"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.
So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
The quotation is just a section from the definition of grandfathered health insurance. Here it is in context:
SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT 2 COVERAGE. 3 (a) GRANDFATHERED HEALTH INSURANCE COV4 ERAGE DEFINED.—Subject to the succeeding provisions of 5 this section, for purposes of establishing acceptable cov6 erage under this division, the term ‘‘grandfathered health 7 insurance coverage’’ means individual health insurance 8 coverage that is offered and in force and effect before the 9 first day of Y1 if the following conditions are met: 10 (1) LIMITATION ON NEW ENROLLMENT.— 11 (A) IN GENERAL.—Except as provided in 12 this paragraph, the individual health insurance 13 issuer offering such coverage does not enroll 14 any individual in such coverage if the first ef15 fective date of coverage is on or after the first 16 day of Y1. 17 (B) DEPENDENT COVERAGE PER18 MITTED.—Subparagraph (A) shall not affect 19 the subsequent enrollment of a dependent of an 20 individual who is covered as of such first day. 21 (2) LIMITATION ON CHANGES IN TERMS OR 22 CONDITIONS.—Subject to paragraph (3) and except 23 as required by law, the issuer does not change any 24 of its terms or conditions, including benefits and 25 cost-sharing, from those in effect as of the day be26 fore the first day of Y1.
And here is a link to the full document: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf Why don't you read it instead of drawing conclusions from uninformed and/or biased new stories? If you aspire to be self-reliant, why not try reading the source documents for yourself rather than relying on others and falling prey to their agendas?
Jolly Roger wrote:The quotation is just a section from the definition of grandfathered health insurance. Here it is in context:
SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE. (a) GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘‘grandfathered health insurance coverage’’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met: (1) LIMITATION ON NEW ENROLLMENT.—
(A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.
(B) DEPENDENT COVERAGE PERMITTED.—Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.
(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.
And here is a link to the full document: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf Why don't you read it instead of drawing conclusions from uninformed and/or biased new stories? If you aspire to be self-reliant, why not try reading the source documents for yourself rather than relying on others and falling prey to their agendas?
This says to me that if you have individual health coverage, that you are grandfathered in to keep it if you want... but if you lose that coverage, you will either have to take government coverage, or you better be getting coverage from an employer. How do you read this differently?
captain.crazy wrote:This says to me that if you have individual health coverage, that you are grandfathered in to keep it if you want... but if you lose that coverage, you will either have to take government coverage, or you better be getting coverage from an employer. How do you read this differently?
The passage in bold script does not mean any of these things in my opinion. It is simply a condition required in order for the health insurance coverage a person has prior to the first day of year 1 to be considered grandfathered health insurance coverage as of the first day of year 1. If you were to acquire health insurance after the first day, there would be no reason for it to be grandfathered.
Granted, I haven't read the entire thing in detail either since I am Canadian and do not give a shit about this piece of legislation. All I wanted to achieve in my original response was to 1) point out that the author of the IBD editorial is, in my opinion, an idiot who probably didn't get past page 16 before going on his or her self-serving tirade and 2) recommend that you read the source documents rather than rely on the biased views (liberal, conservative or otherwise) presented in the media.
thegreekdog wrote:Mr. Roger, I'm not sure what your email proved. In other words, it seems to directly support captain's post and link. Is there something I'm missing?
No, I think JR's point is spot on. However it still leaves unanswered the question of what exactly are the consequences if one loses their grandfathered coverage. What this particular snippet of the bill says is simply that if you already have coverage before the first day of Y1 that you can keep that coverage and the issuer cannot change the terms and conditions on you and if you have a dependent that you want to include on your grandfathered coverage (even after the first day of Y1) you can enroll them in the same coverage package. What it does not say is what happens if you fail to pay your premiums and the issuer drops your coverage. What are your options for coverage then? That is a good question and needs to be answered, but this particular section of the legislation does not in any way say what those consequences are (contrary to what captain.crazy seems to be suggesting).
thegreekdog wrote:Mr. Roger, I'm not sure what your email proved. In other words, it seems to directly support captain's post and link. Is there something I'm missing?
No, I think JR's point is spot on. However it still leaves unanswered the question of what exactly are the consequences if one loses their grandfathered coverage. What this particular snippet of the bill says is simply that if you already have coverage before the first day of Y1 that you can keep that coverage and the issuer cannot change the terms and conditions on you and if you have a dependent that you want to include on your grandfathered coverage (even after the first day of Y1) you can enroll them in the same coverage package. What it does not say is what happens if you fail to pay your premiums and the issuer drops your coverage. What are your options for coverage then? That is a good question and needs to be answered, but this particular section of the legislation does not in any way say what those consequences are (contrary to what captain.crazy seems to be suggesting).
Hmm... I'm pretty sure it says exactly what captain crazy said it says.
captain.crazy wrote:This says to me that if you have individual health coverage, that you are grandfathered in to keep it if you want... but if you lose that coverage, you will either have to take government coverage, or you better be getting coverage from an employer
thegreekdog wrote:Mr. Roger, I'm not sure what your email proved. In other words, it seems to directly support captain's post and link. Is there something I'm missing?
No, I think JR's point is spot on. However it still leaves unanswered the question of what exactly are the consequences if one loses their grandfathered coverage. What this particular snippet of the bill says is simply that if you already have coverage before the first day of Y1 that you can keep that coverage and the issuer cannot change the terms and conditions on you and if you have a dependent that you want to include on your grandfathered coverage (even after the first day of Y1) you can enroll them in the same coverage package. What it does not say is what happens if you fail to pay your premiums and the issuer drops your coverage. What are your options for coverage then? That is a good question and needs to be answered, but this particular section of the legislation does not in any way say what those consequences are (contrary to what captain.crazy seems to be suggesting).
Hmm... I'm pretty sure it says exactly what captain crazy said it says.
captain.crazy wrote:This says to me that if you have individual health coverage, that you are grandfathered in to keep it if you want... but if you lose that coverage, you will either have to take government coverage, or you better be getting coverage from an employer
Nope. He's making an assumption that you will have no other choice but gov't coverage or employer coverage. That is not to say it is definitely not true, but rather that you can't determine that from the section of the bill quoted. It does not address the issue at all. If the captain has additional info and references which show this to be so, then fine. But JR's point was that based on what is shown here, the captain's assertion is pure speculation.
thegreekdog wrote:Oh I see. So, if captain crazy pulls up something that says the only choices are government healthcare or employer-provided, you'd agree with him?
Technically, no. Since his assertion (according to the title of this thread) is that there is NO choice for individual Health Care plan. Clearly there is a choice (perhaps not with the broadest range of options, but a still a choice - at least under some circumstances).
You seem to be implying that there is no way I would ever acknowledge that this piece of legislation is flawed. I don't know why you would think that. If there are only those two choices, I do see that as a flaw. But I haven't seen anything that conclusively shows that those are, in fact, the only two choices under the circumstances described. On the other hand, even if that flaw exists I can't say how big a flaw it would be without further details about the nature of the gov't issued coverage.
Jolly Roger wrote: Why don't you read it instead of drawing conclusions from uninformed and/or biased new stories? If you aspire to be self-reliant, why not try reading the source documents for yourself rather than relying on others and falling prey to their agendas?
thegreekdog wrote:Oh I see. So, if captain crazy pulls up something that says the only choices are government healthcare or employer-provided, you'd agree with him?
At this point, I would question anything captaincrazy pulls up because just about everything he has quoted here is stuff he either completely misunderstood or, likely, did not even bother to fully read.
That said, I want to see what the Senate version is.
thegreekdog wrote:Oh I see. So, if captain crazy pulls up something that says the only choices are government healthcare or employer-provided, you'd agree with him?
Technically, no. Since his assertion (according to the title of this thread) is that there is NO choice for individual Health Care plan. Clearly there is a choice (perhaps not with the broadest range of options, but a still a choice - at least under some circumstances).
You seem to be implying that there is no way I would ever acknowledge that this piece of legislation is flawed. I don't know why you would think that. If there are only those two choices, I do see that as a flaw. But I haven't seen anything that conclusively shows that those are, in fact, the only two choices under the circumstances described. On the other hand, even if that flaw exists I can't say how big a flaw it would be without further details about the nature of the gov't issued coverage.
I posted the title of the article... as the title of the thread. You can read the article, or get your understanding of the notion of it however you wish. The fact remains, Government health care is going to do exactly what it promises that it wont... kill competition.
thegreekdog wrote:Oh I see. So, if captain crazy pulls up something that says the only choices are government healthcare or employer-provided, you'd agree with him?
Technically, no. Since his assertion (according to the title of this thread) is that there is NO choice for individual Health Care plan. Clearly there is a choice (perhaps not with the broadest range of options, but a still a choice - at least under some circumstances).
You seem to be implying that there is no way I would ever acknowledge that this piece of legislation is flawed. I don't know why you would think that. If there are only those two choices, I do see that as a flaw. But I haven't seen anything that conclusively shows that those are, in fact, the only two choices under the circumstances described. On the other hand, even if that flaw exists I can't say how big a flaw it would be without further details about the nature of the gov't issued coverage.
I posted the title of the article... as the title of the thread. You can read the article, or get your understanding of the notion of it however you wish. The fact remains, Government health care is going to do exactly what it promises that it wont... kill competition.
Actually, the title of the article is "It's Not an Option", not "No choice for individual Health Care plan", but whatever.
I did read the article. The author says in the last paragraph that he/she has only read the first 16 pages of the bill (which consists of 1018 pages, mind you). Hardly compelling testimony.
thegreekdog wrote:Oh I see. So, if captain crazy pulls up something that says the only choices are government healthcare or employer-provided, you'd agree with him?
Technically, no. Since his assertion (according to the title of this thread) is that there is NO choice for individual Health Care plan. Clearly there is a choice (perhaps not with the broadest range of options, but a still a choice - at least under some circumstances).
You seem to be implying that there is no way I would ever acknowledge that this piece of legislation is flawed. I don't know why you would think that. If there are only those two choices, I do see that as a flaw. But I haven't seen anything that conclusively shows that those are, in fact, the only two choices under the circumstances described. On the other hand, even if that flaw exists I can't say how big a flaw it would be without further details about the nature of the gov't issued coverage.
So, basically, instead of discussing the flaws in the bill, we're discussing semantics by arguing over the phrase "no choice." That's very constructive... (insert eyeroll here).
When the bill/proposal is in final form, I will probably read it. I would like to see what happens to someone whose employer does not offer health insurance. Is there only one choice for that employee? Perhaps if the cost of providing health insurance to employees is more than the cost of not providing health insurance, I could see employers dropping health insurance all together, forcing a whole lot of people to get government-provided insurance. Should be an interesting time in any event.
thegreekdog wrote:Oh I see. So, if captain crazy pulls up something that says the only choices are government healthcare or employer-provided, you'd agree with him?
Technically, no. Since his assertion (according to the title of this thread) is that there is NO choice for individual Health Care plan. Clearly there is a choice (perhaps not with the broadest range of options, but a still a choice - at least under some circumstances).
You seem to be implying that there is no way I would ever acknowledge that this piece of legislation is flawed. I don't know why you would think that. If there are only those two choices, I do see that as a flaw. But I haven't seen anything that conclusively shows that those are, in fact, the only two choices under the circumstances described. On the other hand, even if that flaw exists I can't say how big a flaw it would be without further details about the nature of the gov't issued coverage.
So, basically, instead of discussing the flaws in the bill, we're discussing semantics by arguing over the phrase "no choice." That's very constructive... (insert eyeroll here).
When the bill/proposal is in final form, I will probably read it. I would like to see what happens to someone whose employer does not offer health insurance. Is there only one choice for that employee? Perhaps if the cost of providing health insurance to employees is more than the cost of not providing health insurance, I could see employers dropping health insurance all together, forcing a whole lot of people to get government-provided insurance. Should be an interesting time in any event.
Roll your eyes if you want, but you and the captain are the ones who are trying to drag this conversation into the realm is nitpicking semantics. I'm discussing the lack of substance in the article the captain linked to in the first post, and the enormous logical leaps that you and the captain have taken based on the tiniest fraction of the data.
The biggest problem is that this is not just one problem, but a combination of crisis situations.
On the one hand, health care is spiraling to the point where no one can afford it but the absolute richest or those with wonderful employer-provided insurance (which, in this context, essentially equals "rich" -- it matters not if the employer passes on the money to buy insurance or gives insurance directly, it is still massive compensation at this point). That last group are becoming fewer and fewer because companies are more and more deciding they would rather just pay employees more or give them other types of compensation and offer only minimal (at least lessor) health insurance.
On the other hand, we have a generally downward economy so that many people cannot afford the houses, food and clothing they have had, never mind health care and even education for their kids (other than free public education, which is also diminishing).
Then we have a healthcare system that is just plain broken on many fronts. We pay for people at the most expensive points -- that is, emergency rooms and deny them basic, maintenance care that would almost always lower costs in the long run(yes, there are exceptions). Most states do pay for completely uninsured children, but those born to parents who work, but who are not wealthy, may not be getting the dental, eye and other care they really need. Add in issues like behavior. Yes, I know full well that's a can of worms, many kids absolutely are over-diagnosed, etc. -- however one reason parents let kids be over-diagnosed is because that is a way to get their kids health coverage, and doctors feed in also because they tend to just get paid when they diagnose problems, so its a circle. That last is another "break" in the system -- that doctors get paid far more, usually even under HMOs for diagnosing and treating problems. They generally do not get paid for keeping people well... so, guess where all their energy goes? (I am not at all suggesting doctors intentionally over-diagnose, but the pressure is hard to resist, hard to fight against) Add in threats of lawsuits and, again, doctors have every incentive to order expensive tests, when they have a patient who can pay. any who cannot pay are just left in the cold.
We also have a research system whereby the government invests millions in advancing research, discovering cures and then simply turns all that over to private companies to make a profit. The government is obligated to do this, but gets no compensation and generally government employees are even proscribed by law from putting their cases forward .. "lobbying". So, many people don't even realize this is happening.
Add to that a malpractice system that essentially just has competent doctors paying huge sums for the idiots (through higher insurance premiums), and therefore inherently discourages doctors from correcting each other, really working for solutions unless absolutely forced (again, many do try to "buck" the system, but it is very difficult).
Those are not the only problems, but its enough for now.
Anyway, in comes this bill that is supposed to somehow fix ALL of those problems in one, feel swoop. Its just not possible.
If this had been taken on back during Clinton, when things were going well in the economy, perhaps we could have avoided a large part of this mess. Remember, a big part of the banking problem was/is foreclosures. Medical costs are now a big part of why people go bankrupt or get homes foreclosed. They are also a big reason why, before those steps, people simply cut way, way back on all sorts of spending. Those things, in turn lead to more job losses ... and its a circle.
So, yes, solving the medical situation IS very much a key to solving our whole economic situation.
HOWEVER, the chances for nice and easy solutions are just gone.
The reality is that all but a few people are just not going to be getting the ultra high levels of insurance to which a few are accustomed. I am not a doctor, or an economist, or a medical ethicist, so I cannot say where the lines should be drawn. I do know triage hurts -- it hurts big time. It hurts to go to an accident and know that maybe, just maybe if you did CPR on that kid, he might well live, but becuase there are 4 other victims, all you can do is try to open the airway, give a breath... and leave to care for the others. However, without that system of triage, you would have even more fatalities. Without a system that says "leave that kid.. and deal with his bleeding sister, his mom who has guts hanging out", etc, you might find yourself doing CPR for 2 hours, only to have that child die along with everyone else OR save that child, but not the rest. Triage is about the worst situation anyone can have to face, I pray none of you ever have to make such choices, but it is necessary.
It could well be that certain types of cancer treatment will not be generally covered, will require either an extra policy or private charity (shriners, etc.). Offhand, I would guess that childhood leukemia, with its wonderful success rate (one of the few really treatable cancers) and involving, as it does mostly kids, will be covered. Dental and eye care really need to be moved back into the mandatory coverage system because they are so fundamental to other issues (dentists, just to name an example, are often first to recognize signs of diabetes).
In some cases, particularly when it comes to elder care, some of these "reductions" in care may well mean truly better care. Why? Because too often doctors wind up ordering fancy, painful procedures for older patients that have little chance of success ... and the doctor knows this, but orders them because they are afraid they will be sued. Again, I am not an expert here, I am not saying "here is a line", I am saying that I have heard wonderful, caring, compassionate, Christian hospice doctors talk about the insanity of taking a patient everyone KNOWS .. absolutely KNOWS is going to die, and despite that person's wishes, despite families' wishes (or maybe because of the wishes of one family member, in the absence of a living will), putting that patient in a cold hospital hooked up to noisy machines, shots, etc. instead of the far more gentle (but competent) end of life care. Worse, doctors are often so reluctant to "give up" that they often end up actually lying to paitents -- not intentionally, but they are so focused on "we will cure this" that they fail to stop and say "wait"., maybe this is not going to happen this time and maybe the family needs to just have time to settle things. Note--even that term, to let someone die is to "give up" is itself a heavy bias. Since when did death become our complete enemy? No, we absolutely should not seek it, but there IS a time when death comes, is natural ... is (and I hesitate to say this because it so easily spins way out of context) a relief. Anyone who has dealt with seriously, seriously ill relatives, as have I knows of what I speak. Yes, there can be abuse, but you don't regulate the whole simply based on those few cases of abuse, you regulate abuse to prevent abuse.
Anyway, the thing is that hospice is often BOTH better AND cheaper.. when properly employed. This is just one example where our current system so often gets in the way of care, instead of advancing it. Talk to almost any doctor working for some time and they will admit something similar.
Anyway, there is no getting around the fact that limits must be employed. The truth is that almost everyone already has limits -- very serious, severe limits in coverage. Ironically, the very poor (particularly poor kids) are the exception. Everyone else has to deal with insurance company-dictated limits.
So, really, all this talk of "choice" is really and truly a red herring. The real and absolute truth is that few people have ANY choice at all. If they have insurance, their employer decides it. Only a few, mostly very large employers, offer any kind of choice in coverage at all. If you lack insurance, you typically have even fewer choices. Only certain companies will cover you -- none if you have serious issues, and the cost is almost always very, very high. By high, I mean over 60-70% of many people's incomes.
The real and true bottom line is that whatever congress comes up with is going to hurt a great many people. But, there just is no choice. Or, rather, the alternative -- to wind up with a system where ONLY the very rich get much of ANY coverage - is far, far worse.
I take no illogical leaps. It's perfectly reasonable to assume that there are two choices for one who previously could choose from three options. I'm not sure why this is a big deal that this is the case, other than personal animosity some have for captain.crazy. He's gone now, by the way.
thegreekdog wrote:I take no illogical leaps. It's perfectly reasonable to assume that there are two choices for one who previously could choose from three options. I'm not sure why this is a big deal that this is the case, other than personal animosity some have for captain.crazy. He's gone now, by the way.
I wouldn't describe it as personal animosity (I kind of enjoyed reading his nonsense and occasionally sparring with him), more like sibling rivalry. And it's not really clear if it's a big deal or not (which was my point). So as for leaps in logic, from the passage quoted, it is a leap in logic to assume that those are the only two choices. The passage quoted was only describing the circumstances under which existing health care coverage would be "grandfathered" in under the proposed legislation. It does not directly address all the options available for coverage or all the possible circumstances under which one would need to acquire some form of coverage. It's a very specific fragment of the bill describing a very specific circumstance and is not a general description of the plan as a whole.
