119. House Bill 3962 – Part 2

This is a review of pages 1-26.

First Division A, Title I. IMMEDIATE reforms.

Whereas the big stuff like exchanges and government public option come later in the bill and are implemented up to 5 years from enactment, there are some things that will take effect IMMEDIATELY and therefore impact Health Care providers, Insurers, States, and you. These are covered in Sections 101 through 115 and summarized following:

1. Creation of a High-risk pool for people with no insurance who were turned down because of preexisting conditions. – Section 101 beginning on Page 16.
1. Temporary program until exchanges become available but limited to 3 years.
2. It is undecided whether federal government will administer this or states. Thus, it’ impossible to come up with a cost. Will this be an additional bureaucracy in the federal government (additional federal taxpayer dollars) or additional effort for states (additional state taxpayer dollars). Get the drift? UNKNOWN TAXPAYER dollars assigned.
3. Are you eligible? Good luck deciphering the text in this bill. My understand of it though is if you are uninsured for more than 6 months and your employer does not offer you insurance and you tried to get insurance but you were either denied or offered an existing high-risk pool package (some states already have this) that was unaffordable, you may be eligible. Otherwise, sorry, you remain uninsured until you qualify.
4. If you are eligible, how do you enroll and are there other qualifications? Well, the Secretary will tell you how (I guess when he determines who will pay for it and who will administer it). But you must be a resident of one of the 50 states or District of Columbia. Interesting that NO ILLEGAL IMMIGRANT statements appear! Thus, I would say if you are an illegal immigrant but declare residency in a state, then you qualify.
5. What will prevent me from dropping my inadequate insurance coverage for my high-risk condition and getting into this pool of “supposedly” lower cost? The watchdogs will not allow you to do this! Nor will it allow your employer or insurer to “encourage” you to do this. Sanctions will be imposed.
6. Now for some real funny math and deception. Page 22 begins an explanation of Premiums and coverage. The Premiums can vary by Age or Geographical Area as in all policies today. Also stated was the Premium “shall be set at a level that does not exceed 125 percent of the prevailing standard rate for comparable coverage in the individual market…Health insurance issuers shall provide such information as the Secretary may require to determine prevailing standard rates.” What does this mean? I can only assume the Secretary will gather the current premiums private insurance companies charge for the high-risk pool people, take an average, and then charge no more than 125% more. Let me see – if the individual already could not afford it, how is this going to help? It may allow some people to GET insurance, but the COST IS STILL HIGH. Then when they follow this up will benefits like no annual or lifetime limits and under $5000 (individual) or $10,000 (family) out-of-pocket (excluding premiums), you have to wonder how they cannot charge the maximum 125%.
7. More funny math. Where do the funds to pay claims come from? This is where the $5,000,000,000 comes in from the Treasury (or should I say your pocket). I have no idea how many people are sitting without insurance because of preexisting conditions, but I know a few personally. Shall we say of the 57M or so uninsured, maybe 5M? Let’s use just 1M. To fund the claims of 1M people who will be sucking the fund dry due to very, very high medical costs (say, conservatively an average of $100,000 per year – but more likely $200,000), the fund must have $1,000,000,000,000 – that’s $1 Trillion. There goes the $5 Billion government added amount in year 1 leaving $995B to be funded by premiums. Ouch, that’s $995B/1M = $995,000/year per person or $79170/month per person. WOW. Why did we waste our time with this “benefit?” So you say my assumptions are wrong. Work it again with lower assumptions. Assume only $50,000 average per year for 500,000 people = $25,000,000,000 ($25B). $25-$5B=$20B funding required. $20B/500,000=$40,000/yr=$3333/month. Ok, what ARE the CORRECT numbers? What will be the cost? Isn’t even $3333/mo. too high? Can we agree it is UNAFFORDABLE and the fund will be insufficient?
8. But wait, we forgot the clause about what happens if the funds are insufficient. Remember on Page 26 and as stated in Post 118: “adjustments … to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists” will be necessary. Well, doesn’t this bring us back to start?
9. Not to worry. Remember, this is only a temporary (VERY) program (that benefits nobody) and will expire when exchanges become available. In other words, sit it out like you are doing. There is no hope for you to get insurance any less expensive than already exists in states that offer high risk pools. For those that don’t, sorry. Nancy Pelosi and Dingell and crew have already wasted your tax dollars creating a Frankenstein out of the first 26 pages for nothing in return by added bureaucracy costs to implement.

Gee. Only 1970 odd pages to go. I’m already certain it is worthless to continue, but I have already gotten to page 119 and will post Part III shortly.

Grade for Section 101 = "F"