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Philadelphia inquirer looks at Health Care Reform proposed legislation.

Discussion in 'Political Discussion' started by Patsfanin Philly, Sep 13, 2009.

  1. Patsfanin Philly

    Patsfanin Philly Rookie

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    The Philadelphia Inquirer looked at some of the provisions in the bills in Congress…. Here’s a few with my take, for what it’s worth. As they say, the devil is in the details. If there is going to be health care reform, I'd just like to see it done right since the risk is so great....Even the president admitted in his Wed address to Congress that the details have to be ironed out.



    A look at 3 health-care bills in the works | Philadelphia Inquirer | 09/13/2009


    1) The bills also would:
    [FONT=&quot]Prohibit setting premium rates on the basis of health or gender, though age would be OK. To limit prices, the House bill says an insurer cannot charge a 64-year-old more than twice what it charges an 18-year-old. The Senate bill would allow a 5-1 ratio.[/FONT]
    While this sounds reasonable and is great based on health, it could lead to discrimination against older employees. Look at it from the company’s perspective if they are forced to pay the majority of the coverage. Are they willing to pay thousand’s more in premiums for an older worker versus a younger one? Think of the company’s that dump older workers for younger lesser-paid ones. It will keep the employment discrimination workers busy. Less likely to happen with a 2-1 ratio than with 5-1…..
    [FONT=&quot]2) Cap out-of-pocket expenses for covered benefits at about $5,000 per person, $10,000 per family. This would not include the cost of, say, getting surgery at an out-of-network hospital.[/FONT]
    Sounds great but the ultimate issue is what is covered and do you find out when selecting the plan or when being prepped for surgery? I understand the necessity to contain costs but worry about who will be the ultimate decider…..
    Here’s one foreseeable problem. A patient wants a higher costing procedure while the insurance company/bureaucrat believes it would save money to do the other one. For example a person on dialysis needs a transplant but really doesn’t want one. It might cost four times as much to continue to do the dialysis over a lifetime versus the transplant ( it could be reversed-this is just a hypothetical). What if they say “we’re not covering any more dialysis unless you go on the transplant list”. I’m not saying it doesn’t happen now, just trying to read the tea leaves….
    If done right, this would eliminate the risk of bankrupt from catastrophic illness or accident....



    [FONT=&quot]3) The Senate Finance bill would not require employers to provide coverage. The other bills would for companies of a certain size. Employers would have to pay 60 percent to 72.5 percent of an employee's premium or face penalties.[/FONT]
    What about the employee’s family? In my area, a single plan is about $380/month while a family one is $1100/month? Who is responsible? If it’s the employee , it could lead to a large increase in what they pay currently.
    The other issue is what to do if it’s a married couple, both employed. Currently if one employer covers both spouses, the other employer /employer could choose to forego coverage and possibly take a higher salary in lieu of coverage. Under HR 3200, it would require both employers to pay for coverage with the employee who would have gotten the alternative benefit in the form of a higher salary forced to duplicate coverage. A fairer plan might be to require employers to cover the employee but use ‘the birthday rule’ in deciding who has to cover the dependents. That is the rule currently used when there is dual coverage. Whoever among the spouse has their birthday come first during the year is the primary carrier for the dependents. This is fair because 50% of the time it will be either spouse and is the fairest way to apply it…
    Last edited: Sep 13, 2009

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