Impeding changes to our Health Care system

[TheMercenary]

Originally Posted by Redux

Have you found the section of both the House and Senate bills on the premium review and certification process, including the premium/admin cost/claims ratio?

Absolutely. I have read it numerous times. Even the levels set by both bills would be a HUGE increase in costs. And depending on which bill you look at your ability to move to the exchage differs based on the percent of your income that the premiums compare with, so there is a lot of room for employer based plans to significantly raise premiums to 0.1% below the threshold and still screw the consumer while not losing the individual or family to the exchange. The loopholes abound.

Originally Posted by TheMercenary

Absolutely. I have read it numerous times. Even the levels set by both bills would be a HUGE increase in costs. And depending on which bill you look at your ability to move to the exchage differs based on the percent of your income that the premiums compare with, so there is a lot of room for employer based plans to significantly raise premiums to 0.1% below the threshold and still screw the consumer while not losing the individual or family to the exchange. The loopholes abound.

Nope...you dont have it yet.

The threshold for premium/admin costs/claims ratio has absolutely nothing to do with plan option costs as percent of income...which has nothing to do with the employer based plans meeting the same ratio thresholds.

The loopholes exists only in your head because you only see what you are pre-conceived to see.

Thats ok. It was expected.

[TheMercenary]

Originally Posted by Redux

Nope...you dont have it yet.

The threshold for premium/admin costs/claims ratio has absolutely nothing to do with plan option costs as percent of income...which has nothing to do with the employer based plans meeting the same ratio thresholds.

The loopholes exists only in your head because you only see what you are pre-conceived to see.

Thats ok. It was expected.

Nothing in either Bill prevents them from raising premiums and co-pays, decreasing coverage and passing through the cost to those with insurance. And nothing you have posted to date disputes that.

If you have something post it. I have read the Bill.

Originally Posted by TheMercenary

Nothing in either Bill prevents them from raising premiums and co-pays, decreasing coverage and passing through the cost to those with insurance. And nothing you have posted to date disputes that.

If you have something post it. I have read the Bill.

I think I have provided it 4-5 times in the last few months...and you deny it every time.

The bills set minimum coverage requirements and limit out-of-pocket expenses (which includes co-pays and deductibles)...and provide for no co-pays ($0) for all preventive care, including colonoscopies or mammograms.

And requires caps on premiums (set in premiums/admin costs ratios) for small group/ individual premiums (one rate) and large group premiums (different rate) or provide consumers with a rebate.

Its all there in black and white....but your mind is closed to anything that contradicts your opinion....so perhaps when you read, your brain just cant process it.

[TheMercenary]

Originally Posted by Redux

I think I have provided it 4-5 times in the last few months...and you deny every time.

The bills set minimum coverage requirements and limit out-of-pocket expenses (which includes co-pays and deductibles)...and provide free co-pays for preventive care, including colonoscopies or mammograms.

And required to spend spending caps on premiums (set in premiums/admin costs rations) for small group/ individual premiums (one rate) and large group premiums (different rate) or provide consumers with a rebate.

Its all there in black and white....but your mind is closed to anything that contradicts your opinion....so perhaps when you read, your brain just cant process it.

And as I stated that is only for certain classes not for all. The rules for existing insurance do not change unless they alter their plans. Many of the breaks are only for the first two years, not for the remaining years, or they phase out over a shore time. You are passing on more propaganda.

So when are you going to step up and repeat the things you said you agreed with Flint about me?

Originally Posted by TheMercenary

And as I stated that is only for certain classes not for all. The rules for existing insurance do not change unless they alter their plans. Many of the breaks are only for the first two years, not for the remaining years, or they phase out over a shore time. You are passing on more propaganda.

Nope.

It effects all plans...individual, small group, large group (employer-based)...just phased in with different start dates. There are no phase outs or sunsetting provisions.

The "rules" absolutely apply to existing insurance. They would be required to change in the year after the effective date... not just in regard to the above, but also regarding required coverage for pre-existing conditions, dropping coverage, etc
'
It is clear to me, perhaps not to others, that you obviously havent read the legislation.

You can fool some of the people, some of the time. You cant fool me.

[TheMercenary]

Employer Responsibility to Provide Coverage:

Provisio: A meaningful contribution toward coverage.

House: Employers are required to contribute 72.5/65% single/family of employees premium costs for coverage purchased inside or outside the exchange. 5 year grace period for some plans (Unions).

Senate: Employers are not required to provide coverage but either pay penalty if no coverage or insufficient coverage. Permanately grandfathers existing plans with any level of coverage.

Or they can provide subsidy to insurance exchanges: House and Senate version only differ by penalty.

Nothing in these provisions control costs of the premiums.

Originally Posted by TheMercenary

Employer Responsibility to Provide Coverage:

Provisio: A meaningful contribution toward coverage.

House: Employers are required to contribute 72.5/65% single/family of employees premium costs for coverage purchased inside or outside the exchange. 5 year grace period for some plans (Unions).

Senate: Employers are not required to provide coverage but either pay penalty if no coverage or insufficient coverage. Permanately grandfathers existing plans with any level of coverage.

Or they can provide subsidy to insurance exchanges: House and Senate version only differ by penalty.

Nothing in these provisions control costs of the premiums.

You are intentionally or ignorantly attempting to confuse the issue.

That provision sets levels of employer contributions.

Premiums are controlled through different provisions. For large group plans (current employer-based), 85 percent of large group premiums dollars are required to be spent on direct health benefits to consumers...they cant jack the price and simply add it to their profits or even claim it as additional administrative costs......and all "extraordinary" (to be defined in regulations) premium increases require approval by the Sec of HHS.

[TheMercenary]

Subsidies*to*Purchase*Coverage*and*Affordability

Ensure Employer Based Plans have similar protections:

House: IF premiums exceed 12% of income then employees can move to insurance exchanges.

Senate: ... if premiums exceed 9.8% of income. More limits if in "small group Markets"

So if your income is $200,000 that means that you premiums can be as high as $24,000 under the house plan and $19,600 under the Senate plan.

Damn dude...you just dont get or wont get it.

This has nothing to do with subsidies.....the bill sets a CAP on percent of premiums (15% for existing large group plans ) that can be claimed as administrative costs (or profits)....or the reverse.. 85% must be applied directly to patient care.

They cant raise premiums and claim more for administrative expenses or profits.

You only see what you want to see.

[TheMercenary]

Originally Posted by Redux

You are intentionally or ignorantly attempting to confuse the issue.

That provision sets levels of employer contributions.

Premiums are controlled through different provisions. For large group plans (current employer-based), 85 percent of large group premiums dollars are required to be spent on direct health benefits to consumers...they cant jack the price and simply add it to their profits or even claim it as additonal administrative costs

Certainly they can, there are no limits set except by income.

......and all "extraordinary" (to be defined in regulations) premium increases require approval by the Sec of HHS.

So you consider that a price control??!?! Please. A Sec of HHS appointed by a President who made back door deals with the Insurance industry and a Senate who basically let a insurance insider write the Bill!??? Are you delusional?

[TheMercenary]

Originally Posted by Redux

Damn dude...you just dont get or wont get it.

This has nothing to do with subsidies.....it is a CAP on percent of premiums that can be claimed as administrative costs (or profits).

I am quoting the Bill. Why are you ignoring the facts. A person making up to 200k can pay premiums as high as 24k without an opportunity to move to the exchanges.

85 percent of large group premiums dollars are required to be spent on direct health benefits to consumers...they cant jack the price and simply add it to their profits or even claim it as additional administrative costs

Are you really that dense?

Carry on.

[TheMercenary]

Originally Posted by Redux

Damn dude...you just dont get or wont get it.

This has nothing to do with subsidies.....the bill sets a CAP on percent of premiums (15% for existing large group plans ) that can be claimed as administrative costs (or profits)....or the reverse.. 85% must be applied directly to patient care.

They cant raise premiums and claim more for administrative expenses or profits.

You only see what you want to see.

No, what it says is that it Requires*that*insurance*companies*rebate*to*policy‐holders*any*spending*in*excess*15% FOR admin costs. Who says what those can be? You are trusting the insurance companies to acurately report the numbers? The same companies that have been screwing us for how long? Fox is incharge of the Hen House. Those rules are so vague that it screams for a scam.

[TheMercenary]

Originally Posted by Redux

85 percent of large group premiums dollars are required to be spent on direct health benefits to consumers...they cant jack the price and simply add it to their profits or even claim it as additional administrative costs

Are you really that dense?

Carry on.

Are you so dense that you can't see that percentages are easily manipulated by these companies? Those are not cost controls. Why are you ignoring what I posted. It depends on which version comes out in the final Bill as to how much you are going to be screwed.