GOP Unveils Health Reform Alternative
Republicans have unveiled their long-awaited alternative to the Democratic health reform proposal. It an amendment in the nature of a substitute with the short title: "Common Sense Health Care Reform and Affordability Act". The 219 page amendment is available here (pdf).
The bill does all those republican things like Association Health Plans, high risk pools, bigger and better health savings accounts, medical liability reform, and my personal favorite - the "Enable Insurers to Ripoff Out-of-State Customers" provision they refer to as selling health insurance across state lines.
I have commented on the many problems that out of state sale of current health insurance products may engender. One of the most pernicious is that a company advertising cheap rates in their home state will be allowed to sell coverage where they have no provider network. Nothing in the Republican proposal even mandates the existence of a provider network. So, think about what happens when you get sick or injured and have to use your insurance.
Here's what is going to happen. Since there is no provider network, all of the providers are going to charge you their "usual and customary" fee rather than the much lower fees they accept under the terms of their network contracts. Moreover, uncontracted providers are under no obligation to write off differences between the insurer's allowable and their usual and customary fees. For example, last spring I was hospitalized for pneumonia. It was a lovely 10-day stay with a price tag of
$63,846.38 based on the usual and customary rate schedule the hospital and doctors use. But since I was protected by a contract between the insurance company and my hospital and doctors, the negotiated fee schedule brought the whole cost down to $6,932.15. If I had bought out-of-state insurance with no local provider network, I would be on the hook for an extra $56,914.23. Of course, I could have gone to the insurers primary state where there is an established provider network, but I needed an Emergency Room and a few days in the ICU. It wasn't like I could go shopping, much less traveling.
There is probably much more to hate in the Republican bill, and it might be useful for TPM readers to pick it apart. Their new rhetoric is probably going to be all about their great plan that the Dems won't pay any attention to.
The bill does all those republican things like Association Health Plans, high risk pools, bigger and better health savings accounts, medical liability reform, and my personal favorite - the "Enable Insurers to Ripoff Out-of-State Customers" provision they refer to as selling health insurance across state lines.
I have commented on the many problems that out of state sale of current health insurance products may engender. One of the most pernicious is that a company advertising cheap rates in their home state will be allowed to sell coverage where they have no provider network. Nothing in the Republican proposal even mandates the existence of a provider network. So, think about what happens when you get sick or injured and have to use your insurance.
Here's what is going to happen. Since there is no provider network, all of the providers are going to charge you their "usual and customary" fee rather than the much lower fees they accept under the terms of their network contracts. Moreover, uncontracted providers are under no obligation to write off differences between the insurer's allowable and their usual and customary fees. For example, last spring I was hospitalized for pneumonia. It was a lovely 10-day stay with a price tag of
$63,846.38 based on the usual and customary rate schedule the hospital and doctors use. But since I was protected by a contract between the insurance company and my hospital and doctors, the negotiated fee schedule brought the whole cost down to $6,932.15. If I had bought out-of-state insurance with no local provider network, I would be on the hook for an extra $56,914.23. Of course, I could have gone to the insurers primary state where there is an established provider network, but I needed an Emergency Room and a few days in the ICU. It wasn't like I could go shopping, much less traveling.There is probably much more to hate in the Republican bill, and it might be useful for TPM readers to pick it apart. Their new rhetoric is probably going to be all about their great plan that the Dems won't pay any attention to.
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