read what was posted on here. But, based on the media attention this thing is getting and what I've heard, I wanted to add my opinion. <img src="i/expressions/face-icon-small-wink.gif" border="0">

HollyCatheryn
08-29-2009, 04:01 PM
A couple of things that concern me - mind you I haven't finished reading the bill yet - are these:
1 - if the govt plan is cheaper, what employer will choose to keep buying a more expensive group plan? Where does that leave their employees, but dumped into a govt plan or buying their own more expensive personal coverage.
2 - currently, many doctors and clinics do not accept people on Medicare or Medicaid because reimbursement for services to these people is so far below reimbursement from group or private plans like BCBS. At the same time that they pay less, they require more from doctors in the way of testing. As an example, my father-in-law who is post heart-transplant 8 1/2 years needed a test, an expensive one. Instead of getting the dr's verification that it was indeed necessary before Medicare payed for it, Medicare required 7, count them up folks, 7 other tests before they would pay for the one he needed. The dr tried to argue that these tests were irrelevent and wouldn't give them any useful information, but Medicare demanded them anyway. This sort of procedure does NOT save money. It costs money to the care providers and the insurance, but a govt program doesn't pay comparably.
3 - I have had both BCBS and Medicare/Medicaid. With BCBS, I never had to worry if something was covered - everything was 80/20. I always knew exactly what the copay was going to be. I always knew that I could get any medication I needed and what it would cost me. Now, since the loss of my husband's university teaching position, I am on Medicare and Medicaid and I literally spend time on the phone every other day trying to get things covered, trying to get medications paid for, get the right equipment. They always want to substitute everything and make it a real hassle by dictating which pharmacies and providers can me used for what. It spreads out my care and means that I get poorer quality than I need sometimes. I would rather pay the copays with BCBS anyday! I have had to have knock-down drag-outs over the phone with pharmacies trying to get them to refrigerate my pulmozyme!

I'm all for insurance coverage for everyone, my husband is currently one of the uninsured and it's difficult and scary. I would love for him to be able to get coverage, but I'm just not sure that this is the way.

HollyCatheryn
08-29-2009, 04:01 PM
A couple of things that concern me - mind you I haven't finished reading the bill yet - are these:
1 - if the govt plan is cheaper, what employer will choose to keep buying a more expensive group plan? Where does that leave their employees, but dumped into a govt plan or buying their own more expensive personal coverage.
2 - currently, many doctors and clinics do not accept people on Medicare or Medicaid because reimbursement for services to these people is so far below reimbursement from group or private plans like BCBS. At the same time that they pay less, they require more from doctors in the way of testing. As an example, my father-in-law who is post heart-transplant 8 1/2 years needed a test, an expensive one. Instead of getting the dr's verification that it was indeed necessary before Medicare payed for it, Medicare required 7, count them up folks, 7 other tests before they would pay for the one he needed. The dr tried to argue that these tests were irrelevent and wouldn't give them any useful information, but Medicare demanded them anyway. This sort of procedure does NOT save money. It costs money to the care providers and the insurance, but a govt program doesn't pay comparably.
3 - I have had both BCBS and Medicare/Medicaid. With BCBS, I never had to worry if something was covered - everything was 80/20. I always knew exactly what the copay was going to be. I always knew that I could get any medication I needed and what it would cost me. Now, since the loss of my husband's university teaching position, I am on Medicare and Medicaid and I literally spend time on the phone every other day trying to get things covered, trying to get medications paid for, get the right equipment. They always want to substitute everything and make it a real hassle by dictating which pharmacies and providers can me used for what. It spreads out my care and means that I get poorer quality than I need sometimes. I would rather pay the copays with BCBS anyday! I have had to have knock-down drag-outs over the phone with pharmacies trying to get them to refrigerate my pulmozyme!

I'm all for insurance coverage for everyone, my husband is currently one of the uninsured and it's difficult and scary. I would love for him to be able to get coverage, but I'm just not sure that this is the way.

HollyCatheryn
08-29-2009, 04:01 PM
A couple of things that concern me - mind you I haven't finished reading the bill yet - are these:
1 - if the govt plan is cheaper, what employer will choose to keep buying a more expensive group plan? Where does that leave their employees, but dumped into a govt plan or buying their own more expensive personal coverage.
2 - currently, many doctors and clinics do not accept people on Medicare or Medicaid because reimbursement for services to these people is so far below reimbursement from group or private plans like BCBS. At the same time that they pay less, they require more from doctors in the way of testing. As an example, my father-in-law who is post heart-transplant 8 1/2 years needed a test, an expensive one. Instead of getting the dr's verification that it was indeed necessary before Medicare payed for it, Medicare required 7, count them up folks, 7 other tests before they would pay for the one he needed. The dr tried to argue that these tests were irrelevent and wouldn't give them any useful information, but Medicare demanded them anyway. This sort of procedure does NOT save money. It costs money to the care providers and the insurance, but a govt program doesn't pay comparably.
3 - I have had both BCBS and Medicare/Medicaid. With BCBS, I never had to worry if something was covered - everything was 80/20. I always knew exactly what the copay was going to be. I always knew that I could get any medication I needed and what it would cost me. Now, since the loss of my husband's university teaching position, I am on Medicare and Medicaid and I literally spend time on the phone every other day trying to get things covered, trying to get medications paid for, get the right equipment. They always want to substitute everything and make it a real hassle by dictating which pharmacies and providers can me used for what. It spreads out my care and means that I get poorer quality than I need sometimes. I would rather pay the copays with BCBS anyday! I have had to have knock-down drag-outs over the phone with pharmacies trying to get them to refrigerate my pulmozyme!

I'm all for insurance coverage for everyone, my husband is currently one of the uninsured and it's difficult and scary. I would love for him to be able to get coverage, but I'm just not sure that this is the way.

HollyCatheryn
08-29-2009, 04:01 PM
A couple of things that concern me - mind you I haven't finished reading the bill yet - are these:
1 - if the govt plan is cheaper, what employer will choose to keep buying a more expensive group plan? Where does that leave their employees, but dumped into a govt plan or buying their own more expensive personal coverage.
2 - currently, many doctors and clinics do not accept people on Medicare or Medicaid because reimbursement for services to these people is so far below reimbursement from group or private plans like BCBS. At the same time that they pay less, they require more from doctors in the way of testing. As an example, my father-in-law who is post heart-transplant 8 1/2 years needed a test, an expensive one. Instead of getting the dr's verification that it was indeed necessary before Medicare payed for it, Medicare required 7, count them up folks, 7 other tests before they would pay for the one he needed. The dr tried to argue that these tests were irrelevent and wouldn't give them any useful information, but Medicare demanded them anyway. This sort of procedure does NOT save money. It costs money to the care providers and the insurance, but a govt program doesn't pay comparably.
3 - I have had both BCBS and Medicare/Medicaid. With BCBS, I never had to worry if something was covered - everything was 80/20. I always knew exactly what the copay was going to be. I always knew that I could get any medication I needed and what it would cost me. Now, since the loss of my husband's university teaching position, I am on Medicare and Medicaid and I literally spend time on the phone every other day trying to get things covered, trying to get medications paid for, get the right equipment. They always want to substitute everything and make it a real hassle by dictating which pharmacies and providers can me used for what. It spreads out my care and means that I get poorer quality than I need sometimes. I would rather pay the copays with BCBS anyday! I have had to have knock-down drag-outs over the phone with pharmacies trying to get them to refrigerate my pulmozyme!

I'm all for insurance coverage for everyone, my husband is currently one of the uninsured and it's difficult and scary. I would love for him to be able to get coverage, but I'm just not sure that this is the way.

HollyCatheryn
08-29-2009, 04:01 PM
A couple of things that concern me - mind you I haven't finished reading the bill yet - are these:
<br />1 - if the govt plan is cheaper, what employer will choose to keep buying a more expensive group plan? Where does that leave their employees, but dumped into a govt plan or buying their own more expensive personal coverage.
<br />2 - currently, many doctors and clinics do not accept people on Medicare or Medicaid because reimbursement for services to these people is so far below reimbursement from group or private plans like BCBS. At the same time that they pay less, they require more from doctors in the way of testing. As an example, my father-in-law who is post heart-transplant 8 1/2 years needed a test, an expensive one. Instead of getting the dr's verification that it was indeed necessary before Medicare payed for it, Medicare required 7, count them up folks, 7 other tests before they would pay for the one he needed. The dr tried to argue that these tests were irrelevent and wouldn't give them any useful information, but Medicare demanded them anyway. This sort of procedure does NOT save money. It costs money to the care providers and the insurance, but a govt program doesn't pay comparably.
<br />3 - I have had both BCBS and Medicare/Medicaid. With BCBS, I never had to worry if something was covered - everything was 80/20. I always knew exactly what the copay was going to be. I always knew that I could get any medication I needed and what it would cost me. Now, since the loss of my husband's university teaching position, I am on Medicare and Medicaid and I literally spend time on the phone every other day trying to get things covered, trying to get medications paid for, get the right equipment. They always want to substitute everything and make it a real hassle by dictating which pharmacies and providers can me used for what. It spreads out my care and means that I get poorer quality than I need sometimes. I would rather pay the copays with BCBS anyday! I have had to have knock-down drag-outs over the phone with pharmacies trying to get them to refrigerate my pulmozyme!
<br />
<br />I'm all for insurance coverage for everyone, my husband is currently one of the uninsured and it's difficult and scary. I would love for him to be able to get coverage, but I'm just not sure that this is the way.

Landy
09-02-2009, 10:10 PM
Good points, HollyCatheryn. Those are valid concerns, IMO.

Landy
09-02-2009, 10:10 PM
Good points, HollyCatheryn. Those are valid concerns, IMO.

Landy
09-02-2009, 10:10 PM
Good points, HollyCatheryn. Those are valid concerns, IMO.

Landy
09-02-2009, 10:10 PM
Good points, HollyCatheryn. Those are valid concerns, IMO.

Landy
09-02-2009, 10:10 PM
Good points, HollyCatheryn. Those are valid concerns, IMO.

MiddleAgedLady
09-04-2009, 12:03 AM
Fascinating discussion! I have an electronic copy of the bill; trying to wade through it too. There have been a couple of helpful (to me) articles on this topic on the Wall St. Journal's site. Here are the links: <a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574378542143891778.html">http://online.wsj.com/article/...74378542143891778.html</a> "Sorting Fact from Fiction" about Obamacare, and
<a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html.">http://online.wsj.com/article/...4374463280098676.html.</a> This 2nd one is about Dr. Ezekiel Emanuel's view of rationing care and scares the SOCKS off of me...

Joan: 55w/cf, cf arthralgia, PA, MRSA, bronchiectasis, asthma, 4 sinus surgeries, GERD, osteoarthritis, fibromyalgia

MiddleAgedLady
09-04-2009, 12:03 AM
Fascinating discussion! I have an electronic copy of the bill; trying to wade through it too. There have been a couple of helpful (to me) articles on this topic on the Wall St. Journal's site. Here are the links: <a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574378542143891778.html">http://online.wsj.com/article/...74378542143891778.html</a> "Sorting Fact from Fiction" about Obamacare, and
<a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html.">http://online.wsj.com/article/...4374463280098676.html.</a> This 2nd one is about Dr. Ezekiel Emanuel's view of rationing care and scares the SOCKS off of me...

Joan: 55w/cf, cf arthralgia, PA, MRSA, bronchiectasis, asthma, 4 sinus surgeries, GERD, osteoarthritis, fibromyalgia

MiddleAgedLady
09-04-2009, 12:03 AM
Fascinating discussion! I have an electronic copy of the bill; trying to wade through it too. There have been a couple of helpful (to me) articles on this topic on the Wall St. Journal's site. Here are the links: <a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574378542143891778.html">http://online.wsj.com/article/...74378542143891778.html</a> "Sorting Fact from Fiction" about Obamacare, and
<a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html.">http://online.wsj.com/article/...4374463280098676.html.</a> This 2nd one is about Dr. Ezekiel Emanuel's view of rationing care and scares the SOCKS off of me...

Joan: 55w/cf, cf arthralgia, PA, MRSA, bronchiectasis, asthma, 4 sinus surgeries, GERD, osteoarthritis, fibromyalgia

MiddleAgedLady
09-04-2009, 12:03 AM
Fascinating discussion! I have an electronic copy of the bill; trying to wade through it too. There have been a couple of helpful (to me) articles on this topic on the Wall St. Journal's site. Here are the links: <a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574378542143891778.html">http://online.wsj.com/article/...74378542143891778.html</a> "Sorting Fact from Fiction" about Obamacare, and
<a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html.">http://online.wsj.com/article/...4374463280098676.html.</a> This 2nd one is about Dr. Ezekiel Emanuel's view of rationing care and scares the SOCKS off of me...

Joan: 55w/cf, cf arthralgia, PA, MRSA, bronchiectasis, asthma, 4 sinus surgeries, GERD, osteoarthritis, fibromyalgia

MiddleAgedLady
09-04-2009, 12:03 AM
Fascinating discussion! I have an electronic copy of the bill; trying to wade through it too. There have been a couple of helpful (to me) articles on this topic on the Wall St. Journal's site. Here are the links: <a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574378542143891778.html">http://online.wsj.com/article/...74378542143891778.html</a> "Sorting Fact from Fiction" about Obamacare, and
<br /><a target=_blank class=ftalternatingbarlinklarge href="http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html.">http://online.wsj.com/article/...4374463280098676.html.</a> This 2nd one is about Dr. Ezekiel Emanuel's view of rationing care and scares the SOCKS off of me...
<br />
<br />Joan: 55w/cf, cf arthralgia, PA, MRSA, bronchiectasis, asthma, 4 sinus surgeries, GERD, osteoarthritis, fibromyalgia

bkc3
09-27-2009, 03:00 AM
I'm not sure why the plan has to be so complicated...
I have never seen so many pages of regulation that doesn't address a lions share of the issues....well since the stimulus...or cash for clunkers...well maybe I have <img src="i/expressions/face-icon-small-wink.gif" border="0">.
it is significantly cheaper for companies to pay a percentage of their payroll than to provide medical coverage. Especially smaller businesses.

It would be nice to see some help for catastrophic or chronic conditions. outside of that, I think the scope is too broad.
Even with "good" insurance, say you have an 80/20 plan, you could still face 15k per day for hospitalization and 8-12k per month in prescriptions...take 20% of that and this would bankrupt anyone that made median salary or less.

What would I do if I lost my job? since my sons and my condition is now "pre-existing"...

bkc3
09-27-2009, 03:00 AM
I'm not sure why the plan has to be so complicated...
I have never seen so many pages of regulation that doesn't address a lions share of the issues....well since the stimulus...or cash for clunkers...well maybe I have <img src="i/expressions/face-icon-small-wink.gif" border="0">.
it is significantly cheaper for companies to pay a percentage of their payroll than to provide medical coverage. Especially smaller businesses.

It would be nice to see some help for catastrophic or chronic conditions. outside of that, I think the scope is too broad.
Even with "good" insurance, say you have an 80/20 plan, you could still face 15k per day for hospitalization and 8-12k per month in prescriptions...take 20% of that and this would bankrupt anyone that made median salary or less.

What would I do if I lost my job? since my sons and my condition is now "pre-existing"...

bkc3
09-27-2009, 03:00 AM
I'm not sure why the plan has to be so complicated...
I have never seen so many pages of regulation that doesn't address a lions share of the issues....well since the stimulus...or cash for clunkers...well maybe I have <img src="i/expressions/face-icon-small-wink.gif" border="0">.
it is significantly cheaper for companies to pay a percentage of their payroll than to provide medical coverage. Especially smaller businesses.

It would be nice to see some help for catastrophic or chronic conditions. outside of that, I think the scope is too broad.
Even with "good" insurance, say you have an 80/20 plan, you could still face 15k per day for hospitalization and 8-12k per month in prescriptions...take 20% of that and this would bankrupt anyone that made median salary or less.

What would I do if I lost my job? since my sons and my condition is now "pre-existing"...

bkc3
09-27-2009, 03:00 AM
I'm not sure why the plan has to be so complicated...
I have never seen so many pages of regulation that doesn't address a lions share of the issues....well since the stimulus...or cash for clunkers...well maybe I have <img src="i/expressions/face-icon-small-wink.gif" border="0">.
it is significantly cheaper for companies to pay a percentage of their payroll than to provide medical coverage. Especially smaller businesses.

It would be nice to see some help for catastrophic or chronic conditions. outside of that, I think the scope is too broad.
Even with "good" insurance, say you have an 80/20 plan, you could still face 15k per day for hospitalization and 8-12k per month in prescriptions...take 20% of that and this would bankrupt anyone that made median salary or less.

What would I do if I lost my job? since my sons and my condition is now "pre-existing"...

bkc3
09-27-2009, 03:00 AM
I'm not sure why the plan has to be so complicated...
<br />I have never seen so many pages of regulation that doesn't address a lions share of the issues....well since the stimulus...or cash for clunkers...well maybe I have <img src="i/expressions/face-icon-small-wink.gif" border="0">.
<br />it is significantly cheaper for companies to pay a percentage of their payroll than to provide medical coverage. Especially smaller businesses.
<br />
<br />It would be nice to see some help for catastrophic or chronic conditions. outside of that, I think the scope is too broad.
<br />Even with "good" insurance, say you have an 80/20 plan, you could still face 15k per day for hospitalization and 8-12k per month in prescriptions...take 20% of that and this would bankrupt anyone that made median salary or less.
<br />
<br />What would I do if I lost my job? since my sons and my condition is now "pre-existing"...

65rosessamurai
09-28-2009, 10:50 PM
I saw that I would fall under the "tax exempt" since I live outside the US, however I question whether they'd allow me carry the insurance while I reside outside the US, especially when the country I'm in has a social insurance program of its own.

I wonder how well Julie would be able to interpret this insurance stuff? I'd imagine she'd have to be able to in order to keep up with her advocate service.

65rosessamurai
09-28-2009, 10:50 PM
I saw that I would fall under the "tax exempt" since I live outside the US, however I question whether they'd allow me carry the insurance while I reside outside the US, especially when the country I'm in has a social insurance program of its own.

I wonder how well Julie would be able to interpret this insurance stuff? I'd imagine she'd have to be able to in order to keep up with her advocate service.

65rosessamurai
09-28-2009, 10:50 PM
I saw that I would fall under the "tax exempt" since I live outside the US, however I question whether they'd allow me carry the insurance while I reside outside the US, especially when the country I'm in has a social insurance program of its own.

I wonder how well Julie would be able to interpret this insurance stuff? I'd imagine she'd have to be able to in order to keep up with her advocate service.

65rosessamurai
09-28-2009, 10:50 PM
I saw that I would fall under the "tax exempt" since I live outside the US, however I question whether they'd allow me carry the insurance while I reside outside the US, especially when the country I'm in has a social insurance program of its own.

I wonder how well Julie would be able to interpret this insurance stuff? I'd imagine she'd have to be able to in order to keep up with her advocate service.

65rosessamurai
09-28-2009, 10:50 PM
I saw that I would fall under the "tax exempt" since I live outside the US, however I question whether they'd allow me carry the insurance while I reside outside the US, especially when the country I'm in has a social insurance program of its own.
<br />
<br />I wonder how well Julie would be able to interpret this insurance stuff? I'd imagine she'd have to be able to in order to keep up with her advocate service.

65rosessamurai
09-28-2009, 11:00 PM
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Landy</b></i>

Jackie,



I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.



As for illegals...here is what was quoted in the Newsweek article:



<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED

ALIENS.</b>

Nothing in this subtitle shall allow Federal payments

for affordability credits on behalf of individuals who are

not lawfully present in the United States.</i>



Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?

As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol



I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol



Good discussion...</end quote></div>

This is a good question..I'm a U.S. Citizen not an Alien, yet I'm not a bonefide resident of the U.S., so it would have me asking myself if I'm not eligible for such insurance despite being a U.S. Citizen, but not a "legal resident".

I guess I could be relieved that if I'm bleeding profusely and my life is on the line, they'll let me into the hospital til I was stablized...(then what?)

65rosessamurai
09-28-2009, 11:00 PM
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Landy</b></i>

Jackie,



I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.



As for illegals...here is what was quoted in the Newsweek article:



<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED

ALIENS.</b>

Nothing in this subtitle shall allow Federal payments

for affordability credits on behalf of individuals who are

not lawfully present in the United States.</i>



Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?

As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol



I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol



Good discussion...</end quote></div>

This is a good question..I'm a U.S. Citizen not an Alien, yet I'm not a bonefide resident of the U.S., so it would have me asking myself if I'm not eligible for such insurance despite being a U.S. Citizen, but not a "legal resident".

I guess I could be relieved that if I'm bleeding profusely and my life is on the line, they'll let me into the hospital til I was stablized...(then what?)

65rosessamurai
09-28-2009, 11:00 PM
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Landy</b></i>

Jackie,



I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.



As for illegals...here is what was quoted in the Newsweek article:



<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED

ALIENS.</b>

Nothing in this subtitle shall allow Federal payments

for affordability credits on behalf of individuals who are

not lawfully present in the United States.</i>



Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?

As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol



I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol



Good discussion...</end quote></div>

This is a good question..I'm a U.S. Citizen not an Alien, yet I'm not a bonefide resident of the U.S., so it would have me asking myself if I'm not eligible for such insurance despite being a U.S. Citizen, but not a "legal resident".

I guess I could be relieved that if I'm bleeding profusely and my life is on the line, they'll let me into the hospital til I was stablized...(then what?)

65rosessamurai
09-28-2009, 11:00 PM
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Landy</b></i>

Jackie,



I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.



As for illegals...here is what was quoted in the Newsweek article:



<i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED

ALIENS.</b>

Nothing in this subtitle shall allow Federal payments

for affordability credits on behalf of individuals who are

not lawfully present in the United States.</i>



Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?

As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol



I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol



Good discussion...</end quote>

This is a good question..I'm a U.S. Citizen not an Alien, yet I'm not a bonefide resident of the U.S., so it would have me asking myself if I'm not eligible for such insurance despite being a U.S. Citizen, but not a "legal resident".

I guess I could be relieved that if I'm bleeding profusely and my life is on the line, they'll let me into the hospital til I was stablized...(then what?)

65rosessamurai
09-28-2009, 11:00 PM
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Landy</b></i>
<br />
<br />Jackie,
<br />
<br />
<br />
<br />I appreciate your views on points mentioned. Now, I do see where they most likely are concerned about real-time insurance information (i.e. co-pays, deduct, etc) on page 58. I wish another word other than "financial" could have been used. I guess anytime I see the word financial, I'm thinking money, bank accts, etc.
<br />
<br />
<br />
<br />As for illegals...here is what was quoted in the Newsweek article:
<br />
<br />
<br />
<br /><i><b>SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
<br />
<br /> ALIENS.</b>
<br />
<br />Nothing in this subtitle shall allow Federal payments
<br />
<br />for affordability credits on behalf of individuals who are
<br />
<br />not lawfully present in the United States.</i>
<br />
<br />
<br />
<br />Notice that it says "Nothing...shall allow Federal payments for affordability credits..." this does not say "shall not provide coverage" it just says that they won't get affordability credits, maybe we are to read between the lines that this means coverage as well?
<br />
<br />As I was quickly skimming thru the bill, I wondered about the "lawfully present" term too. What exactly does this term mean?? If you are studying abroad, are you lawfully present in the US? Maybe I'm reading too much into this! lol
<br />
<br />
<br />
<br />I think we can all agree that the wording in the bill could be more in layman terms. No wonder the members of Congress don't read this stuff! lol
<br />
<br />
<br />
<br />Good discussion...</end quote>
<br />
<br />This is a good question..I'm a U.S. Citizen not an Alien, yet I'm not a bonefide resident of the U.S., so it would have me asking myself if I'm not eligible for such insurance despite being a U.S. Citizen, but not a "legal resident".
<br />
<br />I guess I could be relieved that if I'm bleeding profusely and my life is on the line, they'll let me into the hospital til I was stablized...(then what?)