"Universal" Health Insurnace

New York Times:

In a major surprise on the politically charged new health care law, the Obama administration said Friday that it would not define a single uniform set of “essential health benefits” that must be provided by insurers for tens of millions of Americans. Instead, it will allow each state to specify the benefits within broad categories.

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    yeah, that was pretty much (5.00 / 3) (#1)
    by The Addams Family on Sat Dec 17, 2011 at 06:50:47 PM EST
    my reaction, too, when i read this . . . no comment

    "major surprise"? not when you consider Obama's "states' rights" position on marriage equality

    love your typo: "insurnace" - the very notion of universal health care going up in flames under this administration

    how cool (5.00 / 4) (#2)
    by kmblue on Sat Dec 17, 2011 at 07:00:37 PM EST
    I guess "essentials" in some states will include Viagra for men and a lack of legal abortion for women.

    With indefinite detention and this health insurance crapola, Obama is having a stunning week.

    Merry Christmas to all!  

    Walker, according to a relative (5.00 / 3) (#18)
    by Towanda on Sat Dec 17, 2011 at 11:08:22 PM EST
    in Wisconsin who will have a serious financial hit from this, just has jumped at this opening from Obama.  According to a Forbes article, Walker has "set his sights on ending the availability of cervical and breast cancer screening --- along with multiple sclerosis detection --- for Wisconsin women who have insufficient health insurance to pay for these critical procedures."

    When the likes of Walker like what Obama is doing to health insurance and health care, that says it all.


    And by the way (none / 0) (#3)
    by kmblue on Sat Dec 17, 2011 at 07:13:46 PM EST
    I ain't surprised.  Both Obama and the ACA suck.

    Yes, There are No Surprises (none / 0) (#32)
    by norris morris on Mon Dec 19, 2011 at 06:37:17 PM EST
    Obama remains a political opportunist actually no better than the GOP'ers.

    His latest shticks are costing us our liberties, health care, and a continual assault on women's right to equal protection.



    I must say, when I read this (none / 0) (#4)
    by nycstray on Sat Dec 17, 2011 at 07:37:24 PM EST
    the first thing I thought was, "Thank Gawd I live in good ol' California". Should keep my BP down a bit . . . I'm guessing women will have to pay 100% for their BC in those Viagra states also . . . .

    Perhaps the NYT is surprised, but (5.00 / 5) (#5)
    by Anne on Sat Dec 17, 2011 at 07:41:21 PM EST
    I can't say that I am.

    Once again, the kind of health care one can get coverage for will depend on geography and politics.

    By the time 2014 gets here, we will have circled completely around to where we were when all of this started, except that the costs we will bear will be exponentially greater than they were before the transformative reform of the ACA.

    Bet you a nickel this has something to do with making sure the insurance companies remain profitable.

    No one will take that bet (5.00 / 4) (#24)
    by cal1942 on Sun Dec 18, 2011 at 12:05:33 PM EST
    It was all about insuring the position of the private health care insurance industry from the start.

    Every parasitic health insurance company ought to erect a statue of Obama in front of headquarters or at the very least a bust in the CEO's office.


    Obama & Insurance (none / 0) (#33)
    by norris morris on Mon Dec 19, 2011 at 06:39:18 PM EST
    Obama has made sure that the Insurance companies in America are protected. First.

    As someone wrote recenty Obama worked hard to get (5.00 / 3) (#6)
    by jawbone on Sat Dec 17, 2011 at 08:33:08 PM EST
    a lousy health insurance "reform" bill (actually, a big for profit insurers' profit protection plan) so that no good plan could pass.

    Health "care" has been "done."  Done in, actually. By the president in thrall to the One Percent.

    What further damage does he have left to do the this nation, the economy, the 99%? I do fear that if he has no need to face voters, he will be even ore evil in a second term. He has not loyalty to the Democratic Party as an institution, so he would have no compunction in further eroding its base, its principles.

    I do fear this president.

    Trouble is (5.00 / 2) (#25)
    by cal1942 on Sun Dec 18, 2011 at 12:11:49 PM EST
    He's the face of much of today's Democratic Party.  The party ain't what it used to be.

    Loyalty? Obama? (none / 0) (#34)
    by norris morris on Mon Dec 19, 2011 at 06:44:20 PM EST
    You cannot speak of loyalty to the Democratic Party and Obama in the same breath.

    The guy has no interest in those who voted for him,and his decisions of late are righter than right.

    His Oneness doesn't give a damn.


    Just to set the record straight (5.00 / 2) (#7)
    by NYShooter on Sat Dec 17, 2011 at 08:50:06 PM EST
    My information is that the portion any insurance company pays towards eds meds (Viagra, etc) is infinitesimal. If the script allows, let's say 20 pills per month, the Ins. Co. will pay approximately for 2, maybe 3 pills.

    I'm sure there are "gold plated" insurance plans rich people can afford that pay for more, but, as for average plans,  I think my figures are pretty close to the facts.

    If anyone here has better information, please let us know.

    And, for what it's worth, equalizing men's sexual performance pills with women's reproductive and pregnancy medication is simply outrageous. I'm not discounting men's sexual health issues, but relatively speaking, women's reproductive & sexual freedom is not only serious business but often a matter of life and death.

    i don't think your comment (none / 0) (#16)
    by The Addams Family on Sat Dec 17, 2011 at 10:12:09 PM EST
    comes off this way:

    equalizing men's sexual performance pills with women's reproductive and pregnancy medication is simply outrageous

    you're making a point that others here frequently make as well, correctly imo: that there is an odious double standard with respect to men's & women's sexual/reproductive rights & freedoms


    calling for some Obama fan (5.00 / 1) (#8)
    by The Addams Family on Sat Dec 17, 2011 at 09:03:36 PM EST
    to explain what the thinking was here

    is this somehow supposed to create competition among the exchanges, such that if i live in illiberal Alabama i can opt for coverage from liberal California?

    or is this just election-year "insurance" against charges of "socialized medicine"?

    They do not want to revisit (5.00 / 1) (#10)
    by andgarden on Sat Dec 17, 2011 at 09:34:34 PM EST
    the Plan B debacle.

    Of course, every state that goes there (or worse) will ultimately have been permitted to do so by the Obama Administration. But it will be attenuated, and that works for them politically.


    Obama's Decisions (none / 0) (#35)
    by norris morris on Mon Dec 19, 2011 at 06:48:14 PM EST
    Are based on getting elected and extracting campaign funds from Wall St and super Corps, et al.

    His behavior in the past 3 years and on the campaign trail will be unrelentingly opportunistic. Forget your Obama Dreams.


    That's the sound of a punt (5.00 / 4) (#9)
    by andgarden on Sat Dec 17, 2011 at 09:31:38 PM EST

    Yep, it's like (5.00 / 1) (#12)
    by Edger on Sat Dec 17, 2011 at 09:43:14 PM EST
    the buck stops, ummmm, over there! Or over there!

    so can we also expect (none / 0) (#17)
    by The Addams Family on Sat Dec 17, 2011 at 10:17:40 PM EST
    the effects of this punt to be felt in the decision regarding contraception coverage for women working in Roman Catholic institutions?

    Current differences? (5.00 / 1) (#11)
    by EL seattle on Sat Dec 17, 2011 at 09:42:14 PM EST
    From the NYT story:

    The move would allow significant variations in benefits from state to state, much like the current differences in state Medicaid programs and the Children's Health Insurance Program.


    Does anyone know if there's a good 'Go-To' website that has a listing and side-by-side comparison of the current different variations in states' Medicaid and CHIP programs?  

    I think that it would be interesting to know if some parts of the state programs are mostly the same (in Dec. 2011), and where there are significant variations right now.

    I don't think it's exactly what you're looking for (none / 0) (#14)
    by Edger on Sat Dec 17, 2011 at 09:47:24 PM EST
    and it's from Kaiser, but this may help...

    statehealthfacts.org - Medicaid & CHIP


    Thanks for the link! (5.00 / 1) (#27)
    by EL seattle on Sun Dec 18, 2011 at 12:43:04 PM EST
    There seems to be some good material on this Kaiser site.  It doesn't have everything that I'm hoping to find, but it seems to be worth looking at for the stats that it does have.

    Id like to think that there would be some independent websites that would compile this sort of information, even if it's for 50+ discreet (but similar) situations.  Unfortunately, just finding independent websites can be a challenge sometimes in 2011.  Maybe the internet will get better at this sort of thing over the next year or so.



    Happy to help (none / 0) (#29)
    by Edger on Sun Dec 18, 2011 at 02:01:03 PM EST
    If I run across any others I'll try to let you know, if I see you here...

    I'll have to take a look at the statute, (5.00 / 1) (#13)
    by andgarden on Sat Dec 17, 2011 at 09:47:20 PM EST
    but there might be an APA challenge to be made here.

    health non-insurance (5.00 / 1) (#19)
    by womanwarrior on Sat Dec 17, 2011 at 11:11:58 PM EST
    Basically, our health insurance, offered by our "non-profit" blue went up 24% this year.  We are looking at a $5,000 deductible, which is basically catastrophic coverage.  And our family coverage, which adds our adult child adds $400 a month for our kid to our husband wife coverage.  Wow, such a deal!  We have been trying to cover our employees, and now I think they are going to have to contribute to the premiums.  Otherwise, we will end up paying ourselves less than we pay them.  
    [I am overreacting a little, since I have been waiting for months for a large for me cja voucher for a trial I did as court appointed counsel to be approved. Funny how the prosecutor, agents and judge don't have to wait for their paycheck. The bank doesn't have to wait for the mortgage check. And this was a case where the trial judge ordered me to go out and buy court clothes for my client, out of my pocket of course.] Right now my year end coffers are a bit empty.

    Ezra Klein is a fool. (5.00 / 5) (#22)
    by inclusiveheart on Sun Dec 18, 2011 at 10:23:55 AM EST
    The truth is that the combination of the mandate, lack of pricing controls and the vagaries of coverage for the mandated spend - this horrible monster was always going to be a nightmare of politicization and corruption.

    An army of lobbyists is getting ready to fan out across the country and descend upon the state houses and governors' mansions.  You'll be paying $300 a month so you can get one annual check up and that's it.  If you want more, you'll have to mortgage your house, if you can get a mortgage, that is.


    I am so disgusted.

    Hence the new 2012 Obama Slogan (none / 0) (#23)
    by Edger on Sun Dec 18, 2011 at 10:41:14 AM EST
    "Change IS"

    "Change is health care reform that we passed after a century of trying."

    -- Barack Obama

    Running on, I mean away from, his record, of course...


    I really (5.00 / 1) (#26)
    by NYShooter on Sun Dec 18, 2011 at 12:32:09 PM EST
    do hate pithy (meaningless) slogans

    Can't we just leave bumper sticker campaigning to the Tea Party Wingers?

    The only thing this reminds me of is 2008. "You fooled us once, Suckah....you don't get Twice."

    But, Good News on the Economic Front:

    "Across the Peninsula, a small-scale building boom is under way as developers and wealthy property owners buy million-dollar homes, tear them down and build larger ones."

    Give'm another Tax Cut!!!

    Obama has empowered the Insurance industry ! (5.00 / 1) (#28)
    by samsguy18 on Sun Dec 18, 2011 at 01:29:53 PM EST
    Insurance premiums will be significantly increased and coverage dramatically decreased.
    For profit institutions will upcode and cherry pick! The not for profit and academic institutions will be hammered... I am disgusted...I didn't expect much from Obama !

    Can someone explain something to me? (none / 0) (#15)
    by observed on Sat Dec 17, 2011 at 10:11:26 PM EST
    As I understand the insurance industry, in general, a company based in NJ can sell insurance based on NJ regulations in another state.
    How will this work for medical insurance?

    Bumper Bowling Flexibility. (none / 0) (#20)
    by Addison on Sat Dec 17, 2011 at 11:12:22 PM EST
    If I'm reading this NYT's article correctly, it seems like "flexibility" within pretty narrow boundaries.

    [ACA] lists 10 categories of "essential health benefits" that must be provided by insurance offered in the individual and small-group markets, starting in January 2014. These include preventive care, emergency services, maternity care, hospital and doctors' services, and prescription drugs.

    Under [the new] approach, each state would designate an existing health insurance plan as a benchmark. The benefits provided by that plan would be deemed essential, and all insurers would have to provide benefits of the same or greater value. Plans could modify coverage within a benefit category so long as they did not reduce the value of coverage.

    Each state would choose one of the following health insurance plans as a benchmark:

    1. One of the three largest small-group plans in the state.

    2. One of the three largest health plans for state employees.

    3. One of the three largest national health insurance options for federal employees.

    4. The largest health maintenance organization operating in the state's commercial insurance market.

    Obviously I'd still rather have single payer and we'll see what the plans end up looking like, but I hope people actually read the article. There's a potential for states to INCREASE the mandates if they want, and if someone takes away the idea that (let's say) Texas will be able to set "one apple per week" as the coverage and get away with it they've got it wrong.

    Here's the list of the 10 essential categories: (5.00 / 1) (#21)
    by Addison on Sat Dec 17, 2011 at 11:31:41 PM EST
    • Ambulatory patient services
    • Emergency services
    • Hospitalization
    • Maternity and newborn care
    • Mental health and substance use disorder services
    • Prescription drugs
    • Rehabilitative and habilitative services and devices
    • Laboratory services
    • Preventive and wellness services and chronic disease management
    • Pediatric services, including oral and vision care


    Does it make sense to include the cost of wigs when the cost of coverage is too high for many to begin with?


    "Essential" should be limited to the need to have and exclude the merely nice to have.  



    especially for a woman (5.00 / 1) (#31)
    by The Addams Family on Mon Dec 19, 2011 at 10:41:54 AM EST
    & perhaps also for a man who is newly bald because of chemotherapy, & particularly for one who works in a public role &/or in a high-transference profession (such as medicine, education or psychotherapy), a wig is essential

    do you also consider a breast prosthesis to be "nonessential"? what about a prosthetic leg? a glass eye? just "nice to have"?


    The makers of (2.00 / 0) (#36)
    by Abdul Abulbul Amir on Mon Dec 19, 2011 at 11:24:00 PM EST
    the most expensive wigs are grateful for your support.  

    Uh... (5.00 / 2) (#37)
    by Addison on Mon Dec 19, 2011 at 11:34:57 PM EST
    What evidence do you have that there will be no upper limit for reimbursement on the plans? Do you have any evidence at all? If not, why are you undermining your own credibility on the issue, fighting against insurance-covered wigs for cancer patients and prosthetic legs for amputees? Just for kicks? I don't get why, given ignorance as to which plans the states will choose as benchmarks, you've decided to go ahead and assume one thing instead of another, and then use that (unfounded) assumption to grouse about, of all things, rehabilitation services. Bizarre choice.

    The problems with price setting (none / 0) (#38)
    by Abdul Abulbul Amir on Tue Dec 20, 2011 at 11:33:25 AM EST
    are several.  The first  it creates a powerful incentive to increase the price to whatever the reimbursement limit is.  It also creates a lobby to increase the coverage.  Why limit coverage to only cancer patients when the self esteem of others suffer the very same although the cause(s) of hair loss may differ?  You don't want an unfair system do you.

    The more you mandate as a minimum, the more you make it unaffordable. Those products and services that are both not costly and not life necessary should not be required to be included in a basic policy.  As more expensive Cadillac coverage sure.  

    BTW, laser eye surgery is typically not covered by third party payers, and the cost has not risen the way general health care costs have risen.



    Fine. (5.00 / 1) (#39)
    by Addison on Tue Dec 20, 2011 at 11:51:51 AM EST
    Fine. That's a great abstract rationale. Sounds like something the states will have to deal with when setting overall regulatory policy and choosing a benchmark plan. Doesn't sound like a compelling reason why people putatively with health insurance should have to pay out of their own pocket for basic medically-related rehabilitative or habilitative services.