SEC. 1323. COMMUNITY HEALTH INSURANCE OPTION.
 
(a) VOLUNTARY NATURE.--

 (1) NO REQUIREMENT FOR HEALTH CARE PROVIDERS TO PARTICIPATE.--Nothing in this section shall be construed to require a health care provider to participate in a community health insurance option, or to impose any penalty for non-participation.

(2) NO REQUIREMENT FOR INDIVIDUALS TO JOIN.--Nothing in this section shall be construed to require an individual to participate in a community health insurance option, or to impose any penalty for non-participation.

(3) STATE OPT OUT.--

(A) IN GENERAL.--A State may elect to prohibit Exchanges in such State from offering a community health insurance option if such State enacts a law to provide for such prohibition.

(B) TERMINATION OF OPT OUT.--A State may repeal a law described in subparagraph (A) and provide for the offering of such an option through the Exchange.

(b) ESTABLISHMENT OF COMMUNITY HEALTH INSURANCE OPTION.--

(1) ESTABLISHMENT.--The Secretary shall establish a community health insurance option to offer, through the Exchanges established under this title (other than Exchanges in States that elect to opt out as provided for in subsection (a)(3)), health care coverage that provides value, choice, competition, and stability of affordable, high quality coverage throughout the United States.

(2) COMMUNITY HEALTH INSURANCE OPTION.--In this section, the term ''community health insurance option'' means health insurance coverage that--

(A) except as specifically provided for in this section, complies with the requirements for being a qualified health plan;

(B) provides high value for the premium charged;

(C) reduces administrative costs and promotes administrative simplification for beneficiaries;

(D) promotes high quality clinical care;

(E) provides high quality customer service to beneficiaries;

(F) offers a sufficient choice of providers; and

(G) complies with State laws (if any), except as otherwise provided for in this title, relating to the laws described in section 1324(b).

(3) ESSENTIAL HEALTH BENEFITS.--

(A) GENERAL RULE.--Except as provided in subparagraph (B), a community health insurance option offered under this section shall provide coverage only for the essential health benefits described in section 1302(b).

(B) STATES MAY OFFER ADDITIONAL BENEFITS.--Nothing in this section shall preclude a State from requiring that benefits in addition to the essential health benefits required under subparagraph (A) be provided to enrollees of a community health insurance option offered in such State.

(C) CREDITS.--

(i) IN GENERAL.--An individual enrolled in a community health insurance option under this section shall be eligible for credits under section 36B of the Internal Revenue Code of 1986 in the same manner as an individual who is enrolled in a qualified health plan

(ii) NO ADDITIONAL FEDERAL COST.--A requirement by a State under subparagraph (B) that benefits in addition to the essential health benefits requiredunder subparagraph (A) be provided to enrollees of a community health insurance option shall not affect the amount of a premium tax credit provided under section 36B of the Internal Revenue Code of 1986 with respect to such plan.

(D) STATE MUST ASSUME COST.--A State shall make payments to or on behalf of an eligible individual to defray the cost of any additional benefits described in subparagraph (B).

(E) ENSURING ACCESS TO ALL SERVICES.--Nothing in this Act shall prohibit an individual enrolled in a community health insurance option from paying out-of-pocket the full cost of any item or service not included as an essential health benefit or otherwise covered as a benefit by a health plan. Nothing in subparagraph (B) shall prohibit any type of medical provider from accepting an out-of-pocket payment from an individual enrolled in a community health insurance option for a service otherwise not included as an essential health benefit.

(F) PROTECTING ACCESS TO END OF LIFE CARE.--A community health insurance option offered under this section shall be prohibited from limiting access to end of life care.

(4) COST SHARING.--A community health in surance option shall offer coverage at each of the levels of coverage described in section 1302(d).

(5) PREMIUMS.--

(A) PREMIUMS SUFFICIENT TO COVER COSTS.--The Secretary shall establish geographically adjusted premium rates in an amount sufficient to cover expected costs (including claims and administrative costs) using methods in general use by qualified health plans.

(B) APPLICABLE RULES.--The provisions of title XXVII of the Public Health Service Act relating to premiums shall apply to community health insurance options under this section, including modified community rating provisions under section 2701 of such Act.

(C) COLLECTION OF DATA.--The Secretary shall collect data as necessary to set premium rates under subparagraph (A).

(D) NATIONAL POOLING.--Notwithstanding any other provision of law, the Secretary may treat all enrollees in community health insurance options as members of a single pool.

(E) CONTINGENCY MARGIN.--In establishing premium rates under subparagraph (A), the Secretary shall include an appropriate amount for a contingency margin.

(6) REIMBURSEMENT RATES.--

(A) NEGOTIATED RATES.--The Secretary shall negotiate rates for the reimbursement of health care providers for benefits covered under a community health insurance option.

(B) LIMITATION.--The rates described in subparagraph (A) shall not be higher, in aggregate, than the average reimbursement rates paid by health insurance issuers offering qualified health plans through the Exchange.

(C) INNOVATION.--Subject to the limits contained in subparagraph (A), a State Advisory Council established or designated under subsection (d) may develop or encourage the use of innovative payment policies that promote quality, efficiency and savings to consumers.

(7) SOLVENCY AND CONSUMER PROTECTION.--

(A) SOLVENCY.--The Secretary shall establish a Federal solvency standard to be applied with respect to a community health insurance option. A community health insurance option shall also be subject to the solvency standard of each State in which such community health insurance option is offered.

(B) MINIMUM REQUIRED.--In establishing the standard described under subparagraph (A), the Secretary shall require a reserve fund that shall be equal to at least the dollar value of the incurred but not reported claims of a community health insurance option.

(C) CONSUMER PROTECTIONS.--The consumer protection laws of a State shall apply to a community health insurance option.

(8) REQUIREMENTS ESTABLISHED IN PARTNER SHIP WITH INSURANCE COMMISSIONERS.--

(A) IN GENERAL.--The Secretary, in collaboration with the National Association of Insurance Commissioners (in this paragraph referred to as the ''NAIC''), may promulgate regulations to establish additional requirements for a community health insurance option.

(B) APPLICABILITY.--Any requirement promulgated under subparagraph (A) shall be applicable to such option beginning 90 days after the date on which the regulation involved becomes final.

(c) START-UP FUND.--

(1) ESTABLISHMENT OF FUND.--

(A) IN GENERAL.--There is established in the Treasury of the United States a trust fund to be known as the ''Health Benefit Plan Start-Up Fund'' (referred to in this section as the ''Start-Up Fund''), that shall consist of such amounts as may be appropriated or credited to the Start-Up section to provide loans for the initial operations of a community health insurance option. Such amounts shall remain available until expended.

(B) FUNDING.--There is hereby appropriated to the Start-Up Fund, out of any moneys in the Treasury not otherwise appropriated an amount requested by the Secretary of Health and Human Services as necessary to--

(i) pay the start-up costs associated with the initial operations of a community health insurance option; and

(ii) pay the costs of making payments on claims submitted during the period that is not more than 90 days from the date on which such option is offered.

(2)USE OF START-UP FUND.--The Secretary shall use amounts contained in the Start-Up Fundto make payments (subject to the repayment requirements in paragraph (4)) for the purposes described in paragraph (1)(B).

(3) PASS THROUGH OF REBATES.--The Secretary may establish procedures for reducing the amount of payments to a contracting administratorto take into account any rebates or price concessions.

(4) REPAYMENT.--

(A) IN GENERAL.--A community health insurance option shall be required to repay theSecretary of the Treasury (on such terms as the Secretary may require) for any payments made under paragraph (1)(B) by the date that is not later than 9 years after the date on which the payment is made. The Secretary may require the payment of interest with respect to such repayments at rates that do not exceed the market interest rate (as determined by the Secretary).

(B) SANCTIONS IN CASE OF FOR-PROFIT CONVERSION.--In any case in which the Secretary enters into a contract with a qualified entity for the offering of a community healthinsurance option and such entity is determined to be a for-profit entity by the Secretary, suchentity shall be--

(i) immediately liable to the Secretary for any payments received by such entity from the Start-Up Fund; and

(ii) permanently ineligible to offer a qualified health plan.

(d) STATE ADVISORY COUNCIL.--

(1) ESTABLISHMENT.--A State (other than a State that elects to opt out as provided for in subsection (a)(3)) shall establish or designate a public or non-profit private entity to serve as the State Advisory Council to provide recommendations to the Secretary on the operations and policies of a community health insurance option in the State. Such Council shall provide recommendations on at least the following:

(A) policies and procedures to integrate quality improvement and cost containmentmechanisms into the health care delivery system;

(B) mechanisms to facilitate public awareness of the availability of a community health insurance option; and

(C) alternative payment structures under a community health insurance option for health care providers that encourage quality improvement and cost control.

(2) MEMBERS.--The members of the State Advisory Council shall be representatives of the public and shall include health care consumers and providers.

(3) APPLICABILITY OF RECOMMENDATIONS.--The Secretary may apply the recommendations of a State Advisory Council to a community health insurance option in that State, in any other State, or in all States.

(e) AUTHORITY TO CONTRACT; TERMS OF CONTRACT.--

(1) AUTHORITY.--

(A) IN GENERAL.--The Secretary may enter into a contract or contracts with one or more qualified entities for the purpose of performing administrative functions (including functions described in subsection (a)(4) of section 1874A of the Social Security Act) with respect to a community health insurance option in the same manner as the Secretary may enter into contracts under subsection (a)(1) of such section. The Secretary shall have the same authority with respect to a community health insurance option under this section as the Secretary has under subsections (a)(1) and (b) of section 1874A of the Social Security Act with respect to title XVIII of such Act.

(B) REQUIREMENTS APPLY.--If the Secretary enters into a contract with a qualified entity to offer a community health insurance option, under such contract such entity--

(i) shall meet the criteria established under paragraph (2); and

(ii) shall receive an administrative fee under paragraph (7).

(C) LIMITATION.--Contracts under this subsection shall not involve the transfer of insurance risk to the contracting administrator.

(D) REFERENCE.--An entity with which the Secretary has entered into a contract under this paragraph shall be referred to as a ''contracting administrator''.

(2) QUALIFIED ENTITY.--To be qualified to be selected by the Secretary to offer a communityhealth insurance option, an entity shall--

(A) meet the criteria established under section 1874A(a)(2) of the Social Security Act;

(B) be a nonprofit entity for purposes of offering such option;

(C) meet the solvency standards applicable under subsection (b)(7);

(D) be eligible to offer health insurance or health benefits coverage;

(E) meet quality standards specified by the Secretary;

(F) have in place effective procedures to control fraud, abuse, and waste; and

(G) meet such other requirements as the Secretary may impose. Procedures described under subparagraph (F) shall include the implementation of procedures to use beneficiary identifiers to identify individuals entitled to benefits so that such an individual's social security account number is not used, and shall also include procedures for the use of technology (including front-end, prepayment intelligent data-matching technology similar to that used by hedge funds, investment funds, and banks) to provide real-timedata analysis of claims for payment under this title to identify and investigate unusual billing or order practices under this title that could indicate fraud or abuse.

(3) TERM.--A contract provided for under paragraph (1) shall be for a term of at least 5 years but not more than 10 years, as determined by the Secretary. At the end of each such term, the Secretary shall conduct a competitive bidding process for the purposes of renewing existing contracts or selecting new qualified entities with which to enter into contracts under such paragraph.

(4) LIMITATION.--A contract may not be renewed under this subsection unless the Secretary determines that the contracting administrator has met performance requirements established by the Secretary in the areas described in paragraph (7)(B).

(5) AUDITS.--The Inspector General shall conduct periodic audits with respect to contracting administrators under this subsection to ensure that theadministrator involved is in compliance with this section.

6) REVOCATION.--A contract awarded under this subsection shall be revoked by the Secretary, upon the recommendation of the Inspector General, only after notice to the contracting administrator involved and an opportunity for a hearing. The Secretary may revoke such contract if the Secretary determines that such administrator has engaged in fraud, deception, waste, abuse of power, negligence, mismanagement of taxpayer dollars, or gross mismanagement. An entity that has had a contract revoked under this paragraph shall not be qualified to enter into a subsequent contract under this subsection.

(7) FEE FOR ADMINISTRATION.

(A) IN GENERAL. The Secretary shall pay the contracting administrator a fee for the management, administration, and delivery of the benefits under this section.

(B) REQUIREMENT FOR HIGH QUALITY ADMINISTRATION. The Secretary may increase the fee described in subparagraph (A) by not more than 10 percent, or reduce the fee described in subparagraph (A) by not more than 50 percent, based on the extent to which the contracting administrator, in the determination of the Secretary, meets performance requirements established by the Secretary, in at least the following areas:

(i) Maintaining low premium costs and low cost sharing requirements, provided that such requirements are consistent with section 1302.

(ii) Reducing administrative costs and promoting administrative simplification for beneficiaries. (iii) Promoting high quality clinical care.

(iv) Providing high quality customer service to beneficiaries. 

(C) NON-RENEWAL. The Secretary may not renew a contract to offer a community health insurance option under this section with any contracting entity that has been assessed more than one reduction under subparagraph (B) during the contract period.

(8) LIMITATION. Notwithstanding the terms of a contract under this subsection, the Secretary shall negotiate the reimbursement rates for purposes of subsection (b)(6).

(f) REPORT BY HHS AND INSOLVENCY WARNINGS.

(1) IN GENERAL. On an annual basis, the Secretary shall conduct a study on the solvency of a community health insurance option and submit to Congress a report describing the results of such study.

(2) RESULT. If, in any year, the result of the study under paragraph (1) is that a community health insurance option is insolvent, such result shall be treated as a community health insurance option solvency warning.

(3) SUBMISSION OF PLAN AND PROCEDURE.

(A) IN GENERAL. If there is a community health insurance option solvency warning under paragraph (2) made in a year, the President shall submit to Congress, within the 15-day period beginning on the date of the budget submission to Congress under section 1105 (a) of title 31, United States Code, for the succeeding year, proposed legislation to respond to such warning.

(B) PROCEDURE. In the case of a legislative proposal submitted by the President pursuant to subparagraph (A), such proposal shall be considered by Congress using the same procedures described under sections 803 and 804 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 that shall be used for a medicare funding warning.

(g) MARKETING PARITY. In a facility controlled by the Federal Government, or by a State, where marketing or promotional materials related to a community health insurance option are made available to the public, making available marketing or promotional materials relating to private health insurance plans shall not be prohibited. Such materials include informational pamphlets, guide books, enrollment forms, or other materials determined reasonable for display.

(h) AUTHORIZATION OF APPROPRIATIONS. There is authorized to be appropriated such sums as may be necessary to carry out this section.

SEC. 1324. LEVEL PLAYING FIELD.

(A) IN GENERAL. Notwithstanding any other provision of law, any health insurance coverage offered by a private health insurance issuer shall not be subject to any Federal or State law described in subsection (b) if a qualified health plan offered under the Consumer Operated and Oriented Plan program under section 1322, a community health insurance option under section 1323, or a nationwide qualified health plan under section 1333 (b), is not subject to such law.

(B) LAWS DESCRIBED. The Federal and State laws described in this subsection are those Federal and State laws relating to

(1) guaranteed renewal;

(2) rating;

(3) preexisting conditions;

(4) non-discrimination;

(5) quality improvement and reporting;

(6) fraud and abuse;

(7) solvency and financial requirements;

(8) market conduct;

(9) prompt payment;

(10) appeals and grievances;

(11) privacy and confidentiality;

(12) licensure; and

(13) benefit plan material or information.

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ObamaCare doesn't really start till 2013, but we have to start paying HEAVY taxation for it starting NEXT YEAR. Someone on here the other day made some stupid remark to the tune of "How many more Americans had to die while we waited for Snowe to vote for the bill?" I had to explain to the idiot that however many "Americans died" would still be dead cause this BS doesn't start for THREE YEARS.

TOP 14 PROVISIONS THAT TAKE EFFECT IMMEDIATELY

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE -- Reduces the donut hole by $500 and institutes a 50% discount on brand-name drugs, effective January 1, 2010.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) -- Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.

3. BANS LIFETIME LIMITS ON COVERAGE--Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS--Prohibits insurers from nullifying or rescinding a patient's policy when they file a claim for benefits, except in the case of fraud.

5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS' INSURANCE-- Requires health plans to allow young people through age 26 to remain on their parents' insurance policy, at the parents' choice.

6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE--Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES--Improves the low-income protection programs in Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE-- Prohibits Medicare Advantage plans from charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

9. IMMEDIATE SUNSHINE ON PRICE GOUGING--Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.

10. CONTINUITY FOR DISPLACED WORKERS--Allows Americans to keep their COBRA coverage until the Exchange is in place and they can access affordable coverage.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM--Creates a long-term care insurance program to be financed by voluntary payroll deductions to  provide benefits to adults who become functionally disabled.

12. HELP FOR EARLY RETIREES--Creates a $10 billion fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

13. COMMUNITY HEALTH CENTERS--Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS -- Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.

c-span.org/pdf/health102909_housebill03.pdf

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1965-2009
		1965: President Johnson signed H.R. 6675 to establish Medicare for the elderly in Missouri. President Truman was the first to enroll in Medicare.

January 1965: President Johnson's first legislative message to the 89th Congress, Advancing the Nation's Health, detailed a program including hospital insurance for the aged under Social Security and health care for needy children.

March-July 1965: The House of Representatives (307-116) and the Senate (70-24) passed "the Mills Bill" (H.R. 6675), a package of health benefits and Social Security improvements.

July 30, 1965: President Johnson signed H.R. 6675 (Public Law 89-97) to establish Medicare for the elderly and Medicaid for the indigent in Independence, Missouri, in the presence of Harry S. Truman who advocated for such legislation in a message to Congress in 1945. Presidential remarks during signing ceremony

1965: President Truman was the first to enroll in Medicare.

1965: • Medicare Part A deductible: $40/year • Medicare Part B premium: $3/month

1966: The Social Security Administration announced the selection of private insurance companies to perform the major administrative functions of bill processing and benefit payment functions for Part A (Hospital Insurance) and Part B (Supplementary Medical Insurance) of the Medicare program.

July 1, 1966: Medicare coverage began. All persons age 65 and over were automatically covered under Part A. Coverage began for seniors who signed up for the voluntary medical insurance program (Part B). More than 19 million individuals ages 65 and older were enrolled in Medicare.

1969: The Task Force on Prescription Drugs, chaired by Dr. Philip Lee, released its final report on the costs and feasibility of adding prescription drug coverage to Medicare.

1970: • Medicare Part A deductible: $52/year • Medicare Part B premium: $4/month • Total Medicare population: 20.4 million beneficiaries

1972: October 30, 1972 President Nixon signed the Social Security Amendments of 1972 (PL 92-603), the first major adjustment to Medicare after its enactment. Medicare eligibility was extended to individuals under age 65 with long-term disabilities (who were receiving SSDI payments for two years) and to individuals with end-stage renal disease (ESRD). The amendments also established professional standards review organizations (PSROs) to review patient care, encouraged the use of health maintenance organizations (HMOs), and gave Medicare the authority to conduct demonstration programs.

1972: Medicare benefits were expanded to include some chiropractic services, speech therapy, and physical therapy.

1973: Medicare coverage began for individuals receiving Social Security Disability Insurance (SSDI) cash payments for two or more years. Nearly 2 million people under age 65 with long-term disabilities or ESRD were covered.

1975: • Medicare Part A deductible: $92/year • Medicare Part B premium: $6.70/month • Total Medicare population: 24.9 million beneficiaries

1977: Joe Califano, Secretary of the Department of Health, Education and Welfare, created the Health Care Financing Administration (HCFA) to administer both the Medicare and Medicaid programs. About 1,500 employees were transferred to HCFA from the Social Security Administration. Interview with Joe Califano on the establishment of HCFA

1980: The Omnibus Reconciliation Act of 1980 expanded home health services by eliminating the limit on the number of home health visits, the prior hospitalization requirement, and the deductible for any Part B benefits. It also required the Secretary to develop a list of surgical procedures that could be done on an outpatient basis in an ambulatory surgical center and would be reimbursed on a prospective payment system. The "Baucus Amendments" brought Medicare supplemental insurance, also called "Medigap," under federal oversight and established a voluntary certification program for Medigap policies.

1980: • Medicare Part A deductible: $180/year • Medicare Part B premium: $8.70/month • Total Medicare population: 28.4 million beneficiaries

1981: The Omnibus Budget Reconciliation Act of 1981 (OBRA 1981) included provisions to slow the growth in Medicare spending, including a change that resulted in an increase in the inpatient hospital deductible.

1982: The Tax Equity and Fiscal Responsibility Act (TEFRA) increased the Part B premium to cover 25% of program costs as part of policies designed to slow the growth of Medicare spending. Hospice services for the terminally ill were added to Medicare's covered benefits. TEFRA facilitated HMOs' participation in the Medicare program and established a risk-based prospective payment system for these plans. The Act also expanded HCFA's quality oversight efforts by replacing Professional Standards Review Organizations (PSROs) with Peer Review Organizations (PROs). TEFRA imposed a ceiling on the amount Medicare would pay for a hospital discharge and required HHS to submit a plan for prospective payments to hospitals and nursing homes. TEFRA required federal employees to begin paying the HI payroll tax.

1983: The Social Security amendments of 1983 established an inpatient hospital prospective payment system (PPS) for the Medicare program. The PPS is based on diagnosis-related groups, or DRGs, a pre-determined payment for treating a specific condition. The system was adopted to replace cost-based payments.

1984: The Deficit Reduction Act of 1984 (DEFRA) froze physician fees, established the Participating Physicians' Program, and established fee schedules for laboratory services, all of which were intended to slow the growth of Medicare's spending and constrain the federal deficit.

1985: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) made Medicare coverage mandatory for newly hired state and local government employees. In addition, COBRA established the Emergency Medical Treatment and Labor Act (EMTALA), which required hospitals participating in Medicare operating active emergency rooms to provide appropriate medical screenings and stabilizing treatments.

1985: The Emergency Extension Act of 1985 froze PPS payment rates for inpatient hospital care and continued physician payment freezes to slow the growth of Medicare spending.

1985: • Medicare Part A deductible: $400/year • Medicare Part B premium: $15.50/month • Total Medicare population: 31.1 million beneficiaries

1986: The Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) revised several of the payment procedures for various Medicare services in order to help slow the growth in Medicare spending.

1987: The Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) imposed quality standards for Medicare- and Medicaid-certified nursing homes - in response to well-documented quality problems facing seniors in nursing homes. OBRA 87 also modified payments to providers under Medicare as part of the deficit reduction legislation.

1987: The Medicare and Medicaid Patient and Program Protection Act of 1987 was enacted to improve antifraud efforts and strengthen beneficiary protection programs.

1987: The Balanced Budget and Emergency Deficit Control Reaffirmation Act of 1987 froze Medicare payment rates in an attempt to slow Medicare spending.

1988: The Medicare Catastrophic Coverage Act of 1988, the largest expansion of the program since the enactment of Medicare, included an outpatient prescription drug benefit and a cap on beneficiaries' out-of-pocket expenses, and expanded hospital and skilled nursing facility benefits. Medicaid began coverage of Medicare premiums and cost-sharing for Medicare beneficiaries with incomes below 100% of the federal poverty level, known as Qualified Medicare Beneficiaries (QMB). The U.S. Bipartisan Commission on Comprehensive Health Care (which became known as "Pepper" Commission after the late Congressman Claude Pepper of Florida) was established to assess the feasibility of a long-term care benefit under Medicare. Detailed summary of the Medicare Catastrophic Coverage Act of 1988

1988: Clinical Laboratory Improvement Amendments were enacted to strengthen quality performance requirements for clinical laboratories to provide more accurate and reliable laboratory tests.

1989: The Medicare Catastrophic Coverage Repeal Act of 1989 retracted the major provisions of the 1988 Medicare Catastrophic Coverage Act, including both the outpatient drug benefit and the out-of-pocket limit. QMB benefits were retained.

1989: The Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) established the Resource-Based Relative Value Scale (RBRVS) for physicians, replacing charge-based payments. Limits were placed on physician balance billing. Physicians were prohibited from referring Medicare patients to clinical laboratories in which they have a financial interest. OBRA 1989 also included a number of other provisions designed to slow the growth in Medicare spending.

1990: The Omnibus Budget Reconciliation Act of 1990 (OBRA 1990) established the Specified Low-Income Medicare Beneficiary (SLMB) eligibility group requiring state Medicaid programs to cover premiums for beneficiaries with incomes between 100% and 120% of the federal poverty level. Medicare was expanded to cover screening mammography and partial hospitalization services in community mental health centers. Federal standards were established for Medigap policies, including standardized benefit packages and minimum loss ratios, replacing the voluntary certification system.

1990: The U.S. Bipartisan Commission on Comprehensive Health Care (the "Pepper Commission") recommended the creation of a new Medicare long-term care program that would provide nursing home and home- and community-based services. These recommendations were not enacted.

1990: • Medicare Part A deductible: $592/year • Medicare Part B premium: $28.60/month • Total Medicare population: 34.3 million beneficiaries

1993: The Omnibus Budget Reconciliation Act of 1993 modified payments to Medicare providers, as part of overall deficit reduction legislation, and lifted the cap on wages subject to the HI payroll tax.

1993: States started to cover Medicare Part B premiums for SLMBs.

1995: • Medicare Part A deductible: $716/year • Medicare Part B premium: $46.10/month • Total Medicare population: 37.6 million beneficiaries

1996: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established the Medicare Integrity Program, which dedicated funds for program integrity activities.

1997: The Balanced Budget Act of 1997 (BBA) included a broad range of changes in provider payments to slow the growth in Medicare spending as part of the legislation to balance the federal budget. It also established the Medicare+Choice program, a new structure for Medicare HMOs and other private health plans offered to beneficiaries. The BBA also required HCFA to develop and implement five new Medicare prospective payment systems: inpatient rehabilitation hospital or unit services; skilled nursing facility services; home health services; hospital outpatient services; and outpatient rehabilitation services. The law also provided additional assistance with Medicare Part B premiums for beneficiaries with incomes between 120% and 135% of poverty (QI-1s) through a first-come first-serve block grant program administered by state Medicaid programs. The law provided for partial assistance with premiums for beneficiaries with incomes between 135% and 175% of poverty (QI-2s). The BBA also established the National Advisory Commission on the Future of Medicare and the Medicare Payment Advisory Commission (which replaced both the Prospective Payment Assessment Commission and the Physician Payment Review Commission).

1998: The internet site www.Medicare.gov was launched to provide updated information about Medicare. View Medicare.gov

1999: The toll-free number, 1-800-MEDICARE (1-800-633-4227), was made available nationwide. The first annual Medicare & You handbook was mailed to all Medicare beneficiary households.

1999: The Ticket to Work and Work Incentives Improvements Act of 1999 (TWWIIA) expanded the availability of Medicare and Medicaid for certain disabled beneficiaries who return to work.

1999: The Balanced Budget Refinement Act of 1999 (BBRA) increased payments for some Medicare providers and reduced or froze payment rates for other Medicare services. BBRA also increased payments to Medicare+Choice plans.

1999: The National Advisory Commission on the Future of Medicare completed its work on Medicare reform, but lacked sufficient votes to report out a formal recommendation.

2000: The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 further increased Medicare payments to providers and Medicare+Choice plans, reduced certain Medicare beneficiary copayments, and added covered preventive services. BIPA also enabled people with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) to enroll in Medicare upon diagnosis instead of having to satisfy the 24-month waiting period.

2000: • Medicare Part A deductible: $776/year • Medicare Part B premium: $54.40/month • Total Medicare population: 39.7 million beneficiaries

2001: Secretary of Health and Human Services, Tommy Thompson, renamed HCFA, which became the Centers for Medicare and Medicaid Services (CMS).

2001: Medicare began covering people with ALS.

2002: The Public Health Security and Bioterrorism Preparedness and Response Act of 2002, along with other public health measures, temporarily moved deadlines for submitting Medicare+Choice plan information. The law stated that in 2005, individuals enrolled in M+C plans would only be able to make and change elections to an M+C plan on a more limited basis, which was later changed by the Medicare Modernization Act of 2003.

2003: The Consolidated Appropriations Resolution (CAR) of 2003 increased payments for some hospitals, updated the physician fee schedule, and extended payment of the Part B premium for QI-1.

2003: QI-2 beneficiaries no longer received assistance from Medicaid in paying their Part B premiums.

2003: December 8, 2003 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) was passed by the House (220-215) and the Senate (54-44) in November and signed into law (Public Law 108-173) by President Bush on December 8, 2003, providing a new outpatient prescription drug benefit under Medicare beginning in 2006. In the interim, it created a temporary prescription drug discount card and transitional assistance program. The MMA also established a new income-related Part B premium for beneficiaries with higher incomes (beginning in 2007), indexed the Part B deductible, created regional PPOs under the Medicare Advantage program (previously named Medicare+Choice), along with financial and other incentives for private health plans to contract with Medicare. The MMA also established a new way of assessing Medicare's financial status by looking at general revenues as a share of total Medicare spending. Presidential remarks during the signing ceremony

2004: A temporary Medicare-Approved Drug Discount Card Program began along with a transitional assistance program to provide a $600 annual credit to low-income Medicare beneficiaries without prescription drug coverage in 2004 and 2005.

2005: Medicare begins covering a "Welcome to Medicare" physical, along with other preventive services, such as cardiovascular screening blood tests and diabetes screening tests. Medicare begins education and outreach activities to implement the 2006 prescription drug benefit. Learn more facts about Medicare

2005: • Medicare Part A deductible: $912/year • Medicare Part B premium: $78.20/month • Total Medicare population: 42.3 million beneficiaries Learn more facts about Medicare

Actually, its greatest point of vulnerability will be the 2012 election, since much of it doesn't take effect until 2013. The mandates that will drive up costs will take effect before then--young people will pay much more since premiums will be equalized for all age groups and private companies will have to cover even sick people. Since there will be no opt-out or no competition, they will be able to charge whatever they want.

By 2012, the exchanges that will get small business owners and employees insured are not supposed to be set up. So basically, all the politically and economically costly things go into effect first, and the beneficial things (insuring people and taking burdens off small business) will not have materialized. It's perfect for demonization.

The mandates that will drive up costs will take effect before then--young people will pay much more since premiums will be equalized for all age groups and private companies will have to cover even sick people. Since there will be no opt-out or no competition, they will be able to charge whatever they want.

H.R. 3962

• Expand Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 150% FPL. Provide Medicaid coverage for all newborns who lack acceptable coverage and provide optional Medicaid coverage to low-income HIV-infected individuals (with enhanced matching funds) until 2013 and for family planning services to certain low-income women. In addition, increase Medicaid payment rates for primary care providers to 100% of Medicare rates by 2012. Require states to submit a state plan amendment specifying the payment rates to be paid under the state's Medicaid program. The coverage expansions (except the optional expansions) and the enhanced provider payments will be financed with 100% federal financing through 2014 and 91% federal financing beginning in year 2015. (Effective January 1, 2013)
• Repeal the Children's Health Insurance Program (CHIP) and require CHIP enrollees with incomes above 150% FPL to obtain coverage through the Health Insurance Exchange beginning in 2014. CHIP enrollees with incomes between 100% and 150% FPL would be transitioned to Medicaid and states would receive the CHIP enhanced match rate for children above current levels and up to 150% FPL. Require a report to Congress with recommendations to ensure that coverage in the Health Insurance Exchange is comparable to coverage under an average CHIP plan and that there are procedures to transfer CHIP enrollees into the exchange without interrupting coverage or with a written plan of treatment. (Report due by December 31, 2011)

Baucus Bill:

• Expand Medicaid to all individuals (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL (to be implemented in 2014). Adults with incomes between 100-133% FPL will have the option of obtaining coverage through Medicaid or with federal subsidies through the exchange. All newly eligible adults will be guaranteed a benchmark benefit package that at least meets the minimum creditable coverage standards. Require states to provide premium assistance to any Medicaid beneficiary with access to employer-sponsored insurance if it is cost-effective for the state. To finance the coverage for the newly eligible (those who were not previously eligible for a full benchmark benefit package or who were eligible for a capped program but were not enrolled), states will receive an increase in the federal medical assistance percentage (FMAP). Initially, the percentage point increase in the FMAP will be 27.3 for states that already cover adults with incomes above 100% FPL and 37.3 for other states. These percentage point increases will be adjusted over time so that by 2019, all states will receive an FMAP increase of 32.3 percentage points for the newly eligible. High need states--those with total Medicaid enrollment that is below the national average for enrollment as a percentage of the state population and unemployment rates of 12% or higher for August 2009--will receive full federal funding for the newly eligible for five years.
• Require states to maintain current income eligibility levels for children in Medicaid and the Children's Health Insurance Program (CHIP) until 2019. CHIP benefit package and cost-sharing rules will continue as under current law. Beginning in 2014, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100% and a .15 percentage point increase in the Medicaid match rate. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state exchanges.

H.R. 3962

• Establish a temporary national high-risk pool to provide health coverage to individuals (and spouses and dependents) with pre-existing medical conditions. Individuals who have been denied coverage, offered unaffordable coverage, have an eligible medical condition or who have been uninsured for at least six months will be eligible to enroll in the national high-risk pool. Premiums for the high-risk pool will be set at not higher than 125% of the prevailing rate for comparable coverage in the state and could vary by no more than 2:1 due to age; annual deductibles will be limited to $1,500 for an individual; and maximum cost-sharing will be limited to $5,000 for individuals. (Effective January 1, 2010 and until the Health Insurance Exchange is established)
• Individuals eligible for COBRA continuation coverage may retain COBRA coverage until the Exchange is established or they obtain acceptable coverage. (Effective upon enactment)
• Limit health plans' medical loss ratio to not less than 85% to be enforced through a rebate back to consumers and prohibit plans from imposing aggregate dollar lifetime limits on coverage. (Effective January 1, 2010) Prohibit insurers from rescinding coverage except in cases of fraud. (Effective July 1, 2010)
• Adopt standards for financial and administrative transactions to promote administrative simplification. (Effective upon enactment)
• Require review of increases in health insurance premiums prior to implementation of the increases. (Effective upon enactment)
• Provide dependent coverage for children up to age 27 for all individual and group policies. (Effective January 1, 2010)
• Limit pre-existing condition exclusions for group policies prior to implementation of the insurance market reforms by shortening the period plans can look back for pre-existing conditions from six months to 30 days and shortening the period plans can exclude coverage of certain benefits from 12 months to three months. (Effective January 1, 2010)
• Prohibit reductions to retiree benefits unless reductions also apply to current employees. (Effective upon enactment)
• Prohibit coverage purchased through the individual market from qualifying as acceptable coverage for purposes of the individual mandate unless it is grandfathered coverage. Individuals can purchase a qualifying health benefit plan through the Health Insurance Exchange. (Effective January 1, 2013)
• Impose the same insurance market regulations relating to guarantee issue, premium rating, and prohibitions on pre-existing condition exclusions in the insured group market and in the Exchange. (See creation of insurance pooling mechanisms). (Effective January 1, 2013)
• Improve consumer protections by establishing uniform marketing standards, requiring fair grievance and appeals mechanisms and accurate and timely disclosure of plan information. (Effective January 1, 2013)
• Create the Health Choices Administration to establish the qualifying health benefits standards, establish the Exchange, administer the affordability credits, and enforce the requirements for qualified health benefit plan offering entities, including those participating in the Exchange or outside the Exchange.
• Permit states to form Health Care Choice Compacts to facilitate the purchase of individual insurance across state lines. (Effective January 1, 2015)
• Remove the anti-trust exemption for health insurers and medical malpractice insurers. (Effective upon enactment)

Baucus Bill (No dates set for implemetation):

• Impose the same insurance market regulations relating to guarantee issue, premium rating, prohibitions on pre-existing condition exclusions, risk adjustment, and rescissions in the individual market, in the exchange, and in the small group market, phasing in the new rules for small group market over five years. (See new rating and market rules in Creation of insurance pooling mechanism.)
• Require health plans to report the proportion of premium dollars spent on items other than medical care and require plans to compile information on coverage in a standard format.
• Require all new policies (except stand-alone dental, vision, and long-term care insurance plans) to comply with one of the four benefit categories, including those offered through the exchanges and those offered outside of the exchanges. Require health plans in the individual and small group markets to at least offer coverage in the silver and gold categories. Existing individual and employer-sponsored plans do not have to meet the new benefit standards. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Require small employers to provide a plan with a deductible that does not exceed $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits. This deductible limit will not affect the actuarial value of bronze plans and does not apply to "young invincible" plans. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Allow states the option of merging the individual and small group markets.
• Create a temporary reinsurance program to help stabilize premiums during the first three years of operation of the exchanges when the risk of adverse selection due to enforcement of the new rating rules and market changes is greatest. Finance the reinsurance program through mandatory contributions by health insurers.
• Allow insurers to offer a national health plan with a uniform benefits package in the states in which they are licensed.  National plans would be required to offer plans with silver and gold benefit packages and would be exempt from state benefit requirements. Allow states to opt out of the national plan.
• Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.

H.R. 3962

• Create an essential benefits package that provides a comprehensive set of services, covers 70% of the actuarial value of the covered benefits, limits annual cost-sharing to $5,000/individual and $10,000/family, does not require cost-sharing for preventive services, and does not impose annual or lifetime limits on coverage. The Health Benefits Advisory Council, chaired by the Surgeon General, will make recommendations on specific services to be covered by the essential benefits package as well as cost-sharing levels. Prohibit abortion coverage from being required as part of the essential benefits package; require segregation of public subsidy funds from private premiums payments for plans that choose to cover abortion services beyond those for which public funding is permitted (public funding of abortions is permitted to save the life of the woman and in cases of rape or incest); and require there be no effect on state or federal laws on abortions. (Health Benefits Advisory Council report due one year following enactment; essential benefits package becomes effective January 1, 2013)
• All qualified health benefits plans, including those offered through the Exchange and those offered outside of the Exchange (except certain grandfathered individual and employer-sponsored plans) must provide at least the essential benefits package. (Effective January 1, 2013)
• Require a report on including oral health benefits in the essential benefits package. (Report due one year following enactment)

Baucus Bill (No dates set for implementation):

• Create minimum creditable coverage that provides a comprehensive set of services, covers 65% of the actuarial value of the covered benefits, limits annual cost-sharing to $5,950/individual and $11,900/family, does not impose annual or lifetime limits on coverage, and is not more extensive than the typical employer plan. Require the Secretary to define and annually update the benefit package through a transparent and public process. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Prohibit abortion coverage from being required as part of the minimum benefits package; require segregation of public subsidy funds from private premium payments for plans that choose to cover abortion services beyond Hyde--which allows coverage for abortion services to save the life of the woman and in cases of rape or incest; and require there be no effect on state or federal laws on abortions.

H.R. 3962

• Require all individuals to have "acceptable health coverage". Those without coverage pay a penalty of 2.5% of their adjusted income above the filing threshold up to the cost of the average national premium for self-only or family coverage under a basic plan in the Health Insurance Exchange. Exceptions granted for those with incomes below the filing threshold (in 2009 the threshold for taxpayers under age 65 is $9,350 for singles and $18,700 for couples), religious objections and financial hardship. (Effective January 1, 2013)

Baucus Bill:

• Require U.S. citizens and legal residents to have qualifying health coverage. Enforced through a tax penalty of $750 per adult per year. The penalty will be phased-in according to the following schedule: $0 in 2013; $200 in 2014; $400 in 2015; $600 in 2016; and $750 in 2017. Exemptions will be granted for financial hardship, religious objections, American Indians, and if the lowest cost plan option exceeds 8% of an individual's income or if the individual has income below 133% of the poverty level.

H.R. 3962

• Provide small employers with fewer than 25 employees and average wages of less than $40,000 with a health coverage tax credit for up to two years. The full credit of 50% of premium costs paid by employers is available to employers with 10 or fewer employees and average annual wages of $20,000 or less. The credit phases-out as firm size and average wage increases and is not permitted for employees earning more than $80,000 per year. (Effective January 1, 2013)
• Create a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. Program will reimburse employers for 80% of retiree claims between $15,000 and $90,000. Payments from the reinsurance program will be used to lower the costs for enrollees in the employer plan. Appropriate $10 billion over ten years for the reinsurance program. (Effective 90 days after enactment)

Baucus Bill:

• Provide small employers with fewer than 25 employees and average annual wages of less than $40,000 that purchase health insurance for employees with a tax credit.
• Phase I : For tax years 2011 and 2012, provide a tax credit of up to 35% of the employer's contribution toward the employee's health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $20,000. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 25% of the employer's contribution toward the employee's health insurance premium.
• Phase II : For tax years 2013 and later, for eligible small businesses that purchase coverage through the state exchange, provide a tax credit of up to 50% of the employer's contribution toward the employee's health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. The credit will be available for two years. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $20,000. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 35% of the employer's contribution toward the employee's health insurance premium.
• Create a temporary reinsurance program for employers providing health insurance coverage to retirees ages 55 to 64. Program will reimburse employers or insurers for 80% of retiree claims between $15,000 and $90,000. Appropriate $5 billion to finance the program.

On Saturday, October 24, the Washington Post published an article which said in passing that the "public option" will be run by insurance companies. "The public option would effectively be just another insurance plan offered on the open market," said the article. "It would likely be administered by a private insurance provider, charging premiums and copayments like any other policy." To my knowledge, that is the first time any media outlet or blog, with the exception of the blog maintained by Physicians for a National Health Program, has warned the public that the "public option" will be run by private corporations, not public employees.

 Destor ... Raised an issue . . .

You may find Destor's comment posted yesterday in this thread:

"This isn't a public option because it's not open to everyone. If your employer offers you insurance, you're stuck with that. What does this do to free the millions of Americans from entrapment by the for-profit health insurance system?"

I realize that many commentators have suggested that the public option will be available to only a few people.

But this just isn't true.

The uninsured, the self-employed and those who work for very small companies will be eligible to sign up. (In the first year "small companies "means 10 or fewer employees, but by the second year, it includes companies with 30 or fewer employers--a large group of workers.)

Moreover--and this is what has been overlooked, the House bill (HR 3200, which includes the most detail on the public option) makes it clear that if you are temporarily uninsured (in between jobs, etc) you are eligible to go the Insurance Exchange and choose a plan (either a private plan or the public option).

In addition--and this is very important-- even if your circumstances change (you get a job and have access to good insurance) you can stay in the Exchange until you're 65 and qualify for Medicare. (See section 202 of House Bill)

SEC. 202. EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS.

(a) Access to Coverage- In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

(b) Definitions- In this division:

(1) EXCHANGE-ELIGIBLE INDIVIDUAL- The term `Exchange-eligible individual' means an individual who is eligible under this section to be enrolled through the Health Insurance Exchange in an Exchange-participating health benefits plan and, with respect to family coverage, includes dependents of such individual.

(2) EXCHANGE-ELIGIBLE EMPLOYER- The term `Exchange-eligible employer' means an employer that is eligible under this section to enroll through the Health Insurance Exchange employees of the employer (and their dependents) in Exchange-eligible health benefits plans.

(3) EMPLOYMENT-RELATED DEFINITIONS- The terms `employer', `employee', `full-time employee', and `part-time employee' have the meanings given such terms by the Commissioner for purposes of this division.

(c) Transition- Individuals and employers shall only be eligible to enroll or participate in the Health Insurance Exchange in accordance with the following transition schedule:

(1) FIRST YEAR- In Y1 (as defined in section 100(c))--

(A) individuals described in subsection (d)(1), including individuals described in paragraphs (3), (4), and (5) of subsection (d); and

(B) smallest employers described in subsection (e)(1).

(2) SECOND YEAR- In Y2--

(A) individuals and employers described in paragraph (1); and

(B) smaller employers described in subsection (e)(2).

(3) THIRD YEAR- In Y3--

(A) individuals and employers described in paragraph (2);

(B) larger employers described in subsection (e)(3); and

(C) largest employers as permitted by the Commissioner under subsection (e)(4).

(4) FOURTH AND SUBSEQUENT YEARS- In Y4 and subsequent years--

(A) individuals and employers described in paragraph (3); and

(B) largest employers as permitted by the Commissioner under subsection (e)(4).

(d) Individuals-

(1) INDIVIDUAL DESCRIBED- Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who--

(A) is not enrolled in coverage described in subparagraphs (C) through (F) of paragraph (2); and

(B) is not enrolled in coverage as a full-time employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 312.

For purposes of subparagraph (B), in the case of an individual who is self-employed, who has at least 1 employee, and who meets the requirements of section 312, such individual shall be deemed a full-time employee described in such subparagraph.

(2) ACCEPTABLE COVERAGE- For purposes of this division, the term `acceptable coverage' means any of the following:

(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE- Coverage under a qualified health benefits plan.

(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN- Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102) or under a current group health plan (described in subsection (b) of such section).

(C) MEDICARE- Coverage under part A of title XVIII of the Social Security Act.

(D) MEDICAID- Coverage for medical assistance under title XIX of the Social Security Act, excluding such coverage that is only available because of the application of subsection (u), (z), or (aa) of section 1902 of such Act

(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE)- Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.

(F) VA- Coverage under the veteran's health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Commissioner in coordination with the Secretary of Treasury to be not less than a level specified by the Commissioner and Secretary of Veteran's Affairs, in coordination with the Secretary of Treasury, based on the individual's priority for services as provided under section 1705(a) of such title.

(G) OTHER COVERAGE- Such other health benefits coverage, such as a State health benefits risk pool, as the Commissioner, in coordination with the Secretary of the Treasury, recognizes for purposes of this paragraph.

The Commissioner shall make determinations under this paragraph in coordination with the Secretary of the Treasury.

(3) TREATMENT OF CERTAIN NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS- An individual who is a non-traditional Medicaid eligible individual (as defined in section 205(e)(4)(C)) in a State may be an Exchange-eligible individual if the individual was enrolled in a qualified health benefits plan, grandfathered health insurance coverage, or current group health plan during the 6 months before the individual became a non-traditional Medicaid eligible individual. During the period in which such an individual has chosen to enroll in an Exchange-participating health benefits plan, the individual is not also eligible for medical assistance under Medicaid.

(4) CONTINUING ELIGIBILITY PERMITTED-

(A) IN GENERAL- Except as provided in subparagraph (B), once an individual qualifies as an Exchange-eligible individual under this subsection (including as an employee or dependent of an employee of an Exchange-eligible employer) and enrolls under an Exchange-participating health benefits plan through the Health Insurance Exchange, the individual shall continue to be treated as an Exchange-eligible individual until the individual is no longer enrolled with an Exchange-participating health benefits plan.

(B) EXCEPTIONS-

(i) IN GENERAL- Subparagraph (A) shall not apply to an individual once the individual becomes eligible for coverage--

(I) under part A of the Medicare program;

(II) under the Medicaid program as a Medicaid eligible individual, except as permitted under paragraph (3) or clause (ii); or

(III) in such other circumstances as the Commissioner may provide.

(ii) TRANSITION PERIOD- In the case described in clause (i)(II), the Commissioner shall permit the individual to continue treatment under subparagraph (A) until such limited time as the Commissioner determines it is administratively feasible, consistent with minimizing disruption in the individual's access to health care.

(5) ADVERSELY AFFECTED RETIREE HEALTH BENEFITS GROUP PARTICIPANTS AND BENEFICIARIES-

(A) IN GENERAL- Beginning in Y1, an individual who is a participant or beneficiary in an adversely affected retiree health benefits group who does not have coverage described in paragraph (2)(C) is an Exchange eligible individual, whether or not such an individual has other acceptable coverage.

(B) ADVERAGE AFFECTED RETIREE HEALTH BENEFIT GROUP DEFINED- In this paragraph, the term `adversely affected retiree health benefits group' means the retired participants and their beneficiaries of a group health plan that cancelled or substantially reduced the amount, type, level, or form of health benefit or option provided prior January 1, 2008.

(e) Employers-

(1) SMALLEST EMPLOYERS- Subject to paragraph (5), smallest employers described in this paragraph are employers with 15 or fewer employees.

(2) SMALLER EMPLOYERS- Subject to paragraph (5), smaller employers described in this paragraph are employers that are not smallest employers described in paragraph (1) and that have 25 or fewer employees.

(3) LARGER EMPLOYERS- Subject to paragraph (5), larger employers described in this paragraph are employers that are not smallest employers described in paragraph (1) or smaller employers described in paragraph (2) and that have 50 or fewer employees.

(4) LARGEST EMPLOYERS-

(A) IN GENERAL- Beginning with Y3, the Commissioner may permit employers not described in paragraphs (1) (2), or (3) to be Exchange-eligible employers.

(B) PHASE-IN- In applying subparagraph (A), the Commissioner may phase-in the application of such subparagraph based on the number of full-time employees of an employer and such other considerations as the Commissioner deems appropriate.

(5) CONTINUING ELIGIBILITY- Once an employer is permitted to be an Exchange-eligible employer under this subsection and enrolls employees through the Health Insurance Exchange, the employer shall continue to be treated as an Exchange-eligible employer for each subsequent plan year regardless of the number of employees involved unless and until the employer meets the requirement of section 311(a) through paragraph (1) of such section by offering a group health plan and not through offering Exchange-participating health benefits plan.

(6) EMPLOYER PARTICIPATION AND CONTRIBUTIONS-

(A) SATISFACTION OF EMPLOYER RESPONSIBILITY- For any year in which an employer is an Exchange-eligible employer, such employer may meet the requirements of section 312 with respect to employees of such employer by offering such employees the option of enrolling with Exchange-participating health benefits plans through the Health Insurance Exchange consistent with the provisions of subtitle B of title III.

(B) EMPLOYEE CHOICE- Any employee offered Exchange-participating health benefits plans by the employer of such employee under subparagraph (A) may choose coverage under any such plan. That choice includes, with respect to family coverage, coverage of the dependents of such employee.

(7) AFFILIATED GROUPS- Any employer which is part of a group of employers who are treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated, for purposes of this subtitle, as a single employer.

(8) OTHER COUNTING RULES- The Commissioner shall establish rules relating to how employees are counted for purposes of carrying out this subsection.

(9) TREATMENT OF MULTIEMPLOYER PLANS- The plan sponsor of a group health plan (as defined in section 733(a) of the Employee Retirement Income Security Act of 1974) that is multiemployer plan (as defined in section 3(37) of such Act) may obtain health insurance coverage with respect to participants in the plan through the Exchange to the same extent as an employer not described in paragraph (1) or (2) is permitted by the Commissioner to obtain health insurance coverage through the Exchange as an Exchange-eligible employer

(f) Special Situation Authority- The Commissioner shall have the authority to establish such rules as may be necessary to deal with special situations with regard to uninsured individuals and employers participating as Exchange-eligible individuals and employers, such as transition periods for individuals and employers who gain, or lose, Exchange-eligible participation status, and to establish grace periods for premium payment.

(g) Surveys of Individuals and Employers- The Commissioner shall provide for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of such individuals and employers with the Health Insurance Exchange and Exchange-participating health benefits plans.

(h) Exchange Access Study-

(1) IN GENERAL- The Commissioner shall conduct a study of access to the Health Insurance Exchange for individuals and for employers, including individuals and employers who are not eligible and enrolled in Exchange-participating health benefits plans. The goal of the study is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange.

(2) ITEMS INCLUDED IN STUDY- Such study also shall examine--

(A) the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and

(B) the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.

(3) REPORT- Not later than January 1 of Y3, in Y6, and thereafter, the Commissioner shall submit to Congress on the study conducted under this subsection and shall include in such report recommendations regarding changes in standards for Exchange eligibility for for individuals and employers.

Question Text:

Democracy Corps	As you may have heard, President Obama is preparing a plan to change the health care system. From what you have heard about this plan, do you favor or oppose Obama's health care proposal?
Pew	As of right now, do you generally favor or generally oppose the health care proposals being discussed in Congress?
NBC / WSJ	From what you have heard about Barack Obama's health care plan, do you think his plan is a good idea or a bad idea? If you do not have an opinion either way, please just say so.
Rasmussen	Generally speaking, do you strongly favor, somewhat favor, somewhat oppose or strongly oppose the health care reform plan proposed by President Obama and the congressional Democrats?
NPR	As you may have heard, President Obama and the Democrats in Congress are preparing a plan to change the health care system. From what you have heard about this plan, do you favor or oppose Obama and the Democrats' health care proposal?
Fox	Based on what you know about the health care reform legislation being considered right now, do you favor or oppose the plan?
CNN	From everything you have heard or read so far, do you favor or oppose Barack Obama's plan to reform health care?
PPP	Do you support or oppose President Obama's health care plan, or do you not have an opinion?
ABC/Post	Overall, given what you know about them, would you say you support or oppose the proposed changes to the health care system being developed by Congress and the Obama administration? Do you feel that way strongly or somewhat?
Ipsos/ McClatchy	As of right now, do you favor or oppose the healthcare reform proposals presently being discussed?
YouGov	Overall, given what you know about them, do you support or oppose the proposed changes to the health care system being developed by Congress and the Obama administration?
Public Opinion Strategies	From what you have heard about Barack Obama's health care plan, do you think his plan is a good idea or a bad idea? If you do not have an opinion either way, please just say so.
AP-GfK	In general, do you support, oppose or neither support nor oppose the health care reform plans being discussed in Congress?
Harris	Even if you don't know the details of his plan, how do you feel about President Obama's proposals for health care reform?
OnMessage	Do you favor or pppose the current health care legislation being pushed by President Obama and the Democrats in Congress?
Bloomberg	In general, do you favor or oppose President Obama's plan for health care reform?
CBS/Times	Do you mostly support or mostly oppose the changes to the health care system proposed by Barack Obama, or don't you know enough about them yet to say?
Gallup	Thinking about health care legislation now being considered by Congress, would you advise your member of Congress to vote for or against a healthcare bill this year, or do you not have an opinion?
AllState / National Journal	And, on the topic of health care, as you understand it, do you support or oppose the current legislation to reform health care in the U.S.

10. Which of these would you prefer - (a plan that includes some form of government-sponsored health insurance for people who can't get affordable private insurance, but is approved without support from Republicans in Congress); or (a plan that is approved with support from Republicans in Congress, but does not include any form of government-sponsored health insurance for people who can't get affordable private insurance)?

  Prefer government-   Prefer Republican   Neither/No
 sponsored insurance        support        plan (vol.)

         51                   37                6       

This Washington Post-ABC News poll was conducted by telephone Oct. 15-18, 2009, among a random national sample of 1,004 adults including users of both conventional and cellular phones. The results from the full survey have a margin of sampling error of plus or minus three points. Sampling, data collection and tabulation by TNS of Horsham, Pa.

*= less than 0.5 percent

Public option gains support
Clear Majority Now Backs Plan
Americans still divided on overall packages

By Dan Balz and Jon Cohen Washington Post Staff Writer
Tuesday, October 20, 2009

CBO estimates the cost of the coverage components of the plan to be $774 billion over ten years. These costs are financed through a combination of savings from Medicare and Medicaid and new taxes and fees. The primary sources of Medicare and Medicaid savings include incorporating productivity improvements into Medicare market basket updates, reducing payments to Medicare Advantage plans, creating the Medicare Commission charged with finding savings in the program, changing the Medicaid drug rebate provisions, and cutting Medicaid and Medicare DSH payments. (See descriptions of cost savings provisions in Cost containment.) The largest source of new revenue will come from an excise tax on high cost insurance--insurance plans that exceed $8,000 for single coverage and $21,000 for family coverage--which CBO estimates will raise $215 billion over ten years. The threshold values for high cost plans are indexed to the CPI-U, which typically increases at a lower rate than health insurance premiums, so it is expected that this tax will raise more money over time. CBO estimates the proposal will reduce the deficit by $49 billion over ten years.

The modified Chairman's Mark of the America's Healthy Future Act of 2009, released on September 22, 2009, will use $28 billion of the existing $49 billion surplus to offset the costs of the changes.

www.finance.senate.gov/sitepages/baucus.htm

See: kff.org Side By Side Plan Comparisons

Note: Subsidies are only available for people purchasing coverage on their own in the Exchange (not through an employer). All individuals and families with incomes at or below 133% of the federal poverty level will be eligible for Medicaid.  Others with higher incomes may also be eligible, depending on rules that vary by state.

In a Medium Cost Area:

At 133% of Poverty or $29,327

A family of 4 with the head of household 35 years old.

Medicaid would cover this family.

In a Medium Cost Area

At 200% of Poverty or $44,100

A family of 4 with the head of household @ 35 years old.

Actual annual plan premium: $8,636
      
(age factor = 0.92 )

Cap on premium as % of income: 7.0%
    
Person/family premium payment: $3,087
    
% of total premium paid by person/family: 36%
    
Person/family payment as % of income: 7.0%
    
Government subsidy: $5,549
   
Could the person/family pay less for a less comprehenisve plan? No   

In a Medium Cost Area

At 300% of Poverty or $66,150

A family of 4 with the head of household @ 35 years old.

Actual annual plan premium: $8,636
     
(age factor = 0.92 )

Cap on premium as % of income: 12.0%
    
Person/family premium payment: $7,938
    
% of total premium paid by person/family: 92%
    
Person/family payment as % of income: 12.0%
    
Government subsidy: $698
   
Could the person/family pay less for a less comprehenisve plan? Yes

Premium for the lower cost plan: $7,834
Premium as % of family income: 11.8%

In a Medium Cost Area

At 400% of Poverty or $88,200

A family of 4 with the head of household @ 35 years old.

Actual annual plan premium: $8,636
     
(age factor = 0.92 )

Cap on premium as % of income: 12.0%
    
Person/family premium payment: $8,938
    
% of total premium paid by person/family: 100%
    
Person/family payment as % of income: 12.0%
    
Government subsidy: $0
   
Could the person/family pay less for a less comprehensive plan? Yes

Premium for the lower cost plan: $7,834
Premium as % of family income: 8.9%

Baucus health bill would let private group write rules | LA Times September 28, 2009

The National Assn. of Insurance Commissioners (NAIC)currently writes model laws and regulations that individual states are free to accept or discard. Under the bill by Sen. Max Baucus (D-Mont.), it would craft a model rule governing "health insurance rating, issuance and marketing requirements" that would become "the new federal minimum standard without any further congressional action." States would be permitted to deviate from the standards only by appealing to the Department of Health and Human Services.

In effect, the bill would allow the group to write many of the new rules on issuing and marketing insurance to millions of uninsured Americans who would be required to purchase policies.

  Here's your sand . . .



All three of you worthless so-called Democrats can start pounding this . . .

~OGD~

ps: And for those of you who don't recall my post back on August 16, 2009.

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   In 91 seconds . . .