Thursday, August 5, 2010

The blog is dead

My apologies to my blog, but as many of you have noticed I landed a new job about 3 months ago. Fortunately for everything but the healthcare bill project, I no longer have 9 hours of nothingness per day to fill.

As a side story, my favorite participant in this week-long project that should've lasted a year was Steve. I actually met Steve once in person while we were out with some mutual friends. Sorry to say, I had no idea that Steve was Steve, and instead of engaging in a well-informed political debate I decided to drink until I could no longer pronounce the word "nuclear," and he went to bed before the first game of beer pong.

Oh well, maybe next time.

#missedconnections #beerpong #healthcare #obamamuslim

Monday, March 29, 2010

pp 34-36

Every year health insurers have to report to the Secretary what percentage of their revenues go toward reimbursement for health care, health care improvements, and all other costs not including taxes and regulatory fees. The Secretary will post them online. The Secretary and NAIC will come up with standard definitions for these reports.

From now until 2014, if an insurance company increases their spending by more than 20-25% per year spends more than 20-25% per year on stuff other than claims and taxes, then they have to give a rebate to the people who bought the plan. The more they increase spending in these areas (not on healthcare), the more they have to refund.
States can make the percentage smaller (it's 20% for group plans, 25% for individual plans).

Hospitals have to publish what their standard charges are for services each year.

Friday, March 26, 2010

pp. 29-34

Insurance providers can't limit eligibility for a plan based on an employee's income, but they can make contribution amounts for lower-paid-workers smaller than what they require of higher paid workers in similar situations if they want to.

In 2 years The Secretary will develop reporting requirements for insurance plans that
  • improve health outcomes by managing care better
  • reduce hospital re-admissions using better followups
  • reduce medical errors
  • use wellness programs
At the same time The Secretary will also give regulations that will tell if these reporting requirements affect reimbursements. 3 months after he does that, the Government Accountability Office will report to the House and Senate what kind of an impact this is having on healthcare quality and cost.

Every year the insurance providers have to report on how their program meets these 4 things, and the report must be available to customers when they enroll in a plan. The Secretary can come up with penalties if the reporting isn't done, and also make exceptions to the reporting if a health plan or provider does a good job at meeting these 4 things.

The bill defines "wellness programs" in a pretty common-sense manner: nutrition, physical fitness, stopping smoking, etc.

Just a thought.

Why does this goddamned thing have to be in all italics?

Day 2 part 1. pp. 23-29

I'm an engineer with a decent amount of communications background, so I'm pretty good at sorting out complex documents like this. Sometimes, I do get stuck though, and since I'm only a blogger doing this in my spare time I might need help every once in a while.
So when I'm reading the bill and get stuck in the molasses, I'll throw it up in grey so you know that I was struggling on the paraphrasing. If you see something in grey, please help me out and post your thoughts on that section. I'll go back and edit yesterday's post with this too.

The Secretary has a year to create a standard summary of benefits. He will consult with the National Association of Insurance Commissioners to develop the standard. The standard will:
  • follow the same 4-page format in 12 point font or larger,
  • use language that the average customer can understand
  • contain consistent definitions
  • describe the coverage on the benefits from yesterday's post
  • describe any other benefits the plan has
  • describe any limitations the plan has
  • describe the deductibles and copays
  • say if and how the plan is renewable
  • have examples of common scenarios like pregnancy and serious medical conditions
  • state if the plan meets the minimum coverage requirement, and if it covers 60 percent of the costs of what the plan says is covered.
  • state that the summary is a summary, and not the full coverage document
  • a contact number for additional questions, and a website where the full coverage document can be found
The secretary should review and update the standards periodically.
Starting in 2 years, insurance providers need to provide these summaries: to anyone when they apply for a policy, to anyone when they enroll or re-enroll in a policy, anytime a policy gets issued, and at least 60 days before any changes to the policy go into effect.
The bill then defines what an insurance provider is. No suprises here so I won't paraphrase.
Every time an insurance provider doesn't provide a new summary when they're supposed to, they will have to pay a $1,000 fine.
The Secretary is responsible for coming up with standard insurance and medical terms. The bill lists 23 terms, and says The Secretary can add more.

Good place for a break. Still trying to make it to page 44 today, so stay tuned.