The Health Care Reform for Dummies(Like myself)

What you need to know about the health care bill: Broken down word for word for dummies like me.

I've taken the time to do my research on the health care bill so I can really understand what the FUCK is going on. I know that isn't just me who is confused or worried about the 'tag' you're it game our government is playing with our health care. Here is my understanding of the health care bill from VARIOUS websites. It is not one sided... I did not google search "Why do democrats love the health care reform." In fact, I even google searched "Why do Republicans oppose the health care reform" and I bit my tongue to keep from cursing them all because they are low life nut suckers(in my opinion). Here is a an overview of the health care reform:

The biggest-and most important aspect- of the health care reform is that insurance companies will no longer be able to deny people health care because of pre-existing conditions, drop them because they get sick, or make them pay higher deductibles and out-of-pocket expenses.

What is a deductible, out-of-pocket expense, and pre-existing conditions?

Deductible: A deductible is a fixed amount you must pay out-of-pocket before your health care policy will cover any of your medical expenses.

Out-of-pocket expenses: Out-of-pocket expenses are a non-reimbursible payment you make for what your health care policy will not cover. This includes your pre-existening health issues during the exclusion period.

What is an exclusion period?

Exclusion period: The health care policy you enroll in may take on your case even if you have pre-existing conditions. You're now paying your monthly premium but you are not covered for any of the care you receive for your pre-existing condition. Depending on your policy and your state's insurance regulations this period can last anywhere from six to 18 months. If you get your health care policy through your employer your exclusion period is limited to 12 months and only applies to pre-exisiting conditions that you've received treatment for within the last six months.

What is a premium?

Premium: A premium is a monthly payment you make to your health care provider to cover your health care expenses including all health-related services such as doctor visits, hospitalizations, and medication.

A pre-existing condition is a health problem that existed before you applied for coverage from a health insurance policy or enrolled in a new health insurance plan.

Let's go over a few common pre-exisiting conditions that can automatically deny you from being insurable:

Serious and life threatening diseases: Heart disease, cancer, HIV & AIDs, diabetes.

Here is a list of common cancers that are not coverable unless you have NOT received treatment for them in the listed amount of years:

Bladder Cancer-Free of treatment for 5 years, brain cancer-free of treatment for 10 years, breast cancer-free of treatment for 7 years, cervix/uterus/ovarian cancer-free of treatment for 3 years, colon cancer-free of treatment for 7 years, esophagus cancer-free of treatment for 10 years, eye cancer-free of treatment for 5 years, Hodgkin's lymphoma-free of treatment for 7 years, kidney cancer-free of treatment for 7 years, larynx cancer-free of treatment for 10 years, Non-Hodgkin's lymphoma-All cases not coverable, Leukemia-free of treatment for 10 years, liver cancer-free of treatment for 10 years, lung cancer-free of treatment for 10 years, multiple myeloma-All cases not coverable, oral cavity cancer-free of treatment for 5 years, pancreas cancer-free of treatment for 10 years, prostate cancer-free of treatment for 10 years, skin cancer-free of treatment for 6 months, stomach cancer-free of treatment for 5 years, testicular cancer-free of treatment for 5 years, thyroid cancer-free of treatment for 5 years.

Now, you might ask yourself how much would it cost to treat something like Lung Cancer without health insurance.

On average a patient who is treated successfully and survives costs were: $39,891 in the first year.

On average a patient who is not treated successfully and does not survive costs were: $41,098. The access cost is the terminal care provided to the patient in the remaining three months of their lives. Basically stating that in order to die comfortably from a failed treatment plan costs roughly $1,207.

Lung cancer is NOT the most expensive cancer to treat. For instance the treatment for rare types of lymphomas can cost $24,000 a month. And a popular treatment for colon cancer, a disease that strikes 106,000 Americans a year, cost $17,000 a month. Can you imagine being unemployed and uninsurable with a bill like that? The 5 year treatment for cancer as a whole can well exceed $350,000 with frequent treatments and check-ups.

Another comparison to weigh in is that Stage 1 Breast Cancer is 95% curable with health insurance. Those statistics drop to 51% without health insurance. Preventive care is a necessity to keep ourselves healthy. It should be a right, not a privilege to get preventive screenings like a mammogram considering that 1 out of every 8 woman in their lifetime will have some form of breast cancer.

Serious but controllable conditions: High blood pressure, high cholesterol, asthma, complicated pregnancies, heart murmurs, and infantile autism

Ridiculously inconvenient 'pre-existing' conditions: Previous injury, acne, domestic violence, ADD, Bipolar disorders, Dwarfism, pregnancies, Rape, Suicide attempts, Bulimia, Electroconvulsive therapy(Shock therapy), Transsexualism, breast implants, infertility, expectant fathers, therapy/counseling within the last 6 months, currently experiencing symptoms for which a physician has not been consulted.

What the health care reform will do:

Insurance companies are no longer allowed to deny people or drop them based on their medical history. Everyone is entitled to insurance coverage. Insurers cannot charge you higher prices for being sick. Immediately after the bill is passed companies will be barred from denying coverage to children with pre-exisiting health conditions and people will who are currently uninsurable but do not qualify for medicare or medicaid now will have access to a temporary "high-risk pool" until provisions are made.

What is medicare & medicaid?

Medicare: Medicare is health care for people over the age of 65.

Medicaid: Health care for the needly.

In 1996 congress passed HIPPA(Health Insurance Portability and Accountability Act). HIPPA protects you when you need to buy, change, or continue your health insurance policy. It DECREASES your chances of losing or being denied health insurance. HIPPA makes it easier to switch plans or enroll in new ones if you lose your job. HIPPA's protections include:

Limits the exclusion period for pre-exisitng conditions, prevents discrimination of charging your more or denying you coverage based on you or your family's health problems, it often guarantees that if you lose your job you have the right to purchase your own health insurance, and it usually guarantees that you can renew your coverage regardless of new conditions with your family.

In the case of losing your job HIPPA's "Creditable coverage" will give you 63 days to find a new job and acquire a new policy before they can subject you to pre-existing condition exclusions.

Insurance for small business and individuals:

Each state will set up it's own health insurance exchange. An exchange, which will be set up on a website, will allow you to view all policies available to you at one time instead of shopping around and enroll in the policy you choose through the exchange. People who can't afford the insurance through the exchange can get subsides to help them.

A subsidy is a grant paid by the government to a business to secure assistance.

Subsidies will be available to families of four or more up to $88,000 a year. Out-of-pocket payments will not exceed $11,900 per family and $5,900 per individual. It may seem like a lot but it is much less then many are spending right now. Subsidies will not cover abortions. If a woman wants her insurance to cover abortions she will need to purchase a separate policy then the one she is getting through the exchange.

If you do not enroll in a health insurance policy you will be charged a fine of 2.5% of your income to the IRS. Small business will receive tax credits of up to 35% for enrolling their employees in a health insurance policy.

A tax credit is a deduction on your yearly income taxes. If your taxes are $10,000 they will be reduced by up to 35% making them $6,500.

The exchange will dramatically reduce the number of those in our country that are uninsured. Of the 32 million Americans who do not have insurance, 24 million Americans will be covered through the exchange and 16 million will be covered through medicaid.

Insurance through employers:

Employers with 50 or more employees will be required to offer insurance. Business that don't offer coverage pay $2,000 per employee if any of their employees do not qualify for federal subsidies. Employee premiums will fall by at least 3% and their will be a new tax on on employers "Cadillac plans" to keep employers from offering overpriced and needless insurance policies.

Policies will be required to cover preventive care with no co-payments(co-payments make up your deductible). Children can stay on their parents health insurance policies until they are 26 years-old. Insurers HAVE to pay 80-85% of premiums on actual medical services instead of pocketing the rest or the money, which is what they do now. Lifetime limits on the amount of medical care your insurance company will pay will become illegal and annual limits will be tightly regulated.

The Medicare Donut Hole:

Those insured by medicare who joined the part D drug plan had to pay $310 of their prescription drugs until they met their deductibles. After they reached their deductible they paid 25% for their drugs while the plan paid for the rest of the 75% until the costs reach $2,830. After reaching $2,830 those who were covered by the plan paid 100% of their medication costs until they reached $4,550. Once they'd reached $4,550 their plan covered the cost of their medications for the remainder of the year, i.e. they've just been fucked.

The medicare 'donut hole' will be closed completely by 2020 and frozen by 2011 making it impossible for seniors to fall into the overpayments. Medicare taxes will be charged on dividends(the portion of profits paid out to stockholders), capitals gains(the amount by which a selling price exceeds it's purchased price), and other unearned income from people making more then $250,000 a year but it is very likely this number will be changed to those who make more then $1,000,000 a year.

How will all of this cut costs?

It's estimated that we'll spend $943 billion dollars over the next ten years on health care. Not cheap, you think... Until you hear that we spend $2.5 trillion each year on the health care we have now.

Where will the $943 billion dollars come from?

The $943 billion dollars is already paid for. New fees are being charged to pharmaceutical companies, manufactures of medical devices, and other industries that will benefit from the expansion of health care because more people then ever before will be using their products. Those who don't buy insurance and get taxed by the IRS will help pay our bill, and higher taxing on those who make more then $250,000 a year, but like I said this number is likely to get changed to $1,000,000 when the bill is revised. Most of the savings are from the government spending less then ever before on medicare and medicaid.

The foundations of health care will stay the same. You will pay the insurance companies, they will reimburse your doctors.

Congress has been debating the health care reform for more then a year. It went though three house committees and two senate committees. The house passed its own revised version of the bill on November 7th, 2009 and the senate passed their revised version on December 23, 2009. After Scott Brown won Massachuesett's senate seat in January the Republicans had enough of a vote in the senate to filibuster(A legislator(someone who makes/writes/passes the law) that delays something that opposes) anything that the house sent its way. So bitter sweetly, the House passed the Senate's revised version of the health care reform(that for lack of a better word 'sucks' and makes very little changes to our current health care), unrevised with the house's ideas for President Obama to sign. The new law will impact all segments of our healthcare system-consumers, insurers, hospitals, health plans, and manufacturers of drugs and medical equipment. Whether you are for or against the health care reform it is NOW the law and we will see it's effects in the coming years.

So now that you've read this you're probably asking-What's all the hate about? This seems pretty harmless.

Concerns:

People will lose their current insurance: According to the bill, no American will have to give up a plan that he or she doesn't want too. It is mostly an alteration to the health care companies, not your health care coverage. Put it this way, you'll still have the same healthcare, you just wont need to fear getting dropped or having to pay more then you should. The biggest change right now is teaching the insurance companies to play fair and hitch all the uninsured up with working insurance.

There will be on government-run plan and we wont have any choices: False. There are several options-keep your own plan, medicaid and medicare, private option, or a public option. Even the most basic will cover essential health care needs, it mostly differs in out-of-pocket expenses which are going to be tightly regulated.

People will have to go before death panels: Oh, Sarah Palin.... Physicians will be reimbursed for taking the time to talk to their patients about their desires and end-of-life wishes, although it is not mandatory. These discussions are essential to prevent performing aggressive and painful treatments to keep someone alive when it's against their wishes. It's basically the same thing as signing a 'do not resuscitate' order once you become old or ill.

We'll lose our privacy: People are fearing that the government will have access to our personal records. They already do, it's called the IRS. However, what information that they do not have access too is protected by HIPAA.

The government is going to tell my doctor how to treat me: No, there is nothing in the bill that would allow the government to control what treatment your doctor does and doesn't give you. There is nothing in the bill that allows the government to put their slimy hands into your treatment, in fact, your doctor won't have any communication or relationship with the government concerning your health care. The bill just doesn't change that much.

I can't get a second opinion: This is true. The government is hoping to eliminate cost of unnecessary testing. The medical field is always changing so it's important for doctors to stay up-to-date on the current information and research being done. When the health care costs were reviewed their was a substantial amount of money spent on unnecessary and out-dated testing. They'd like to reduce costs spent from jumping from doctor to doctor and open up access for doctors to have the best available equipment and treatments available for you.

I won't be able to choose my doctor: There is no reason that you'd have to stop seeing your doctor, not ask for your doctor's recommendations for a specialist, or choose a doctor that you like. If you are insured your health care wont change. The point of the health care reform is to get those who are uninsured insured and to keep costs down by cutting out the criminal things that the health care insurance companies do.

FIN!