Dems Kick Ass, Take Names: Health Care Reform Act – A Short, Readable Version


Lauren from thinkspin and K. from Citizen K., two fabulous bloggers in their own rights and frequent visitors here at MP, were curious as to whether the new health care reforms in place will keep premiums from rising. And that got me doing my research in earnest again this morning. Purely a serendipitous thing, coming across this abbreviated version from the Senate itself, in a tweet by salleegal. I was extremely grateful to come across her tweet, as I have been looking for a good summary of the changes and timelines for implementation for a week and have not been satisfied enough with any of them to use the content here on the blog. My thanks to all three of you for moving my quest along!

Now I know what you’re thinking, that 65 pages of legislation is the last thing you want as weekend reading. Okay, granted, 65 pages is a healthy read, but it’s a considerable improvement over the official document, running in the thousands of pages. (And yes, it’s a complex topic and it does need all those pages, primarily to keep the insurance companies from wheedling their way around the provisions that will cost them their profits and give Americans reasonable care!) But you and I aren’t professional politicians, with aides to read the bill in its entirety, and we have a need for the Reader’s Digest version, so to speak.

As I read through the summary of the bill, most of the information regarding the “will health insurance premiums rise?” question is in the first part of the Act, in Title I, Section 2718, the first few pages of the summary. It’s an important concern, so it’s answered right up front. “Bringing Down The Cost of Health Care Coverage” states that the insurance companies must report yearly how much they spent on patient care, clinical services and all other non-claim costs…in other words, how they spent the money they brought in. That’s a good start, right? But the best part of that clause is that 80-85% of money taken in from premiums must be spent on patient care (wait for it…) or must be rebated back to the customer. Yes, that’s right! Sounds smart. Sounds fiscally wise. Sounds like we might get some bang for our medical buck. How refreshing is that? And no wonder the insurance companies have been paying through the nose for their “grassroots efforts” to propagandize this Act.

But it gets better: Section 1002 provides funding to states for a health insurance consumer advocate or ombudsman to help you negotiate those payments that insurance tries to pass on to you, or to deal with any limits of care that are placed upon your treatment. Another way to protect against rate hikes.

And in Section 1003, we hit pay dirt. It’s entitled, “Ensuring that consumers get value for their dollars,”
and sets up annual review of premium increases. States can now decide who has made “unjust premium increases” and recommend that they are excluded from the exchanges, or pools, of insurers for that state. I thought that I’d previously read that this would go into effect six months down the line, but according to the summary, 1002 and 1003 take effect immediately upon the bill’s signing. Now that’s a provision that makes sense!

So, to answer your question, Lauren, the states will be watching rate hikes from now on. It’s now up to the insurance company to show cause for a rate hike, and unjust premium increases can be rejected by the state. As of now. Right now. Immediately. Now, does it forbid the insurance companies from raising their rates? No. Have many providers rushed ahead to get their increases in before the Act was passed? Oh, yeah. Anthem/Blue Cross up 39-75% for some customers…remember those headlines? But remember, if 80-85% of premiums aren’t spent, then they are rebated back to the the enrollees. I am certain that big insurance has their lawyers working around the clock to find loopholes in that one…

So, for now, it appears that companies will have to show just cause for premium increases. And there are all kinds of great provisions in the bill if you give it a read. Just peruse the bold type headers throughout for areas that might affect you, or that you have an interest in exploring. Skip the rest. It won’t take long, it’s not a horribly challenging read for the most part (it definitely has its “let me re-read that” moments, to be sure), and you’ll be surprised by the positive, “people-not-profits”-oriented, “get great, common sense things done for the American people” measures that are put in place in the Health Care Act. It isn’t perfect, and it doesn’t solve all our competition-type issues, but it’s a helluva good first step. It’s legislation of which we can be proud. It’s reason to be proud of our government again. And between this and the other first-year accomplishments of The President, I think Dems can breathe easy for the midterms…”Hell, no you can’t!” may be Boehner’s rallying cry, but it’s not one that’ll win elections. especially once folks start getting their 24 year olds back on their policies and start getting insured again despite their pre-existing conditions. It’s really refreshing to see our government do something of, by and for the people again, and that’s not just a good feeling, it’s a way to win elections, and just plain the right thing to do.

Thanks again to Tweenie for her typing assistance while this momma’s back heals – you’re a great kid and I am proud you are mine!

So, what do you predict for the months ahead? Will health care reform live up to expectations? Will single-payer make a comeback? Will insurance companies spend billions and find a loophole? I can’t wait to hear your reactions to the passage of this historic Act, so comment below at Momma Politico!

6 Comments

  1. "Sounds smart. Sounds fiscally wise. Sounds like we might get some bang for our medical buck."Sounds Communist. I'm outa here.I suspect there will be a shakeout period during which the insurance companies discover loopholes and Congress moves to close themWe're a ways off from single-payer, although I hope you see it in your lifetime, at least. A public option is another thing altogether. Sen Ron Wyden (D-OR, and a great guy) points out that the states have latitude to change the legislation as long as they don't reduce coverage. I'd look for some of the more progressive states to add public options. Reps and senators will continue to bring it up in Congress as well.Hey, thanks for the props! I never miss Momma Politico!

  2. There are all kinds of good things in the bill/law I guess it is now…lol Within 90 days people without insurance who have pre-existing conditions can now get insurance…. No longer will they be denied. Small businesses will get a great tax break on the price of their policies.. Starting with 2010 taxes, small businesses with fewer than 25 employees that pay at least 50% of the health care premiums for their employees qualify for a tax credit up to 35% of your premiums (50% after 2014 if you purchase insurance through an exchange). How much of a credit you'll get depends on the number of employees you have and their average wage. Gotcha alert: The tax deduction is not available to sole proprietors, so you may want a different corporate legal form. That's this year… So for people who are ill who have done without insurance, they now have a way forward and it starts in just 90 days…… and Small Business owners have a chance to take advantage of this year too. All great things that are there…. This is a good thing and I think the Dems are going to see real results this year in the elections.

  3. Thanks, K., you commie sympathizer, you! (We leftists gotta stick together, Man!);) I think you're right on. Gonna be the shakedown cruise this year, and we'll have to get the bugs worked out. Wyden is a straight shooter and an all-around good guy, true! At least states will have the freedom to go with a public option of some sort. It'll be interesting to see where that goes. San Francisco has a great system that could be a model for the entire state, so who knows?Great to have you swingin' by, my friend. Thanks for the great comments!

  4. Hi Annette, Yeah, I keep catching myself referring to it as a bill, but now it's a law!!! ("Oh, I'm just a bill, yes I'm only a bill, but someday I'm gonna be a law!") I just love that you are so knowledgeable and so willing to share what you know here on MP! Amen to all you've said, and how great is all of that? And it's just the tip of the iceberg. I know it;'s traditional for the incumbent party to lose a few seats, but if the present administration can keep talking up their accomplishments and move forward with new legislation, we'll be a-o.k. in 2010. Thanks again for sharing such terrific info in the comments. So glad you're a regular contributor! :)

  5. Perry,Great post. Dissecting those pages and breaking it out into a well-written easily digestible piece was not an easy feat. Thank you. I still question the integrity of the state's senates, especially Republican run state senates, to monitor their sugar daddies. The "L" word, Loophole,is also of great concern. There's a reason the insurers have been in power for so long. I fear their influence runs deep to the very core of our democracy. It's like getting rid of termites in a house. The country needs a really good exterminator right now. I don't know if our legislatures on the state level are up to the task.

  6. I hear ya, Lauren. I know for a fact that the California State Legislature is not up to the challenge. Now, if Ah-nuld was to follow the San Fran model (uh, not at ALL likely…), we'd be in good shape. Gavin Newsom built a great plan there, and the entire city is covered. But the Rethugs will set things up to fail if they are given their druthers. Loopholes, too, are a huge worry. The bill is a step forward, but there is always that chance. I really think there are some terrific provisions in the act, and once it begins to affect people's lives (older kids still on parents' insurance, no recission, etc.), I think it'll be a definite ace in the hope for Dems come November. Lauren, I love that you're keeping an eye out – vigilance will need to be our watchword! ;) Thanks for the kudos, too – found another great summary of the bill – will include it in my next post! Thanks for swinging by, Girlfriend. Always love your comments!

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I refuse to cave to a minivan. I am still a tomboy - comfortable in Levi's, my Yankees cap and Converse. And I always have a political opinion...hell, I always have an opinion, period. The hubby, my kids and my friends think I should run for office. Maybe one day. But for now, Momma Politico blogs. Peruse, enjoy, and know that our busy lives are as significant as those in The Washington Post. Cheers, Heidi Haines AKA Perry MacNeil Momma Politico

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