Subject to Change

SEC. 113. INSURANCE RATING RULES.

AKA: Tinkering with premiums.

This section establishes the guidelines for premiums charged by a qualifying health plan. Since I’m not in the insurance business, it’s hard for me to say what the impact would be. I’m sure there’s no shortage of opinions.

Sec. 113(b)(2) REPORTS- Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable agencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers. Not later than 18 months after the first day of Y1, the Commissioner shall submit to Congress and the applicable agencies an updated report on such study, including updates on such recommendations.

“Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure…”

I read that part aloud to my wife. If there’s any question about whether this bill is attempting to kill private insurance it’s answered in that statement.

“ensure that the law does not provide incentives for small and mid-size employers to self-insure…”

I have a diabetic friend who runs his own business. He’s not going to like reading that.

SEC. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS

A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.

As I understand it, there are protections currently in place to provide continuous coverage. You cannot be denied by your employer’s insurance for pre-existing conditions, so long as you have no lapse in coverage. This looks like an expansion to that idea. Nobody can be denied coverage, period. This, of course, sound nice. The debate that must be had is whether the change is economically prudent.

There’s a comment section on this post if you care to begin the debate right now.

In case you haven’t heard, HR 3200 is the health care bill that’s getting all the attention lately, also known as ‘America’s Affordable Health Choices Act of 2009.’ A co-worker challenged me to slug through this bill, like I did with the ISG report, and I decided to give it a shot. I have no idea how far I’ll get before my brain melts, but here we go!

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