Monday, August 10, 2009

Questions for your health care town hall: Secs. 122-124 

Gary Gross has begun to highlight Section 122 of H.R. 3200, which defines the benefits that any private plan must provide to be considered qualified. He actually bridges 122 and 123, and in this post I will include parts of Sec. 124; you need to see them together as a whole to understand this part of the bill. Below you will find ten questions (or sets of questions) that will help you define where your legislator is on controlling your health insurance.

Section 122 defines a list of benefits that any qualified plan would have. The rule would not apply to any plan you currently have -- that is the part the President is using to say "if you like your health insurance you can keep it," which is a vacuous promise, but not needed to discuss here. Let's read 122 in full:

That leads to a few questions right off the top.
  1. Congressman/woman, Does the lack of cost-sharing for preventative services under 122(c)(1) help control costs? A CBO letter last Friday to Rep. Nathan Deal points to a study that shows "that slightly fewer than 20 percent of [preventative] services that were examined save money, while the rest add to costs."
  2. Does the annual cap of $5000 for a single and $10,000 for a family come on TOP of my current premium? According to the pro-reform page put up by HHS, we currently pay $1,522 in cost-sharing. Does sec. 122(c)(2)(B) mean I am going to see higher co-pays and deductibles?
  3. Do you favor a cafeteria plan for choosing benefits, as Gary highlighted in his interview of Rep. Paul Ryan? Why is it a better for cost control to define minimum benefits than it is to permit individuals to pick the services they want? Do you support the Patients' Choice Act?
Let's move on to Sec. 123, which creates a committee that decides on what is in the essential benefits package:
Questions here:
  1. The committee that decides what has to be in a qualified plan contains at least twenty (20) people, yet it only guarantees one physician is on the panel. Do you think this is the right level of participation of medical professionals?
  2. The committee membership includes the words "shall at least reflect" various health insurance stakeholders. Isn't that vague? Would you want to change that?
  3. Does Congress get any say in who's on this committee?
  4. Borrowing from Gary: Senator or Congressperson, do you believe that this committee would unduly restrict the relationship between a patient and her or his doctor? Why or why not?
On to Section 124, which defines how the process works from recommendation by the Health Benefits Advisory Committee to action.
This raises questions too:
  1. Where is Congress' input into what shall be in the plan? Does your senator or congressperson think this plan vests too much power in the hands of the HHS Secretary?
  2. In particular, can the Secretary decide to ignore the Health Benefits Advisory Committee and impose a minimum plan? (The answer is yes, only subject to the cost rules in Sec. 122.)
  3. The rules for updating the benefits package is vague, only providing for "periodic updating". Do you think this should be that vague?

I urge you to read all of the posts done here for questions about the bill. Ask your legislator these questions and please post in comments any answers you receive. Also send them to me at comments at scsuscholars*dot*com. I'd like a diary of any of these you get.

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