America’s Affordable Health Choices Act

I remind you that this bill this not the final bill, which will ultimately require presidential signature to pass into law.

And that I’m not a journalist nor a lawyer.

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IN THE HOUSE OF REPRESENTATIVES

Mr. DINGELL (for himself, Mr. RANGEL, Mr. WAXMAN, Mr. GEORGE MILLER

of California, Mr. STARK, Mr. PALLONE, and Mr. ANDREWS) introduced

the following bill; which was referred to the Committee on _____.

A BILL

 

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,SHORT TITLE.—This Act may be cited as the ‘‘America’s Affordable Health Choices Act of 2009’’.

GENERAL DEFINITIONS.

PURPOSE.—

IN GENERAL.—The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending.

BUILDING ON CURRENT SYSTEM.—This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken.

INSURANCE REFORMS.—This division enacts strong insurance market reforms; creates a new Health Insurance Exchange, with a public health insurance option alongside private plans; includes sliding scale affordability credits; and initiates shared responsibility among workers, employers, and the government; so that all Americans have coverage of essential health benefits.

((“alongside private plans” means this most certainly is not a government takeover of health insurance. “sliding scale affordability“ means that lower income individuals on the government option will pay less, unlike private insurance plans.))

Subtitle A—General Standards

IN GENERAL.—The premium rate charged for an insured qualified health benefits plan may not vary except as follows:

LIMITED AGE VARIATION PERMITTED.—By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.

BY AREA.—By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).

BY FAMILY ENROLLMENT.—By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner.

((At this stage the bill puts a great many stipulations unto the Commissioner while retaining the existing powers of State law and insurance regulators.))

SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.

DUTIES.—The Commissioner is responsible for carrying out the following functions under this division:

QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.

HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.

INDIVIDUAL AFFORDABILITY CREDITS.— The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.

IN GENERAL.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange.

COMPLIANCE EXAMINATION AND AUDITS.—

IN GENERAL.—The Commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance.

RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such QHBP offering entities.

DATA COLLECTION.—The Commissioner shall collect data for purposes of carrying out the Commissioner’s duties, including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the Secretary of Health and Human Services

SANCTIONS AUTHORITY.—

IN GENERAL.—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph

REMEDIES.—The remedies described in this paragraph, with respect to a qualified health benefits plan offered by a QHBP offering entity, are— (A) civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section 1857(g) of the Social Security Act; suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur;SEC. 2714.

ENSURING VALUE AND LOWER PREMIUMS.

IN GENERAL.—Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.

(“ensure adequate participation by issuers” is the key concept to understand.)

UNIFORM DEFINITIONS.—The Secretary shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate the medical loss ratio. Such methodology shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans.The provisions of section 2714 shall apply to health insurance coverage offered in the individual market in the same manner as such provisions apply to health insurance coverage offered in the small or large group market.

IMMEDIATE IMPLEMENTATION.—The amendments made by this section shall apply in the group and individual market for plan years beginning on or after January 1, 2011.SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE

TRANSACTIONS.STANDARDS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS.—

IN GENERAL.—The Secretary shall adopt and regularly update standards consistent with the goals described in paragraph (2).

(2) GOALS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS.—The goals for standards under paragraph (1) are that such standards shall be unique with no conflicting or redundant standards; be authoritative, permitting no additions or constraints for electronic transactions, including companion guides; be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications; enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card; enable, where feasible, near real-time adjudication of claims; provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary; describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and harmonize all common data elements across administrative and clinical transaction standards.

TIME FOR ADOPTION.—Not later than years after the date of implementation of the X12 Version 5010 transaction standards implemented under this part, the Secretary shall adopt standards under this section.

REQUIREMENTS FOR SPECIFIC STANDARDS.—The standards under this section shall be developed, adopted and enforced so as to— (A) clarify, refine, complete, and expand, as needed, the standards required under section 1173; (B) require paper versions of standardized transactions to comply with the same standards as to data content such that a fully compliant, equivalent electronic transaction can be populated from the data from a paper version; (C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice; (D) require timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing; (E) 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; and (F) provide for other requirements relating to administrative simplification as identified by the Secretary, in consultation with stake holders.

BUILDING ON EXISTING STANDARDS.—In developing the standards under this section, the Secretary shall build upon existing and planned standards.

IMPLEMENTATION AND ENFORCEMENT.—Not later than 6 months after the date of the enactment of this section, the Secretary shall submit to the appropriate committees of Congress a plan for the implementation and enforcement, by not later than 5 years after such date of enactment, of the standards under this section.

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Bernanke On The Record

ben bernanke

“My goal is to talk to people outside the Beltway to hear what they are thinking, and do the best I can to explain what’s happening in the economy.”

Many people who care very little for facts have been saying a great deal of nonsensical words in regards to conspiracies and wild theories. In this time of historic actions being done by the government in what amounts to an expanse in federalism it is important to understand the truth of the matter and not allow yourself to be lead astray by people who care nothing for the truth and only seek to promote their own twisted agendas.

Federal Reserve Chairman Ben Bernanke recently did a open forum event hosted by PBS in which the public could ask him questions in regards to his job and the state of the American economy.

Reality Check: Economics in America

1.globe_and_moneyLet it be said that I am not bought off and not invested in how much money you make one way or the other.

I am one of last people on the web that is willing to tell the truth and attempt to remove all the shadowing and spin that resides over all that is the media.

Allow me to be plain:

We are headed for a depression.

I repeat this as a man with three businesses and a successful career in marketing said this statement to me.

A math teacher of high credentials has said to same to me in the past year.

You won’t hear this from the bought and paid for economists who sat on their hands and let our economy crumble beneath us as they remained mute.

While the word ‘depression’ in regards to economics is about to appear on the FFC Banned Words List there is much to be understood about what awaits us.

I’ll remove as much jargon as I can.

The economy will go up. But then it will come back down again.

They call me a “W” in terms of my economic perspective in that I believe we will regain strength in the market in coming quarters. But I think these will be temporary gains and ultimately we will fall back into a recession cycle that will lead to a depression.

Most media economists tell you that they are a “V” which to me just denotes that they are blindly optimistic or much more likely bought and paid for.

Some maintain that there will be no improvement and they are labeled the “L‘s”.

And some still think we will have gradual and slow recovery that is unhampered and they are labeled as “U‘s”.

Anyone like myself who speaks of a forthcoming American Depression would squarely fit into the “W” or the “L” camps.

However, the notion that all hope is lost is a false one.

Most of us ‘money-savvy’ people already know that fortunes can be made in depressions and that the wealth of the nation will not dissolve into thin air but rather will be distributed down to the people who have the intelligence and the foresight to take advantage of the downturn.

This is just a sliver-lining though. Each family should take real steps right away to build up the value of your home, maximize your portfolio and be prudent about major expenses.

But it’s important to realize that if we are going to prove me, a math teacher and a successful business man wrong that this nation will have to refocus itself on consumer spending.
If all of America continues to tighten it’s belt in this endless fashion then you begin to see why some predict this outcome at a latter date. Most say about three years and I would estimate a little longer span of time but the same end result.

The Joy of Passive Aggressive Post-It Notes

postit1

Post-it note.1

Does anyone else have this little problem?

I have no tolerance for it. If you have something to say to me, you come and say it to my face.

Part of the issue is that I wasn’t living in the shameful situation of being back at home after having failed at striking out on my own, but the matter is old and frankly I’m sick of being nice to passive aggressive people and their evasive, elusive little hints.

I am officially a ‘mean guy’ because I’m not going to reduce myself down to this whimpering and pathetic note passing.

I’ll just tell you I think your a social coward and don’t have what it takes to cut it in the real world.

Or you could stop leaving your stupid, unhelpful notes around…

Partisanship Revisited

It occurs to me that many people in America care little to perceive and discern political partisanship in both the media and coming from representatives of their party.

Partisanship, better described as political hatred, is the driving force in the televised media and has been the bread and butter of radio broadcasting for as long as one cares to recall.

No person who advocates bipartisan coverage in the media is asking others to forego their own conclusions nor to silence their tongue in terms of political commentary.

Those who request a more bipartisan government and a more bipartisan media are only asking that the rancor and untruths spread by both sides be called out as such. We only ask that a person of any political stance be mindful of the simple fact that using slander, propaganda, and biased reporting does not contribute to the body politic of the nation.

The need to declare one’s self as part of any group is also an element of bipartisanship known as ‘full disclosure.’ This fact does not allow any person to call themselves ‘balanced’ and ‘fair’ in their dialogue while they proceed to make vast assumptions and baseless assertions about another group that they do not belong to nor share any common ideologies with.

The value to the nation is lost. These endless left versus right debates with no mutual respect and no interest in reviewing facts in the process is only serving to tear the nation further away from attaining mutual goals.

We the people did this to ourselves, lest someone feels the urge to blame the media.

The people of America seem to enjoy staying perfectly ‘safe’ within their respective spheres of politics and dare not to stray away from the ‘status quo’ generated by whatever biased programming they choose to absorb.

The media only responds to what it perceives the public wants. The public seems to want to drowned in slanderous, untrue, and vague reporting coming from pundits who make their careers off of lying and obfuscating facts about politics.

The bottom line is that media pundits have tied their own noose around their neck. If even one of them were to admit that they say these slanderous remarks and hateful comments to boost their ratings or book sales they would be thrown away by the very people who currently pay them respect.

I assert that if true honesty and true patriotism were to be included in the modern political media that people would reject these current figures in the media and exchange them so others who would not ever be honest and straight forward with the public could take their place.

In a world where each political camp is dedicated to the notion that the other is ‘evil’ and ‘immoral’ we shall never do anything worthy of the name American in this country.

We shall forever be a nation divided and shall never be a nation united.