HHS: How Health Insurance Reform will Help People with Disabilities

From the Department of Health and Human Services:

Stable and Secure Health Care for America
How Health Insurance Reform Will Help People with Disabilities

Greater Choices for Americans with Disabilities

•  Eliminate Discrimination in Obtaining Health Insurance: Health insurance reform legislation will prevent any insurance company from denying coverage based on a person’s underlying health status, including genetic information.
•  Make Health Care Accessible to Everyone: By expanding health insurance to all Americans and providing premium assistance to make it affordable, health insurance reform will significantly increase access to a choice of health insurance plans for individuals with disabilities. This will enable individuals who are employed to keep their jobs rather than giving up employment in order to receive Medicaid benefits.
•  More Affordable Choices: Health insurance reform will create a health insurance exchange so you can compare prices and health plans and decide which quality affordable option is right for you and your family. In addition, some bills would provide a new voluntary insurance program that helps families deal with long‐term care costs if a loved one develops a disability.
•  Expand the Medicaid Program: Health insurance reform will expand the Medicaid program to more Americans, including people with disabilities. This expansion will assist low income adults who have disabilities but do not meet the stringent requirements of the SSI program to receive Medicaid coverage.

Lowering Costs by Rewarding Quality and Cutting Waste

•  Provide Deep Discounts for Medications in the Medicare “Donut Hole”: For individuals with disabilities who are dually eligible for Medicare and Medicaid, prescription drug coverage through Medicare Part D leaves them at risk of hitting the “doughnut hole,” or the gap in prescription drug coverage. In an historic agreement, the drug industry has agreed to provide individuals with a discount of at least 50 percent for medication costs that fall in this coverage gap, saving thousands of dollars for some enrollees.
•  Financial Relief for Low‐Income Medicare Beneficiaries: Health insurance reform will simplify the application process for financial support for low‐income Medicare beneficiaries. It will also increase premium subsidies and decrease certain copayments for Medicare’s drug benefit.

Assuring Accessible, Quality, Affordable Health Care for People with Disabilities

•  Preventive Care for Better Health: People with disabilities are less likely to receive preventive care and are more likely to be diagnosed with screenable cancers at a later stage. By ensuring that all Americans have access to preventive care and investing in public health, health reform will work to create a system that prevents illness and disease instead of just treating it when it’s too late.
•  Improve Care for Chronic Disease: One in every 10 Americans experiences a major limitation in activity because of a chronic condition. Health insurance reform will encourage innovations in the treatment of these diseases to prevent disabilities from occurring and progressing.
•  Promote High Quality Care: Health insurance reform legislation will establish medically driven priorities and standards on quality, require quality reporting by hospitals, and provide incentive payments for high quality performance. As a result, people with disabilities will have better information to support their health care choices.

Comments

[Ric]

From HR 3200 - • The government will audit your books if you self-insure: The newly created Commissioner will submit a report to the government that includes "any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure." (21.23-23.3)

• The government will define your "health benefits": "[Establish] a private-public advisory committee . . . of medical and other experts to be known as the Health Benefits Advisory Committee" to recommend what will be in the "covered benefits" and what are "essential, enhanced, and premium plans." (30.13-30.18)

• The government will ration your care: Establish an annual limitation on cost sharing to ensure that "the cost-sharing incurred . . . with respect to an individual (or family) for a year does not exceed the applicable level specified--$5,000 for an individual and $10,000 for a family." (29.4-29.16)

• The government will establish and administer a public health insurance option: "The Secretary's primary responsibility is to create a low-cost plan without compromising quality or access to care." (page 116, lines 1-17)

• The government will tax employers for not providing healthcare: If an employer does not provide health insurance coverage, a contribution "shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund." The rate will be 8 percent for a large employer payroll (over $400,000), 6 percent and lower for a small employer payroll. (page 149, line 14--page 151, line 5)

• The government will tax individuals unless you are a foreign resident: "Tax on individuals without acceptable health care coverage...imposed tax equal to 2.5 percent of the [gross income]." (page 167, line 17--page 168, line 4) This "shall not apply to any individual who is a non-resident alien." (page 170, lines 1-3)

• The government will order you to get end-of-life counseling and show proof: "[An ] advance care planning consultation between the individual and a practitioner . . . [is required if] the individual involved has not had such a consultation within the last 5 years," including an explanation by the practitioner of "end-of-life services." (page 424, line 20--page 425, line 23) "A consultation . . . may include the formulation of an order regarding life sustaining treatment or a similar order," including end-of-life services. (page 429, lines 1-3). "Orders regarding life sustaining treatment," including "end of life" directions, can be signed either by a physician or "a nurse practitioner or physician's assistant who has the authority under State law." (page 429, line 8-16)

• The government will limit your hospital readmissions by penalizing hospitals: "The Secretary shall reduce the payments" to any hospital with "excess re-admissions," based upon a ranking of hospitals by a national readmission ratio to be developed by the Secretary. (280.10-288.22) The Secretary "shall conduct a study to determine how the readmissions policy described in the previous subsections could be applied to physicians . . . [including] a payment reduction for physicians who treat the patient during the initial admission that results in a readmission." (page 297, line 17--page 298, line 14)

• The government will restrict coverage of special needs patients: Restrict enrollment of new "special needs plans" within Social Security, beginning January 1, 2011, and "the Secretary shall submit to Congress a report" on recommendations regarding the treatment of existing plans, "as the Secretary deems appropriate." (page 353, line 13--page 355, line 6)

• The government will not let you sue over coverage limits and costs decisions: "There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224." (page 124, line 4--page 125, line 2)

• The government will mandate what physicians make: The Secretary "shall provide for" physician participation under the public health insurance option, "for which payment may be made for services furnished during the year. . . ."(page 127, lines 1-16)

• The government will have access to your bank accounts: "Require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part." (page 59, line 21--page 60, line 8)

• The government will not call the fees it imposes taxes: "The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55." (page 203, lines 13-18)

• The government will issue you a health ID card: "include utilization of a machine-readable health plan beneficiary identification card." (page 58, lines 5-13)

• The government will create a new bureaucracy to include phone healthcare: "The Secretary shall appoint a Telehealth Advisory Committee to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services. . . ." (page 379, line 8--page 380, line 14)

Does JFA really want this?

[Ralph]

Definitely, JFA and AARP and the other millions of "non-profit" agencies that the current bureaucracy is propping up with trillions of government dollars, are wishing for this fraud - or should I say to make worse the fraudulent actions that have been taking place.
No mention is made of Obama's promise to repeal the FDA preemption - which denies any kind of redress against the medical industry.
No mention of the fraudulent actions done by our doctors to make us think that we are much more sick than we know. No way to report bad doctors. No way to guard our safety. No way to correct fraudulent medical "histories" let alone the "medical mistakes".
"Preventative" is obviously defined by the "sick=profit" equation. Can anyone actually believe that ALL of the intrusive and harmful "tests", "innoculations", and mandated "drugs" that the AMA is pushing will prevent anything? I think not.
We DO NOT HAVE CHOICE of treatment now. What is different about this legislation? - NOTHING, except more people will be FORCED to bend to the will of the medical industry, lining their pockets fighting for our lives throughout these "one-size-fits-all" policies. Have we all forgotten that the SSA REQUIRES us to be compliant to these unreasonable requirements in order to get any "benefits"?
But what we have to do with the medical industry? - as far as the government can see, we are all "disabled" - what better groups to experiment on than the elder and the disabled. Surely we don't believe that the media will come to our rescue?

[Sherrie F. Eugene, Oregon]

Hey Ric, I see your dreaming up, drumming up and taking things out of context AGAIN!

Your numbers and decimals mean NOTHING!

List your supposed quotes from the Part, Title Number and EXACT Sec. number under the Title you purport in YOUR claims found in H.R.3200 please!

Such as:
Title I, Subtitle D, Sec. 132(d);
Which is listed under: REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS.

And states in such:
(d) Construction- Nothing in this section shall be construed as affecting the availability of judicial review under State law for adverse decisions under subsection (b) or (c), subject to section 151.

Scroll down to Sec. 151(1)(B):
(B) individual rights and remedies under State laws shall apply.
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

Pulling a part of a quote that isn't even under a Title's Section... is like pulling a quote from ANY book found under a listed category in the library! And in most of what you posted; I can't even find that!

It's sad and OBVIOUS that some are posting under false and SELF-interested pretenses here!

I can read, I can follow along(w/o someone else "telling" me what it says) and I've been a patient in the medical industry my ENTIRE life! I read quite a bit and see NOTHING at all that does NOT benefit US as patient's in this Bill!

Btw, your "end-of-life" scare has ALREADY been debunked! Neeexxxt!!!

[Sherrie F. Eugene, Oregon]

P.S. Ric, It works something like this:

You posted:
• The government will create a new bureaucracy to include phone healthcare: "The Secretary shall appoint a Telehealth Advisory Committee to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services. . . ." (page 379, line 8--page 380, line 14)

Guess what? Telehealth is NOTHING new! It can be found under Sec. 1834. [42 U.S.C. 1395m] http://www.ssa.gov/OP_Home/ssact/title18/1834.htm

...Which SEC. 1191. TELEHEALTH EXPANSION AND ENHANCEMENTS.(where your quote can be found) in H.R.3200 is referring and directing to AMEND and ADD a NEW subclause to Sec. 1834. [42 U.S.C. 1395m] to INCLUDE:

A renal dialysis facility (Again, this IS a GOOD thing for those in NEED of such!)

PLEASE learn how to follow and read such Bills BEFORE further misleadings, misconstruings or spreading fictitious and baseless falsehoods of that which is and would DIRECTLY benefit people in NEED!

[Sherrie F. Eugene, Oregon]

If anyone here needs help to direct an OUT OF CONTEXT and/or MISQUOTE to the TRUTH and FACTS in the Healthcare Reform Bill H.R.3200 (that President Obama supports)... I think I can help, so please don't hesitate to ask!

"We are our brothers and sisters keeper".
~[President] Barrack Obama

[Sherrie F. Eugene, Oregon]

Please forgive me for the double "R" typo in Barack! :)

[Ethan B. Ellis]

The other night I went to Congressman Frank Pallone’s (D-NJ) town hall meeting on health care reform in the Piscataway Municipal Building. Pallone is my congressman; Piscataway is my town, where Janet and I are raising our three-year old son.

The meeting was at 7. When I got there at 6:15, people were lined up for two blocks and the parking lots were full. There was a space reserved for people with disabilities, hidden behind the police department. I took it and began the long trek to the end of the line.

It was tough going because Janet had our van so I had to use my walker. As I inched past the people in the front of the line, one man pushing another in a wheelchair offered to let me in front of him. No one else objected so I slid in gratefully.

The crowd was noisy. People opposing reform argued with those in favor all along the line, now four blocks long. Half the crowd was carrying signs and organizers from both sides were racing up and down, handing out leaflets to anybody who would take them. It got even more heated when the doors opened and the meeting began. The anti-reformers spouted the misinformation their lobbyists had fed them and the pro-reformers answered with their talking points. Each salvo brought a cacophony of cheers and jeers from both sides, in a shouting match that covered neither with glory.

Pallone, unruffled and cool, managed to turn the provocative questions and comments into opportunities to provide real, substantive information about H.R. 3200, the bill he supports and the alternatives being considered in the Senate. Despite the din, I learned more in an hour than I had in months of sorting through news and opinion on TV and online. I even got in a question that filled in some of the blanks.

Here’s how H.R. 3200 will affect people with disabilities:
• Every health insurance company must offer a plan that covers everyone’s basic needs.
• All the plans are in one place so you can compare what each offers and costs.
• No plan can refuse to cover anyone with a pre-existing condition or charge more if they have one.
• It provides a subsidy of up to 80% for people who can’t afford to pay the full cost.
• It increases the amount of money doctors will be paid for treating people on Medicaid and Medicare so more doctors will take them.
• It maintains the same eligibility for Medicaid and Medicare so no one will lose those benefits.

Here’s what that means in a nutshell.

If you have a disability and get a job, you can get health insurance you can afford. You can work as many hours and earn as much as you can and not worry about losing your Medicaid or Medicare because you won’t need it. The government will pay up to four-fifths of your private insurance bill if you can’t afford the whole amount. The insurance company you choose can never drop you or charge you more because of your disability or any illness.

If you don’t think you can work, you can stay on SSI or SSDI and get Medicare and/or Medicaid. The only difference will be that doctors will be paid more for treating you so it will be easier to find one who will.

Here’s how it benefits the disability community and the country as a whole. There are twelve million people with disabilities on SSI or SSDI who get Medicare and/or Medicaid. Surveys show that more than 90% of them want to work. Many of them are not looking for work or are only working part-time because they can’t get private insurance and can’t risk losing their Medicaid/Medicare by earning too much – the maximum is $940 a month and $11,280 a year.

Not all 12 million will find jobs – discrimination is still alive and well in this country. But several million can and will and the more that do, the less discrimination the rest of us will face in finding work and becoming independent.

And the more people with disabilities become independent, the more will bring their resources to the struggle to live with pride as equals in this country. That’s reason enough to unite with others across the nation to pass H.R. 3200. Let’s do it!

[Sherrie F. Eugene, Oregon]

Thank you Ethan B. Ellis! I am a 44 yrs-old woman born with birth defects; and that has been my impossibilities to work situation since I was living on my own at age 17 yrs. Although I had spent my teens and 20's wanting and trying to work... it kept coming down to one thing: I'd lose my Healthcare if I did! Finally, in my mid 30's no one would listen to me as I was lied to or told that "we'd cross that bridge later". I found myself thrown into Voc. Rehab's hands who decided to spend thousands & thousands of dollars on what "they" had decided I would need in order to go to work long term. When all was said and done, I would have to buy my own Healthcare Insurance. Well surprise! Not only could I not find any Healthcare Ins. Co. that would accept me but one co. told me IF they did, my premium would cost me $5,000 a month or more! Needless to say, I never bothered tryng to work again; nor did any agency approach me thereafter to do so.

I NEVER EVER again want another human being to be surpressed of their abilities and contributions to society like my own have been due to rules and laws that continue to exclude me simply because I was born with birth defects that may require some assumed but unknown medical procedures and needs! It has been a disguisting shame and a pathetic waste of my life that OUR country has known and yet has ignored for far, far too long!

President Obama is the FIRST hero that I have ever had in my entire life because he recognizes people like me and is working so hard to address and correct such wrongs that I suffer but he cannot do it alone!

I just NEEDED reassurance that I would always have Healthcare for Godsake, and then I could have been anything I wanted to be! What's WRONG with this country? What's wrong with those who accept paying taxes towards a check that places me amongst the poorest of all income brackets to stress and struggle each month but will not accept the possibility of paying taxes towards an equal chance and footing to EARN a REAL living that I've been denied my entire life because I was BORN a "pre-existing condition" that private healthcare insurers do not see as a "normal" part of one's life in this country? I'm sorry my needs or "look" differ from most but that has/does not make me any less normal or deserving of the weight or equality to a life of my capabilities and which so far I have been denied such acceptance of only by those who do not know me. Such sickness needs more treatment than I ever will! Enough!

[Bryan Sam]

great article. I believe everyone should have accesss to the healthcare they need. I built a website for people to search and find health insurance.