Reading The Healthcare Bill Part 2




I figured I'd pick up where I left off reading "America's Affordable Health Choices Act of 2009", better known to the rest of us as "the healthcare bill".

The style in which the document was put together is starting to make some sense now - it almost seems like there is an adjunct "how we are going to do this" section for every "this is what we're going to do" section - a pretty standard format that echoes the manner in which contracts flow.

The section on transparency:

SEC. 133. REQUIRING INFORMATION TRANSPARENCY AND PLAN DISCLOSURE.

(a) ACCURATE AND TIMELY DISCLOSURE.—
(1) IN GENERAL.—

A qualified health benefits plan shall comply with standards established by the Commissioner for the accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information as determined appropriate by the Commissioner. The Commissioner shall require that such disclosure be provided in plain language.



while it seems pretty innocuous, reads a lot like the HMDA (Home Mortgage Disclosure Act) directives I used to deal with in the mortgage business that kept a close eye on who was making loan applications and who was being denied. The reason why people rail so much on talk radio about the evils of the Fair Lending Act is because it works, and it keeps mortgage companies from screwing their customers so badly and lying to the public about it claiming how their entire business loses money every time they make a Community Reinvestment Act loan.


SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.

(a) IN GENERAL.—Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.


One of the things about the health insurance industry that has always nagged at me is their methodology on setting rates for health insurance coverage. The life insurance loss ratios seem to be calculated against the characteristics of the entire class of insureds for whom the company has policies in force, while health insurance rates appear inexplicably to be calculated against the characteristics of each individual group of insureds for whom the company has policies in force.

My own theory is that the process of negotiation that health insurance companies go through in order to win the right to enroll large groups of people has transformed what is essentially an actuarial model of the probability loss into a situation where a health insurance company often takes on groups who are likely to be losing propositions without very aggressive procedure denial cost containment efforts.

I haven't heard a lot about this section, but this concept, along with the section on transparency, seems to be leading towards the same public utility model I've talked about before. It's the same as when you get rebates back from your utility companies now if their profitability exceeds a certain predetermined ratio.

As I've said here before, explaining where we are headed with this is an area where President Obama and his troops have definitely fallen down on the job. There is really no way around the fact that this entire process is designed to limit profits per enrollee for health insurers. The irony is, even though that profit may be limited, the number of enrollees is likely to increase. Newsvine Digg It! Stumble Delicious Technorati Tweet It! Facebook

1 comments:

almostakbl company said...

خدمات مكافحة الحشرات من شركة المستقبل
شركة مكافحة حشرات ببريدة
شركة رش مبيدات بالقصيم
تقدم شركة المستقبل خدماتها لمكافحة الحشرات الطائرة من ناموس وغيرها ومكافحة الحشرات الزاحفة كالصراصير والنمل بأنواعه وغيرها من الحشرات المؤذية ومكافحة أيضا الفئران والزواحف الضارة، فالشركة تهتم بصحة عملائها الذين تتعامل معهم، ويجب أن يكون العميل على معرفة بأضرار تواجد هذه الحشرات على صحة الأسرة، فوجود الفئران في المنزل يهدد الجميع في المنزل ويؤرق راحتهم، أما عن تواجد الحشرات فهي خطر على صحة الأطفال وتؤثر عليهم فالأطفال ليس لديهم وعي بخطورة هذه الحشرات التي تسبب الأمراض.
شركة مكافحة النمل الابيض بالرياض
مكافحة النمل الابيض
شركة المستقبل هي شركة متخصصة في مجال مكافحة جميع أنواع الحشرات، الشركة لديها الخبرة الطويلة في التعامل والقضاء على جميع أنواع الحشرات، وأيضا الشركة لديها الخبرة الطويلة في التعامل مع المبيدات المختلفة والتي تستخدم في القضاء على الحشرات، فيتم بعد معرفة نوع الحشرة المتواجدة في المنزل تركيب المبيد ومعرفة الطرق والأساليب المختلفة والتي تستخدم في شركة المستقبل للقضاء على الحشرات بأنواعها.
شركة مكافحة حشرات بجدة
شركة رش مبيدات بجدة
يتم استخدام مبيدات لا تؤثر على صحة الأفراد وآمنة ولكن في نفس الوقت فعالة ولها القدرة على القضاء على الحشرات بسهولة وبسرعة، يتم أيضا استخدام الأساليب والتقنيات والأدوات الحديثة والمتطورة للقضاء على أنواع الحشرات المختلفة، ويتم تدريب العاملين في شركة المستقبل على استخدام هذه الأدوات والمبيدات حتى يكون لديهم الخبرة الكافية للتعامل مع أنواع الحشرات المختلفة وذلك بالتعاون مع الخبراء والباحثين الذين لديهم خبرة ودراية كاملة في مجال مكافحة الحشرات.
شركة مكافحة حشرات بالدمام
شركة رش مبيدات بالدمام
شركة المستقبل هي الشركة الأولى في مجال القضاء على الحشرات، اتصل بالشركة وسوف تجد الاهتمام البالغ في التعامل والمساعدة الكاملة وتنفيذ جميع مطالبك، تعامل مع شركة المستقبل وسيختفي جميع أنواع الحشرات لديك في المنزل نهائيا وبدون عودة للمنزل لتستمتع بحياة بدون حشرات.

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