==Rescission

HR 3590 is the one that got passed. In it contains an amendment for 2712, which is found on page 13, sec 2712. For future reference, many sections written in the aforementioned linked bill are amendments or are an amendment for a section found here.

Sec. 2712 doesn’t seem like reform, even though consumer protections are laid out in 2702(c) or 2742(b). These 2 numbers are directly referring to TITLE 42 > CHAPTER 6A > SUBCHAPTER XXV. 2702(c) can be found here under (c) Genetic testing, and 2742(b) is here under (b) General exceptions. So the only real reform found in this amendment is that the insurance companies cannot force one to undergo a genetic test, and rescind your coverage based off your refusal to take the test or the results of one.

However, other amendments made by HR 3590, to SUBCHAPTER XXV, such as the ones on pages 19-21 & 769-770 on the HR 3590 link provided earlier, introduce a better appeal process. Both 2719 and 2793 provide an external reviewing process that is paid for by your insurer. The amendments also make it the responsibility of the insurers to make available to you the information about the internal and external appeal processes and how to proceed. You also have more rights during the appeal process.

What it boils down to is, at a minimum, the availability of the NAIC, who will review your insurers decision to rescind your coverage. This is done by submitting to NAIC these completed documents (that is an old draft version). The amendment also opens the door for other external reviewing commissions that can later become mandated by the State or Secretary, and if you seek an appeal, and if you’re not an idiot, an external appeal, then they have to continue to provide coverage until the decision on the appeal is completed. The appeal process, both internal and external, are also more transparent to the public.

The issue then becomes how the external commissions and federal government will utilize and define 2742(b2), which is:

(2) Fraud
The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage.

So in the end, this reform only serves to make the rescission appeal process more transparent and it can be reviewed by an external commission. The fact that 2742(b2) is defined by the companies own coverage agreement means that it will still be difficult to prove that you did not break the guideline, when the facts of the contract indicate otherwise. On the other hand, if you did not break the contract, then hopefully an external reviewing commission will come to that conclusion more readily.

==Extending coverage to young adults and Individual Responsibility (Mandate Tax)

Another significant change is the extension of health care provided to parent by a plan, to include their children under the age of 26 under their parent’s private plan (sec. 2714 page 14), or one is eligible for medicaid if they were or became a foster child at an age of 18 or higher (sec. 10201 page 799). This may not seem important, but it used to be the case that these plans stopped covering persons before they were ~20.

This is significant because many young adults may decide not to buy health insurance during their post-secondary education, or it’s are not offered through their early jobs, which are also sometimes too low paying for these earners to choose to use some of their wage on buying health insurance. By extending coverage, they will be making more money by the time they are forced off their plan and into buying their own health insurance, or face a monthly penalty (sec. 1501 and sec. 1502 page 124-131).

==Pre-existing condition

On page 777 sec. 2709e, children under the age of 19 cannot be barred from insurance for reasons involving pre-existing conditions (for now starting in 6 months. In addition, according to sec. 2704 on page 36, insurance companies will no longer be allowed to deny any application because of pre-existing conditions. In sec. 2708, page 43, it states that they are not allowed to make you wait more then 90 days before they accept your application.

This is significant reform because in the event of rescission, nothing can stop someone from getting health insurance from another provider. The only concern I have is the 90 day gap, and the fact that one is usually rescinded when they are under review for expensive treatment. Insurance companies will use these 90 days to the full extent, and so you will be waiting longer then 3 months before you can be covered for any treatment because you will have probably wasted time appealing.

==Reflection on some of these changes

The results of these changes are appealing. It will reduce the number of people who choose to lie about their medical history on their application, because people will opt for higher premiums, rather then to risk their coverage being rescinded. In addition, the more developed appeals process will significantly reduce baseless or weak decisions to rescind coverage of the poor and/or lazy/uninformed, whom did not have the means to appeal under the old system. However, this doesn’t change the fact that if you intentionally leave out information, which the health insurance companies can access easily for the most part, in order to pay lower premiums, then your coverage will probably be rescinded and that decision will probably stand under current laws. Lastly, if your coverage is rescinded or you are uninsured, and you have a pre-existing condition, then you will still have the option of buying health insurance. In order for this system to not be abused, which can be done by people waiting until they need expensive treatment before buying insurance, and then dropping their insurance after treatment is paid for, will require for a penalty tax to provide the necessary incentive to make people buy insurance (page 124-131). Those who are unable to afford insurance, and are not eligible for medicare/aid, may be eligible for assistance as outlined in sec. 1501 and sec. 1502 (p. 124-131).

—Speculation and random stuff

-Within the reforms I spoke of, I am convinced that this bill will save countless lives.

-Apparently there are measures in the bill that mitigate the variations between premiums which may become more pronounced now that individuals with pre-existing conditions have to be accepted. I have not figured out where these provisions are located.

-As for the premium price control regulations that exist in this bill, I have not yet looked at them.

-As for the methods that the bill will employ in order to finance this bill without bankrupting insurance companies, citizens, and the government, I am not even going to try to figure out how they work. Most of us are going to have to wait 5-10 years before we can come up with an informed analysis.

-Nothing in this post has anything to do with the Reconciliation Bill of 2010 that was passed on March 21, 2010, found here. That bill is now headed back to the Senate, and attempts to restore many of the amendments that the Senate removed from HC 3590 before it was made law.

-Lastly, if any public option, or single payer system, is made available, then almost all concerns will no longer be an issue.

c0mputar

c0mputar

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