Could, if enacted, Health Care Bill 3962 help you?
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By Mitch Gurney
November 15, 2009
There seems to be a tendency for most of us to look only for the negatives rather than the positives yet each exist in all things. Setting aside for a moment the phobias and hysteria of government involvement and the debates and scare tactics surrounding health care reform how could HR 3962, if enacted, help you?
Some of us may have been forced into medical bankruptcy at one time or are faced with such a situation now or we may know someone else that this applies to. But what happens to someone who rather than filing bankruptcy commits to paying back a huge medical bill if they were uninsured or underinsured at the time of a major accident or illness? How would HR 3962 as passed recently by the House potentially help them or you?
I was following a blog exchange on another website between an individual and others that unfolded shortly after HR 3962 passed the House and begin thinking about the broader implications of the reforms in this bill and the ways it might have produced different outcomes for this individual and others in a similar situation had it been enacted some time in the past or if enacted now how it could help them now.
In the blog exchange an individual had shared that while they were in between jobs they were not insured and had a major accident incurring over $100,000 in medical debt, their credit is now ruined, and is ineligible for insurance. They are committed to paying this debt back and interestingly are adamantly opposed to these reforms. I can only assume the story they tell is true and even if it isn’t I am certain there are people in our country in which a similar fate has befallen them.
I commend this individual and others like them for their courage and tenacity. Realistically, however, the medical bills this person owes could take a life time to pay back unless they earn above average income, or win the lottery, or have some huge inheritance on their horizon. Even if they are in a financial position to pay $1000 per month, without factoring in interest, it would take over 8 years to pay off. Now, ineligible for coverage, they may be hoping they won’t suffer a major illness or another accident before they pay this debt off otherwise this would add more medical debt to the mountain they already have. For anyone in this particular situation the prospects for a bright future are rather bleak and demonstrate that no system is perfect. The current insurance company dominated system has certainly left them hanging and extremely vulnerable.
With this scenario in mind, let’s take look at what HR 3962 (full PDF text) would have to offer such a person in this situation.
If the bill had been enacted prior to their accident they may not have lost coverage while in between jobs. The provisions outlined in Sec 301 – 311, pgs 155- 210, provide that once an individual is covered in a health plan through their employer and should that plan be through the Health Insurance Exchange the individual would have been able to maintain their insurance by continuing to pay their monthly premiums directly to the insurance company rather than through their employer. In such a scenario their premium would not change and as long as they maintained their payments would be covered. If their employer had provided insurance outside the exchange the individual would be able to participate directly in the exchange on their own and select coverage that meets their needs and budget.
In addition, Subtitle C, Sections 341 -347, pgs 225 – 267, outlines provisions for individuals and or families to receive financial assistance with insurance premiums provided through the exchange. That is an individual and or their family could receive a government subsidy to offset the cost of their premiums. This subsidy, referred to in the bill as “affordability premium credit” (Sec. 343) is calculated on a sliding scale. These credits are more generous for those just above the proposed new Medicaid eligibility levels and decline as annual incomes increase so that premium and cost-sharing support is reduced and are completely phased out when income reaches 400 percent of the federal poverty level ($43,000 for an individual or $88,000 for a family of four).
The current bill does not have provisions to remedy any current medical debt a person might have but if it were enacted as currently voted on in the House this individual would now be eligible for coverage as outlined in Sections 101, 106 and 212 of HR 3962. Access to insurance coverage for those uninsured and denied coverage due to pre-existing conditions would be one of the top priorities of the bill once enacted. The affordability credit would potentially be available to those needing this assistance as well.
Mitch Gurney
Fact Sheets:
WHAT YOU NEED TO KNOW ABOUT HEALTH INSURANCE REFORM
MAKING COVERAGE AFFORDABLE – The AFFORADABILTY CREDIT
TOP 14 PROVISIONS THAT TAKE EFFECT IMMEDIATELY
CONSUMER PROTECTIONS AND INSURANCE MARKET REFORMS
INNOVATIVE DELIVERY SYSTEM REFORM
IMMEDIATE INVESTMENTS ON THE ROAD TO REFORM
Posted on November 15th, 2009 by m_gurney
Filed under: Mitch Gurney, Tracking the Health Care Debate
Good article Mitch.
What happens if we want to keep the insurance between jobs but we do not have the money.
The reason I ask is that I do need insurance but I have no money to pay.
We can discuss why that is but anybody that has been following my articles on wages for the last 30 plus years will know why I can’t afford to pay it.
Personally, I’m not against a better system, although I am against the government running it, but at the same time I trust the corporations even less after writing that article today about gentech.
We’re kind of in a damned if you do and damned if you don’t situation.
As explained in my article provisions in the bill provide for financial assistance based on a person’s annual income. Those at poverty level may be provided Medicaid coverage; a program funded by states and the Federal government for the poor, or they may receive greater assistance depending on need.
The Health Insurance Exchange would potentially be a vast market exchange created by the government pulling together the insurance companies around the US that elects to participate in it for both companies and individuals to shop for their insurance needs. The theory being that the bigger this pool of premium payers becomes the lower premiums could become for all participants. The premiums paid by either the companies or the individuals are made directly to the insurance company they have chosen through the exchange, under this scenario the government is serving as a regulating broker.
The misnomer here is that the government is “running” health care providers or insurance companies. YES, the government, if HR 3962 is enacted, would be regulating and standardizing the insurance coverage these companies would provide across the country and the care given by providers but the government is NOT taking over ownership of these firms or institutions which would constitute a true government take over.