Assertion: Your health care is RATIONED!

FALSE

Found in multiple websites across the internet is the assertion that the bill provides for rationing of health care. The cited passage of the bill is section 122, page 29.

(B) APPLICABLE LEVEL.

—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

The applicable level does not refer to benefits paid by the plan. Reading before this section explains what the Applicable level is for:

 (c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE.—

 (1) NO COST-SHARING FOR PREVENTIVE SERVICES.—There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.

 (2) ANNUAL LIMITATION.—

 (A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

"Cost-sharing" includes copays and co-insurance for covered services. The annual limitation is the "Annual Out of Pocket Maximum" that is present in almost all private insurance policies that exist today.

What this means is that there will be a maximum that an insured individual or family will be expected to pay under the plan of $5,000 or $10,000  respectively. Once the Annual Limitation (OOP Max) has been met, the insured or insureds will no longer have to participate in cost-sharing: in other words, no more copays will be required for the remainder of that plan year for covered services.

This does not mean that health care will not be rationed, it means that there is no such provision for rationing in the bill itself. I believe the bill will evenutally lead to rationing, as every other plan based on this structure has. Some in the not so distant past (see Commonweath Health Insurance [or Massachusetts health care reform law of 2006]).

Locked in, locked out--where does it all leave me?

 Assertion #1. There are many aspects of the bill that the opposition is against. Are they true? The following is a quote from a list from this web page. 

Page 16: States that if you have insurance at the time of the bill becoming law and change, you will be required to take a similar plan. If that is not available, you will be required to take the gov option!

Page 16 states:

16

 SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE. 

GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘‘grandfathered health insurance coverage’’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met: 

    (1) LIMITATION ON NEW ENROLLMENT.—

 (A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1. 

So, what does that mean? It means that except for the exceptions put forth in this paragraph, if an insured individual (or family) already has health insurance through a private insurer, they may keep that plan with that insurer. However, if the effective date of that private plan will be after the date of Y1 (in other words, this bill), the private insurer is not allowed to insure that individual (or family).

Part 2 addresses change in coverage by the current plan:

(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

What this means is that your insurer can not change the terms and conditions of the plan as long as the beneficiary is enrolled. Including, but not limited to, raising premiums, changing copays, deductible and out of pocket costs, as well as lowering copays, premiums and out of pocket costs.  When your plan changes its provisions, you are no longer locked into your plan. And if you are not locked into your plan, and you can not opt for another private plan....

Since I am reading the plan in progressive order, and this section has not requied that I go to another section and subsection, I interpret this to be a fairly straight forward section.

And so it begins.

It seems I have been called to task by someone in the world wide web with regards to my opposition to the new health care bill that is currently being discussed/debated/argued nationwide. Unfortunately, the venue was not to my liking for providing detailed explanations, links and images. There are just some things Facebook can not do. I made a blog for the purpose of giving better formatted and user-friendly rebuttal. We'll see how much that helps my position.

I call upon my friends and acquaintances of like mind to rally with me, beside me, in front of me, or where ever you're comfortable. We enjoy such challenges and now have the opportunity to have a genuinely civil and thoughtful conversation, engaging people with whom we disagree and are no less passionate about the topic at hand. I also call upon my friends and acquaintances who subscribe to a different opinion and ask that they make their voices heard here. All opinions and positions are welcome if well reasoned and supported.