Mike Kueber's Blog

November 23, 2012

ObamaCare takes shape

Filed under: Issues,Medical,Politics — Mike Kueber @ 12:31 am
Tags: ,

On November 20th, the Department of Health and Human Services published three proposed regulations that are designed to implement important features of the ObamaCare.  Because the regulations are based on the law, there are no significant surprises.  Although federal agencies sometimes push into areas not authorized by law, the Obama administration and Secretary Kathleen Sebelius have apparently decided that the law is already pushing America strongly to the left and pushing even more through the regulations would risk a backlash.

Essentially, the proposed rules prohibit denial of coverage based on pre-existing conditions, severely limit any underwriting by insurance companies, and standardize the coverage in policies.  That doesn’t sound like the insurance business that I grew old in, and it doesn’t sound very much like free-market competition.  Rather, it sounds like something that will inevitably become a sclerotic, paper-pushing bureaucracy. 

My major objection to ObamaCare, other than my judgment that universal coverage should have been deferred until our nation’s economy was righted, is that the federal government is not the best place (or the constitutional place) to develop progressive, innovative ways to deal with problems.  But the free market and the state governments brought this impending disaster on themselves by failing to provide Americans available and affordable health insurance. 

Maybe if we had more RomneyCares, we wouldn’t have needed an ObamaCare. 

The three rules proposed by HHS are as follows:

Proposed Rule #1:  .

  1. No denial of coverage because of pre-existing condition.
  2. Premium can vary based on age (3:1), tobacco use (1.5 to 1), family size, and geography.  All other factors – such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry – are prohibited.
  3. Insurers are prohibited from having more than two pools of insureds in a state.  They can have one pool for individuals and one pool for businesses.
  4. Nonrenewal is prohibited.
  5. Catastrophic plans are authorized, but they must cover preventive serves without cost sharing.

The actual rule is 132 pages.  

Proposed Rule #2:  

  1. Essential health benefits that must be included in all policies, with each state having some control over the specifics –
    1. Ambulatory patient services
    2. Emergency services
    3. Hospitalization
    4. Maternity and newborn care
    5. Mental health and substance use disorder services, including behavioral health treatment
    6. Prescription drugs
    7. Rehabilitative and habilitative services and devices
    8. Laboratory services
    9. Preventive and wellness services and chronic disease management
    10. Pediatric services, including oral and vision care

    The Actuarial Value, or AV, of each policy will be calculated as the percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an AV of 70 percent, on average, a consumer would be responsible for 30 percent of the costs of all covered benefits – 60% for a bronze plan, 70% for a silver plan, 80% for a gold plan, and 90% for a platinum plan.

The actual rule has 120 pages.  .

Proposed Rule #3:   

Wellness programs.  These include, for example, programs that reimburse for the cost of membership in a fitness center; that provide a reward to employees for attending a monthly, no-cost health education seminar; or that provides a reward to employees who complete a health risk assessment without requiring them to take further action. 

The actual rule is 81 pages.

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5 Comments »

  1. But keeb, obama care is going to cut our government costs! don’t you listen?

    q

    Comment by Q — November 23, 2012 @ 9:30 pm | Reply

    • Providing free coverage to 16 million Americans, and subsidized coverage to another 14 millions, will inevitably cost something. To say otherwise, it patent nonsense.

      Comment by Mike Kueber — November 24, 2012 @ 12:50 am | Reply

  2. come on now, i didn’t think you were an IP lawyer…

    q

    Comment by Q — November 24, 2012 @ 4:17 am | Reply

    • Q, if IP means intellectual property, I’m not sure what that has to do with ObamaCare.

      Comment by Mike Kueber — November 24, 2012 @ 6:40 pm | Reply

  3. […] in November, I blogged about some growing pains as ObamaCare took shape.  The post was prompted by HHS publishing […]

    Pingback by More problems with ObamaCare « Mike Kueber's Blog — January 25, 2013 @ 9:20 pm | Reply


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