Obama Care- Baucus Markup- #17 #obc50- State Exchanges
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www.kingdom.com › CD-DVD Duplicators - Cached - SimilarPage 18This page deals with rules governing the members of the State Insurance Exchanges.Original Bill provides that all insurers licensed by a State (those insurers that the State has determined meet the “market-reform requirements”) must be available for these “Insurance Exchanges.”So no company can choose whether or not to participate. This reminds me a bit of the auto insurance “assigned risk pool,” those who are required to provide coverage for the risks that no one wants. Except there participants are few, and the onus was periodically transferred from one to another throughout the pool of licensed insurers. No one was required to be in the barrel all the time.Now to the amendments:All are required to have an internal claims process. No real problem there.“Child-only and Dental Plans”Insurers must have provision for these, with the Dental plans required to provide Pediatric dental benefits. It’s unclear if the Pediatric portion is a stand alone plan or not. All plans must “comply with all consumer protection requirements,” whatever that means?“Emergency Room Protections”Insurers must allow care without prior notification and without regard for contractual relationships between insurer and care provider. AND, the enrollee may NOT be charged any higher co-payment, etc., for using an “out-of-network” provider.So any protection an insurer has for reduced care rates negotiated with providers is lost here.Establishment of State ExchangesNow we see that States are REQUIRED to establish an individual AND a Small Business Health Options Program (SHOP). SHOP (aren’t they missing a B?). They both must be established, “with technical assistance from the Secretary, in 2010.” It scares the heck out of me what that “technical assistance” would include.The Secretary must establish “a database of plan offerings for use by state exchanges” or contract out the operation of the database, including entering into an agreement with a “Sub-Exchange” for carrying out it’s (the Secretary’s) functions (Is this where ACORN butts in?).1 See below for the 2009 FPL charthttp://www.coverageforall.org/pdf/FHCE_FedPovertyLevel.pdf join http://teamsarah.org to help freedom fight back against obama care
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