This is a 615 page Bill. It seems huge. I am working my way through the bill, word for word and analyzing the Bill Part by Part.

Up front everyone should know I've had health insurance coverage through the federal government for around 20 years. It has changed somewhat over the years, larger co-pays, but we also have lots of choices. I read each pamphlet provided by insurance companies. I have successfully forced our insurance company to pay for services they denied. Federal Employee Health Benefits (FEHB) managed by the Office of Personnel Management (OPM). If an employee has problems with an insurer, they have certain recourse through the OPM appeal process. As I read through this bill and report back we will find out how this bill will attempt to manage insurers to contain costs for everyone.

An individual without insurance gets a double whammy in the system. Insurance companies negotiate with hospitals, doctors groups, etc.  lower costs for treatments etc, in order for that provider to be listed with the insurer. Same goes for prescriptions. The uninsured individual pays full cost for a service provided.

Part A: Mandates on pre-existing conditions: and I think this is where we are going to have a problem.

Insurance coverage may not impose any pre-existing condition exclusion with respect to such plan or coverage.

The key words here are may not. May is often used to express a possibility rather than a certainty. So we will have to see how this is used and if insurers will use the may not as a way to game the system against those with pre-existing problems who have not been insured recently.

Subpart 1:

This part is based on existing structures in the FEHB system managed by the OPM. If people want to know what a community rating area is:

http://www.opm.gov/fedregis/1997/62r47569.txt

This sets premiums for insurance plans based on geographic area. A variety of factors are analyzed to set premiums.  Urban centers generally have higher premiums. Rural areas have lower premiums.

Subpart 2:

Such rate shall not vary by health status ... etc,

Interestingly the terminology here is shall not, more explicit, shall: intend, expect, oblige. There is no wiggle room here, which is why I question the use of may not in the pre-existing condition regulations.

Again, look at the language of the bill here:

Guaranteed availability of coverage mandates any insurer operating in a state must accept every employer and individual in the state.

Must is the key word. Must: obliged, bound to by requirement. Individuals can only be restricted from applying for coverage iff (if and only if) the change is not due to a qualifying life event.

Renewability: used the word must, must renew or continue in force coverage.

Insurers shall submit a report detailing how premium money is spent, yearly.

So far the question not answered: Will individuals purchase coverage at the same cost as groups? Who will pick up the employer co-pay? We will see if there is an answer to this question down the road. Because even though we as  family pay around 260.00 a month for our insurance, the feds pick up around 735.00 per month, where will that money come from?

Preventive Services: No co-pays (pretty standards in health insurance policies)

Extension of dependent coverage: up to age 26.

Here is an important part of the bill: too bad they used the dreaded may not in the sentence structure.

Insurers may not establish lifetime or annual limits on benefits - for any participants or beneficiary.

But what are we to make of the weak may not qualifier? Can it be used to impose some limits?

In the next few days I will report back on more of the Bill.