Senate voted 60-39 to start debate on the healthcare bill introduced by Senator Reid.  The bill is about 2000 pages long.

We are here providing our thoughts on a portion of the bill at a time.

Title I, Subititle A, Subpart II of the bill covers “improving coverage”.    The section has following Sections.

• No life time or annual limits: The provider may not establish life time or unreasonable annual limit on the dollar valie for any participant of beneficiary.  However, the provider may do so if they are not required to provide essential health benefits as per Sec 1302 b of Patient Protection and Affordable Care Act as long as it is permitted un the Federal or State Law. 

Section 1302b defines the essential health benefits requirements which will be discussed separately in the future.

• Prohibition of recissions: Providers may not rescind plan or coverage for a participant once person is covered under such plan except the person has committed fraud or intentional mistake.  The coverage may be cancelled with prior notice as permitted by section 2702c and 2742b.  Unfortunately, I was not able to locate the section 2742 altogether and 2702c in the bill.
• S2713. Coverage of preventive health services: Insurer will be required to provide coverage for preventive care without imposition of any cost sharing requirements.  These preventive care services including immunizations will be defined by the US Preventive Services Task force.  The section also authorizes the secretary to develop guidelines to permit insurer to utlize value based insurance designs.

The section however does not elaborate on the meaning of “value based insurance design”

• S2714. Extension of dependent coverage: The insurers must provide coverage to dependent unmarried child upto the age of 26.  Secretary will have the responsbility to define the meaning of dependent.  The coverage to dependent child do not extend to the children of dependent children.
• S2715. Development and utilization of uniform explanation of coverage documents and standardadized definitions: The section requires creation of a clear communication of the coverage, scope, continuation, cost sharing provisions etc. to the consumer in a user friendly language.  Section also has provision of fine for those who fail to provide clear information to the consumer to the extent of $1000 per consumer.
• S2716. Prohibition of discrimination based on salary:  The sections prohibits the decision of coverage eligibility  based on the salary of an employee.  It however allows insurer or employer to devise plans with different payment options for different salary-range employee.
• S2717. Ensuring the quality of care: Section requires HHS secretary to work with healthcare experts and stakeholders in developing a reporting requirement for insurers.  These may include activities such as quality reporting, effective case management, care compliance initiatives, hospital readmission, comprehensive discharge planning, patient safety, reduction in medical errors, etc.   Reports are required to be made available to common public throught internet.
• S2718. Bringing down the cost of health coverage: Section requires the provider to submit annual report the the secretary about the breakdown of the reimbursement such as amount spend on improvement of healthcare quality, non-claim costs, etc.

The Section also requires hospitals to publish menulist of services and cost.  Insurers are required to provide annual rebate to enrollee.  The rebate program shall be in effect till Dec 2013.

• S2719.  Appeals process:  Providers are required to setup a consumer friendly appeal process including providing enrollee complete access to relevant files.
• S1002/2793. Health insurance consumer information:   The stakes will be provided financial support for their health insurance cosnumeer assistance or ombudsman programs.  In return states must follow the federal rules such as reporting on inquiries, complains, and educating consumers on their rights and responsibilities.
• S 1003/2794 Ensuring that consumers get value for their dollars: Section requires Secretary and Sates to establish and execute a process for annual review of plans.  Insurers will be required to provide regular report justifying unreasonable increase in premiums.  The secretary is required to monitor the premium increases in coverages offered through an exchange or outside of an exchange.