March 28, 2010 Coverage Now for Sick Children? Check Fine PrintBy ROBERT PEAR WASHINGTON — Just days after President Obama signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.
Mr. Obama, speaking at a health care rally in northern Virginia on March 19, said, “Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”
The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was to provide those youngsters with access to insurance and to a full range of benefits once they are in a health plan.
To insurance companies, the language of the law is not so clear.
Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.
William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”
Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.
“The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform,” said Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee.
Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, said: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”
The issue is one of many that federal officials are tackling as they prepare to carry out the law, with a huge stream of new rules, official guidance and brochures to educate the public. Their decisions will have major practical implications.
Insurers say they often limit coverage of pre-existing conditions under policies sold in the individual insurance market. Thus, for example, an insurer might cover a family of four, including a child with a heart defect, but exclude treatment of that condition from the policy.
The new law says that health plans and insurers offering individual or group coverage “may not impose any pre-existing condition exclusion with respect to such plan or coverage” for children under 19, starting in “plan years” that begin on or after Sept. 23, 2010.
But, insurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a “guaranteed issue” requirement before then.
Consumer advocates worry that instead of refusing to cover treatment for a specific pre-existing condition, an insurer might simply deny coverage for the child or the family.
“If you have a sick kid, the individual insurance market will continue to be a scary place,” said Karen L. Pollitz, a research professor at the Health Policy Institute at Georgetown University.
Experts at the National Association of Insurance Commissioners share that concern.
“I would like to see the kids covered,” said Sandy Praeger, the insurance commissioner of Kansas. “But without guaranteed issue of insurance, I am not sure companies will be required to take children under 19.”
A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.
Starting in January 2014, health plans will be required to accept everyone who applies for coverage.
Until then, people with pre-existing conditions could seek coverage in high-risk insurance pools run by states or by the secretary of health and human services. The new law provides $5 billion to help pay claims filed by people in those pools.
Federal officials will need to write rules or guidance to address a number of concerns. The issues to be resolved include defining the “essential health benefits” that must be offered by all insurers; deciding which dependents are entitled to stay on their parents’ insurance; determining who qualifies for a “hardship exemption” from the requirement to have insurance; and deciding who is eligible for a new long-term care insurance program.
As originally conceived, most of the new federal requirements would have taken effect at the same time, in three or four years. The requirements for people to carry insurance, for employers to offer it and for insurers to accept all applicants were tied together.
But as criticism of their proposal grew, Democrats wanted to show that the legislation would produce immediate, tangible benefits. So they accelerated the ban on “pre-existing condition exclusions” for children.
Consumers will soon gain several other protections. By July 1, the health secretary must establish a Web site where people can identify “affordable health insurance coverage options.” The site is supposed to provide information about premiums, co-payments and the share of premium revenue that goes to administrative costs and profits, rather than medical care.
In addition, within six months, health plans must have “an effective appeals process,” so consumers can challenge decisions on coverage and claims.
-------------------- Wise men learn more from fools than fools from the wise. Posts: 3827 | From: beautiful California | Registered: Sep 2008
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quote:Originally posted by Lockman: Sounds like congress should of done some research before they passed this legislation.
Same old story.
Hey, when you force a bill through just for the sake of passing it so you can say you did something....you are bound to have major problems down the road. Especially this.
Posts: 6949 | Registered: Apr 2004
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posted
Flap on Children's Coverage Settled Insurers Say They Will Accept Pre-Existing Conditions After Dispute on Timing, Warn of Higher Prices
Insurers said they would comply with regulations the government issues requiring them to cover children with pre-existing conditions, after a dispute with lawmakers over interpretation of the new health-care legislation.
posted
I was concerned when i heard that several large corporations announced they would begin losing hundreds of millions if not a billion $ this year due to the health care bill.
how could that be since most of the costs don't kick in for several years?
well, it turns out that under the prescription drug plan of 2003, TAXPAYERS were subsidizing prescription drug costs for corporations.
so, basically, a tax loophole was closed, and yes that increases taxes but it also decreases govt spending.
-------------------- Don't envy the happiness of those who live in a fool's paradise. Posts: 36378 | From: USA | Registered: Sep 2003
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posted
i also hear that Waxman has requested those corporations to come to DC and explain why they are losing that money this year exaclty, since it was not anticipated by the writers of the bill that they would incur those costs for a while yet....
-------------------- Don't envy the happiness of those who live in a fool's paradise. Posts: 36378 | From: USA | Registered: Sep 2003
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quote:Originally posted by Lockman: Sounds like congress should of done some research before they passed this legislation.
Same old story.
Hey, when you force a bill through just for the sake of passing it so you can say you did something....you are bound to have major problems down the road. Especially this.
Force a bill through? For real? The Rs had a year to contribute and get involved, but they pouted and said no, no, no. How long should peeps wait?
Anyway, it's now like dealing with cockroaches. You can't simply put out a few traps and proclaim, "Roaches be gone." You may have to step on a few...
Now, that is *not* to be construed as lead-in to justify violence. Just sayin', the cockroach factor has to be eliminated.
Look at this way: I used to think insurance was invented to help people. Then I realized, it's just a "product," like a mouse trap, a doorknob, or any other widget.
But it's not supposed to be a "widget." It *should* be basic policy to help people, based on the strength of the pool and the best statistics we can get a hold of.
Now, if profit-motivated companies want to offer gold-plated policies *above* that--why, sure, get to marketing.
Personal example: when I was moved to "gen-pop" from BICU, I shared a room with a poor sum***** with Crone's, who was reduced to begging for painkiller. We were on divergent paths: he wanted dope to die without pain, while I had forced the issue to stop my "pain-management system."
To be more than frank, I'll be brutally honest: the guy bugged the ever-loving chit of compassion from my last nerve.
But, looking back, I would have happily shared a "floor," like you see on MASH.
I didn't need a remote-control TV, or a multi-position bed. By the same token, I didn't need fifty-dollar tissues (metaphorical) or 12-hundred-dollar (not so metaphorical) "respiratory treatments."
quote:Originally posted by glassman: I was concerned when i heard that several large corporations announced they would begin losing hundreds of millions if not a billion $ this year due to the health care bill.
how could that be since most of the costs don't kick in for several years?
well, it turns out that under the prescription drug plan of 2003, TAXPAYERS were subsidizing prescription drug costs for corporations.
so, basically, a tax loophole was closed, and yes that increases taxes but it also decreases govt spending.
quote:Originally posted by Lockman: Sounds like congress should of done some research before they passed this legislation.
Same old story.
Hey, when you force a bill through just for the sake of passing it so you can say you did something....you are bound to have major problems down the road. Especially this.
Force a bill through? For real? The Rs had a year to contribute and get involved, but they pouted and said no, no, no. How long should peeps wait?
Anyway, it's now like dealing with cockroaches. You can't simply put out a few traps and proclaim, "Roaches be gone." You may have to step on a few...
Now, that is *not* to be construed as lead-in to justify violence. Just sayin', the cockroach factor has to be eliminated.
Look at this way: I used to think insurance was invented to help people. Then I realized, it's just a "product," like a mouse trap, a doorknob, or any other widget.
But it's not supposed to be a "widget." It *should* be basic policy to help people, based on the strength of the pool and the best statistics we can get a hold of.
Now, if profit-motivated companies want to offer gold-plated policies *above* that--why, sure, get to marketing.
Personal example: when I was moved to "gen-pop" from BICU, I shared a room with a poor sum***** with Crone's, who was reduced to begging for painkiller. We were on divergent paths: he wanted dope to die without pain, while I had forced the issue to stop my "pain-management system."
To be more than frank, I'll be brutally honest: the guy bugged the ever-loving chit of compassion from my last nerve.
But, looking back, I would have happily shared a "floor," like you see on MASH.
I didn't need a remote-control TV, or a multi-position bed. By the same token, I didn't need fifty-dollar tissues (metaphorical) or 12-hundred-dollar (not so metaphorical) "respiratory treatments."
Anybody get what I'm saying here?
No, not really.
-------------------- It isn't so much that liberals are ignorant. It's just that they know so many things that aren't so. Posts: 6949 | Registered: Apr 2004
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quote:Originally posted by glassman: I was concerned when i heard that several large corporations announced they would begin losing hundreds of millions if not a billion $ this year due to the health care bill.
how could that be since most of the costs don't kick in for several years?
well, it turns out that under the prescription drug plan of 2003, TAXPAYERS were subsidizing prescription drug costs for corporations.
so, basically, a tax loophole was closed, and yes that increases taxes but it also decreases govt spending.
Hey at least they passed the partial birth abortion act. For some reason Dems think that is ok.
-------------------- It isn't so much that liberals are ignorant. It's just that they know so many things that aren't so. Posts: 6949 | Registered: Apr 2004
| IP: Logged |
quote:Originally posted by glassman: I was concerned when i heard that several large corporations announced they would begin losing hundreds of millions if not a billion $ this year due to the health care bill.
how could that be since most of the costs don't kick in for several years?
well, it turns out that under the prescription drug plan of 2003, TAXPAYERS were subsidizing prescription drug costs for corporations.
so, basically, a tax loophole was closed, and yes that increases taxes but it also decreases govt spending.
Hey at least they passed the partial birth abortion act. For some reason Dems think that is ok.
quote:Originally posted by Lockman: Sounds like congress should of done some research before they passed this legislation.
Same old story.
Hey, when you force a bill through just for the sake of passing it so you can say you did something....you are bound to have major problems down the road. Especially this.
Force a bill through? For real? The Rs had a year to contribute and get involved, but they pouted and said no, no, no. How long should peeps wait?
Anyway, it's now like dealing with cockroaches. You can't simply put out a few traps and proclaim, "Roaches be gone." You may have to step on a few...
Now, that is *not* to be construed as lead-in to justify violence. Just sayin', the cockroach factor has to be eliminated.
Look at this way: I used to think insurance was invented to help people. Then I realized, it's just a "product," like a mouse trap, a doorknob, or any other widget.
But it's not supposed to be a "widget." It *should* be basic policy to help people, based on the strength of the pool and the best statistics we can get a hold of.
Now, if profit-motivated companies want to offer gold-plated policies *above* that--why, sure, get to marketing.
Personal example: when I was moved to "gen-pop" from BICU, I shared a room with a poor sum***** with Crone's, who was reduced to begging for painkiller. We were on divergent paths: he wanted dope to die without pain, while I had forced the issue to stop my "pain-management system."
To be more than frank, I'll be brutally honest: the guy bugged the ever-loving chit of compassion from my last nerve.
But, looking back, I would have happily shared a "floor," like you see on MASH.
I didn't need a remote-control TV, or a multi-position bed. By the same token, I didn't need fifty-dollar tissues (metaphorical) or 12-hundred-dollar (not so metaphorical) "respiratory treatments."
posted
Republicans Back Away From Promises To Repeal Health Care Law Republicans responded to passage of the health care law by promising to build a new movement to repeal the measure. Maverick Sen. John McCain (R-AZ) led the charge against the bill and Rep. John Boehner (R-OH) and Sen. Jim DeMInt (R-SC) introduced gimmicky legislation to rescind the law. With the help of Fox News, Republicans built up the state-based constitutional challenges and reassured their base that could undo the damage. “If we can get to 218, we can force Nancy Pelosi to bring a repeal to the floor for a vote. If the Senate can do that…we have a chance to put a repeal on President Obama’s desk and make him veto that bill,” Rep. Steve King (R-IA) explained. “Repeal and replace will be the slogan for the fall,” Minority Leader Mitch McConnell (R-KY) told CNN’s John King just last week.
But after less than 10 days of staying on message, the GOP is now moving “away from trying to repealing the bill and toward focusing on the law’s impact on businesses and jobs.” Several prominent lawmakers have since come out against the knee-jerk repeal strategy:
- Sen. Bob Corker (R-TN): “The fact is that’s not going to happen, OK?” Corker said today at Vanderbilt University. He also said last week that repeal is “probably not going to be practical.”
- Sen. Richard Burr (R-NC): “It may not be total repeal at the end of the day,” said Burr in a radio interview. “It may be a series of fixes over the course of this bill getting enacted that allow us to change and possibly bend that cost curve down.”
- Sen. John Cornyn (R-TX): “The focus really should be on the misplaced priorities of the administration…Candidates are going to test the winds in their own states. … In some places, the health care bill is more popular than others”
- Rep. Mark Kirk (R-IL): promised to lead the charge on repeal just two weeks ago, he now refuses to answer when reporters “asked repeatedly “if he wanted to repeal health care reform.
Moving towards jobs and the economy would make sense, particularly since most of the major provisions in the health care bill don’t kick in until 2014, while some of the immediate benefits — like eliminating life time caps and ending the common insurer practice of denying coverage to children with pre-existing conditions — are too popular for conservatives to openly oppose. They’ve now settled on repealing provisions that would cut into corporate profits.
For those who have covered health care reform for the last 17 months, the Republican confusion is a bit surprising. Throughout the debate, the party maintained a unified message of opposition, arguing that the legislation represented a government take over of the health care system, no matter how conservative the bill actually became. Post reform, they’re scrambling for a message, but I suspect they’ll find one soon enough. They’ll settle on exploiting the fall out from the legislation, with the retiree drug benefit and the Medicaid payment fall off as exhibits one and two.
-------------------- Wise men learn more from fools than fools from the wise. Posts: 3827 | From: beautiful California | Registered: Sep 2008
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posted
Once again CCW. Partial Birth abortion is a form of abortion. It has nothing to do with the age of the fetus. If you were to take a two week old cluster of cells out of the uterus before it was killed that would be a partial birth abortion. Also...that really has nothing to do with the topic.
-------------------- No longer eligible for government service due to lack of tax issues. Posts: 5178 | From: Up North | Registered: Dec 2005
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CRS: Health Law May Allow Viagra Coverage for Sex Offenders April 7, 2010, 12:42pm By John Stanton Roll Call Staff
The Congressional Research Service confirmed in a memo Wednesday that rapists and sex offenders may get federally subsidized Viagra and other sexual performance enhancing drugs under the recently passed health care reform law — information that Republicans charge will haunt Democrats in upcoming elections.
-------------------- It isn't so much that liberals are ignorant. It's just that they know so many things that aren't so. Posts: 6949 | Registered: Apr 2004
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