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Old 03-28-2010, 11:34 PM  
Taco John Taco John is offline
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Democrats furious at insurance companies interpretation of new law

What a bunch of dopes...


Coverage Now for Sick Children? Check Fine Print
By ROBERT PEAR
Published: March 28, 2010


WASHINGTON — Just days after President Obama signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.

Mr. Obama, speaking at a health care rally in northern Virginia on March 19, said, “Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”

The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was to provide those youngsters with access to insurance and to a full range of benefits once they are in a health plan.

To insurance companies, the language of the law is not so clear.

Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”

Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.

“The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform,” said Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee.

Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, said: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”

The issue is one of many that federal officials are tackling as they prepare to carry out the law, with a huge stream of new rules, official guidance and brochures to educate the public. Their decisions will have major practical implications.

Insurers say they often limit coverage of pre-existing conditions under policies sold in the individual insurance market. Thus, for example, an insurer might cover a family of four, including a child with a heart defect, but exclude treatment of that condition from the policy.

The new law says that health plans and insurers offering individual or group coverage “may not impose any pre-existing condition exclusion with respect to such plan or coverage” for children under 19, starting in “plan years” that begin on or after Sept. 23, 2010.

But, insurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a “guaranteed issue” requirement before then.

Consumer advocates worry that instead of refusing to cover treatment for a specific pre-existing condition, an insurer might simply deny coverage for the child or the family.

“If you have a sick kid, the individual insurance market will continue to be a scary place,” said Karen L. Pollitz, a research professor at the Health Policy Institute at Georgetown University.

Experts at the National Association of Insurance Commissioners share that concern.

“I would like to see the kids covered,” said Sandy Praeger, the insurance commissioner of Kansas. “But without guaranteed issue of insurance, I am not sure companies will be required to take children under 19.”

A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.

Starting in January 2014, health plans will be required to accept everyone who applies for coverage.

Until then, people with pre-existing conditions could seek coverage in high-risk insurance pools run by states or by the secretary of health and human services. The new law provides $5 billion to help pay claims filed by people in those pools.

Federal officials will need to write rules or guidance to address a number of concerns. The issues to be resolved include defining the “essential health benefits” that must be offered by all insurers; deciding which dependents are entitled to stay on their parents’ insurance; determining who qualifies for a “hardship exemption” from the requirement to have insurance; and deciding who is eligible for a new long-term care insurance program.

As originally conceived, most of the new federal requirements would have taken effect at the same time, in three or four years. The requirements for people to carry insurance, for employers to offer it and for insurers to accept all applicants were tied together.

But as criticism of their proposal grew, Democrats wanted to show that the legislation would produce immediate, tangible benefits. So they accelerated the ban on “pre-existing condition exclusions” for children.

Consumers will soon gain several other protections. By July 1, the health secretary must establish a Web site where people can identify “affordable health insurance coverage options.” The site is supposed to provide information about premiums, co-payments and the share of premium revenue that goes to administrative costs and profits, rather than medical care.

In addition, within six months, health plans must have “an effective appeals process,” so consumers can challenge decisions on coverage and claims.

http://www.nytimes.com/2010/03/29/he.../29health.html
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Old 03-28-2010, 11:41 PM   #2
Taco John Taco John is offline
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A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.”


Planned to issue regulations? LOL!

Obama thinks that he can just sit at his desk and write regulations?

What a piece of crap this administration and these Democrats have unilaterally hung around our necks. Embarassing!
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Old 03-28-2010, 11:44 PM   #3
Shaid Shaid is offline
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If they don't want people misinterpreting it, write the law clearer.
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Old 03-28-2010, 11:48 PM   #4
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Old 03-28-2010, 11:57 PM   #5
2bikemike 2bikemike is offline
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Quote:
Originally Posted by Shaid View Post
If they don't want people misinterpreting it, write the law clearer.
I think Law Makers typically try to cover all the bases in the writing of law which in turn just muddies the water so nobody freaking understands it.

We have so many regulations in my line of work that its very onerous to interpret and comply so its extremely likely your going to end up with an NOV. (Notice of Violation)
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Old 03-29-2010, 12:15 AM   #6
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Quote:
Originally Posted by Taco John View Post
Planned to issue regulations? LOL!

Obama thinks that he can just sit at his desk and write regulations?
They ALWAYS issue regulations! LOL in spades at you! You're just bound to be outraged at everything!

Try learning about how your government actually works:
Federal Regulations
The Laws Behind the Acts of Congress
By Robert Longley, About.com Guide

Federal regulations are the actual enforceable laws authorized by major legislation enacted by Congress. The Clean Air Act, the Food and Drug Act, the Civil Rights Act are all examples of landmark legislation requiring months, even years of highly publicized planning, debate, compromise and reconciliation in Congress. Yet the work of creating the vast and ever-growing volumes of federal regulations, the real laws behind the acts, happens largely unnoticed in the offices of the government agencies rather than the halls of Congress....

http://usgovinfo.about.com/od/uscong...egulations.htm
http://www.regulations.gov/search/Regs/home.html#home

Last edited by orange; 03-29-2010 at 12:29 AM..
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Old 03-29-2010, 07:37 AM   #7
stevieray stevieray is offline
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Enter Cass Sunstein -regulatory czar..who wrote a book about FDR's 2nd bill of rights, and why it's needed more than ever.
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Old 03-29-2010, 07:48 AM   #8
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Quote:
Originally Posted by Shaid View Post
If they don't want people misinterpreting it, write the law clearer.
Then they wouldn't have ever been able to pass it, there would have been too much opposition. They have to have vague wording so that it is up to interpretation of the lawyers and court for the laws they create.
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Old 03-29-2010, 08:10 AM   #9
Garcia Bronco Garcia Bronco is offline
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Well government got involved, and as expected...it's more ****ed up than ever.
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Old 03-29-2010, 08:45 AM   #10
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Quote:
Originally Posted by Taco John View Post
A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.”


Planned to issue regulations? LOL!

Obama thinks that he can just sit at his desk and write regulations?

What a piece of crap this administration and these Democrats have unilaterally hung around our necks. Embarassing!
No matter your opinion in this legislation, the intent was to have children with pre-exsisting conditions covered this year. This is not trying to add some new regulation into the bill. Everyone who voted for or against this bill thought pre-exsisting conditions were covered for children this year. There was no decption.

Insurance companies are just up to their old tricks of trying to not cover or pay out a dime unless they are forced too. This is just legal BS by the the teams of lawyers that insurance companies pay to avoid coverage that will cost them money. It's about friggin time that Americans come first, not big corporations with deep pockets and lawyers.
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If it's effective, who are you, me, or anybody else to call it abuse? I worked with a guy back in Moberly who would shove a finger up his son's ass each time he had anything worse than a C on his report card. If he came home with 2 D's and an F, that's 3 fingers (and this was a big dude). Does that sound hideous and disgusting? Absolutely. Did the kid ever get anything worse than a C after this rule was implemented? Not a chance.

I'm not saying it's morally right or wrong, but does it make the child because of it? Think about that for a second.
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Old 03-29-2010, 08:48 AM   #11
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Quote:
Originally Posted by stevieray View Post
Enter Cass Sunstein -regulatory czar..who wrote a book about FDR's 2nd bill of rights, and why it's needed more than ever.
Yeah, that was his economic Bill of Rights but he died before he could implement. ( He would have needed an Amendment which wouldn't have been easy.) But his wife Eleanor wrote them in to the UN Charter. The whole second half of it is communism. Right to a job, right to a living wage, right to democracy ( socialism really) and a right to well just keep reading....it's all positive rights none of them natural or inalienable which means they can be taken away.
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Old 03-29-2010, 08:52 AM   #12
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Quote:
Originally Posted by Taco John View Post
A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.”


Planned to issue regulations? LOL!

Obama thinks that he can just sit at his desk and write regulations?

What a piece of crap this administration and these Democrats have unilaterally hung around our necks. Embarassing!
So, now you're upset that the legislation doesn't go far enough in coverage? I thought you didn't think the government should be involved at all? You should be celebrating that these sick kids won't get insurance coverage, shouldn't you? Could you focus your outrage a bit for us?
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Old 03-29-2010, 09:03 AM   #13
Taco John Taco John is offline
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Originally Posted by banyon View Post
So, now you're upset that the legislation doesn't go far enough in coverage? I thought you didn't think the government should be involved at all? You should be celebrating that these sick kids won't get insurance coverage, shouldn't you? Could you focus your outrage a bit for us?
What gave you the impression that I'm upset that this thing doesn't go far enough in coverage? I'm laughing at the foolish democrats who were counting on this stuff for November, and now have a fight on their hands just to implement their first step.

My outrage is that this stuff got unilaterally forced on us against the will of the American people. I give you too much credit. Someone with ability to retain information would be able to know this without the confusion that you suffer.
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Old 03-29-2010, 09:10 AM   #14
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Quote:
Originally Posted by Taco John View Post
What gave you the impression that I'm upset that this thing doesn't go far enough in coverage? I'm laughing at the foolish democrats who were counting on this stuff for November, and now have a fight on their hands just to implement their first step.

My outrage is that this stuff got unilaterally forced on us against the will of the American people. I give you too much credit. Someone with ability to retain information would be able to know this without the confusion that you suffer.
See bolded + "...and apparently forced by people who failed to actually READ the bill"
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Old 03-29-2010, 09:26 AM   #15
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Yet some idiots still wonder why most Americans think healthcare needs to be fixed...even if we may disagree about precisely "how" to fix everything. Well, at least it's no longer profits ahead of healthcare.

The devil is in the details, no doubt; but at least it's moving forward. Much to the chagrin of these poor, poor health insurance companiess. Wah.
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