The parts of the health-reform bill you don’t know about — but should
December 4, 2009 by Jim GiulianoPosted in: Health care, Special Report
Surely, you’re aware of the breast-milk-pumping-at-work provision. No? Well, there’s that, and much more.
It’s inevitable that a 2,100-page piece of legislation would contain some nooks and crannies where senators could hide some of their pet causes. Some of those “little” provisions of the health bill — detailed in a Kaiser study — are minor and of limited scope, but some others really do affect employees and the workplace:
Nursing mothers. The provision mandates that employers would have to provide “reasonable” time and aprovate place for nursing mothers to express breast milk in the first year after giving birth. Exempted are companies with fewer than 50 employees if the requirement would impose “an undue hardship.”
Retiree health benefits. A section of the bill is aimed at cutting out-of-pocket costs for retirees who are under 65 and get health insurance from a former employer. The provision would create a temporary “reinsurance” program under which the government would pick up 80% of some high-cost insurance claims filed by retirees. Freed of many high-cost claims, employers would be expected to reduce retirees’ share of health premiums or other costs. This one has a real chance of making the cut, since it has wide support among employer groups, labor unions and retiree-advocacy groups.
Prescription drug pricing. This one’s aimed at pharmaceutical benefit managers, who administer drug plans for many Americans and their employers. Those benefit managers negotiate discounts on prescription drugs with retail pharmacies and wholesalers and also get rebates from drug makers. The Senate bill would force the benefit managers to disclose details of those negotiations – including how much of the savings were passed on to consumers. As you might imagine, groups representing the prescription benefit managers oppose the provision.
Tags: health bill, health premiums, Kaiser, retirees
December 7th, 2009 at 10:48 am
they are nuts.
December 7th, 2009 at 11:37 am
I would like to see the amount of government regulation in the health care issue limited to revoking the regulation on insurance companies crossing state lines so it will spur more competition between insurance providers. That would probably reduce the bill to 10 pages or less! The more details included in this bill to ‘get everything right’ opens more doors for loopholes and exceptions to be fought over in courts so the ONLY people benefiting from this is the attorneys!
December 7th, 2009 at 11:55 am
These sound like good topics to discuss and to resolve. We are one of the few westernized countries that does fully support new mothers. there is a direct connection between how we treat our babies and children (health,safety, education) to many of the issues that we have in society today. The “change” that is needed is at these basic levels where we begin valuing all children and begin the process of setting them and their families up for success.
I also think that we need to have transparency in access to prescripiton drugs as well as pricing. There are medications that have been used for years in Europe that are tested, safe and inexpensive that are not available here because “there is no money in it for the big pharma companies. Other drugs are expensive because they are popular. This is not fair or just.
Lastly, I must comment on the fact that I have noticed a trend that when highly “political” issues are dealth with by this site, there is an “undertone” of sarcasm as in “can you believe it” in the articles. Please keep me informed, but kindly keep your “politics” out of the story.
December 7th, 2009 at 12:10 pm
This on top of bean counters deciding that cervical cancer and breast cancer aren’t important enough to warrant regular screenings as prescribed by doctors; it’s a wonder this doesn’t also cancel our right to vote. It’s nice to see that we can breast feed at work, after all, that’s our duty – just this side of being barefoot and pregnant! Why isn’t NOW burning bras and marching on the Mall about this? Being a woman and supporting this disappointing piece of legislation is like being a willing dog working for the county dog catcher … luring other dogs into the cages.
Rancid food for starving people is not a solution. Nice try, Washington, what’s next, will we cut off the supplemental coverage for erectile dysfunction treatment … no more Viagra on the gov’t dole? Oh, wait, that primarily benefits men …
That isn’t nuts; it’s insulting!
December 7th, 2009 at 12:16 pm
I missed something. What is insulting and/or nuts about these provisions.
December 7th, 2009 at 12:21 pm
I have been reading about Grover Cleveland. Now THERE is a President who knew the limits of government. And the constitution. We are so far away from that, it really would take a complete breakdown of America, and a START over. But not the start over this adminstration has in mind. Go Tea Party.
December 7th, 2009 at 12:54 pm
“Nursing mothers. The provision mandates that employers would have to provide “reasonable” time and aprovate place for nursing mothers to express breast milk in the first year after giving birth. Exempted are companies with fewer than 50 employees if the requirement would impose “an undue hardship.”
The others I will have to consider why they are in or out of line but the one above is not offensive at all. My only concern with finding accomodation would be for those women who we have working on crews but I’m certain that our company is compassionate enough to “think outside the box”. For those working primarily in the office, this would be irregular for a company to make a decision that would offend a nursing mom – basically tell her “no”, you can not, that could be actionable under other laws that are already in existence, Title VII, etc.
MAC
December 7th, 2009 at 12:56 pm
Perfect Health Care Reform will never exist. BUT Millions of uninsured Americans does exist. As HR professionals we should be able to see how Health Care Reform is not a simple thing. We work everyday with our own health plans that don’t meet every need of every employee. Our own plans get misused. BUT the do benefit most people and most people do use them for the right reasons.
Don’t lose sight of the purpose for reform.
December 7th, 2009 at 12:58 pm
Just more of the same mentatlity that a job is created for the benefit of the employee and not for the benefit of the employer. Doesn’t anyone realize that in the long run, all these concessions to employees will cost jobs?
December 7th, 2009 at 1:01 pm
It’s extremely hard to see the facts and rationale of many of the most accomplished professionals these days, because many private and public conversations are laced with so much negative emotion. I’ve never experienced this type of major reform–maybe I’m not up on my history on President Cleveland, either. However, I am looking forward to a rational discussion about healthcare reform. Has anybody thoroughly read this bill? Thanks to HR Morning for sharing a few highlights. I actually don’t see what’s so horrid about those, although I agree with what many have stated. There are pertinent cost-saving issues that need to be addressed, but why the divisive outrage? It’s almost offensive, and I believe it pushes a lot of people away, who desperately need to hear and understand the meat of the matter. Let’s get more people on board with our views by having a solid, facts-driven, and less-biased discussion.
December 7th, 2009 at 1:07 pm
Lajeli,
Historically, the imbalance has leaned to the companies benefit. I disagree that what they are proposing will costs jobs. How do you come to this opinion? While I agree, generally, that employees do need to be thankful for some of the benefits that they have, there are reasons that these laws exist – and are proposed. What I don’t know, and want to research is why are the benefits managers being targeted. If there has been impropriety then yes disclose the information. If not, it seems unnecessary. The retirees – how many people actually “retire” from a company nowadays. It’s correction will be in how employers structure their retirement compensation packages – if it’s even necessary. Again, the nursing mothers provision – is not unheard of – and is not irregular – I see Title VII all over this if I declined a nursing mom a place to pump. It may not be a clear case, but it is not a compassionate employer who will decline to provide a place for a lactating woman to pump. Why not do that for your employees? We aren’t sweat shops. So yes, the reason that the law intervenes is because there are employees, who in past, were mistreated. So the law steps in the ensure that we are all treated fairly and without bias. So what real concessions do you see that are so “pro employee”?
December 7th, 2009 at 1:51 pm
Since the government cannot pay for anything, they will have to tax for the money to cover the retiree health benefits proposed above. If they tax individuals, those individuals will spend less in the general economy and that will cost jobs. If they tax employers, it will cost jobs.
Publishing the results of negotiations for prescription benefits will take time and that will cost money and that weill cost jobs.
Employers should not be involved in health insurance at all in the first place; we should not be passing more requirements for emplouers in this area
December 7th, 2009 at 1:52 pm
It makes more sense for the Employer to pay an honest days wage for an honest day’s work. With all the rules and regulations, and the recorded keeping necessary to manage them, and the fines, and potential fines for non compliance and on and on.
No, companies are in business now days for 1 reason. To give jobs to people who can pay taxes. And do all the collecting for the Government. There certainly is no profit motive…….because there is no profit. And if there was, the Government would take that too, one way or another. I for one am FED UP. Our company has gone from 40 employees and a decent profit in 2008 to 14 employees and a loss every month. When we use up all our capital, we will have to close the doors. The way this administration is handling things, I see no help in sight.
December 7th, 2009 at 1:57 pm
I strongly urge everyone to read the entire proposed plan, it is frightening … not just the provisions mentioned in this small blurb. Take the time to read it, it is important. If you actually read it, I seriously doubt any of you would come to the logical conclusion that this is a good plan. It is not party politics; this is just greed and stupidity tossed onto paper by people who will not be subject to the outcome if it were to pass. They – our congressmen – still get the FREE Healthcare at our expense. That should be a key indicator that they KNOW it is complete pap.
December 7th, 2009 at 2:00 pm
I am with JAGGER 100%.
Why can’t I just hire soemone to do something and pay them a fair rate for it?
All the extra expense is breaking our economy.
We compete globally with companies who do not have these expenses and we are losing this competition in a BIG, BIG way. How many jobs have to be lost overseas before we stop burdening employers and let them focus on doing what they are in business to do?
December 7th, 2009 at 2:05 pm
I am with you Lisa! I have read about 85% of thisb thing so far and it is a nightmare!
December 7th, 2009 at 3:46 pm
Isn’t the nursing mother’s provision already somewhat covered by ADA? If a nursing mother requests reasonable accommodation, I believe ‘”reasonable” time and aprovate place for nursing’ be part of that. So if this becomes a requirement for all employers with over 50 employees, does this stay a part of ADA accommodation? Does it change expectations with regard to reasonable accommodation for pregnancy, etc? Anyone with any specific insight? Would be appreciated.
December 7th, 2009 at 3:58 pm
You ask how this bill will cost jobs? The majority of the small employers, such as the one I work for, are struggling to keep the doors open. Everything that can possible be cut spending wise, as well as salary wise has been done just to stay above water. We don’t know what break even means any more, let alon a profit! The government can not increase its spending without getting the money from somewhere. The middle American will lose with this bill. Our taxes are going to go up to support it and the taxes our employers pay are going to go up to support it. The small employers will be forced to shut their doors and then it will move on to the medium employer. Is this politics talking, no, it’s reality talking. For the reoord, we do not offer health insurance to our employees, we were priced out of the market. Therefore, I am uninsured. Do I or my co-workers look at this as my salvation? No, we look at it as a major burden that will lower our standard of living drastically.
December 7th, 2009 at 3:59 pm
Healthcare started being offered by the employer because of union demands. Give health benefits instead of larger raises. This was a good compromise for the union employee. Nonunion employers soon jumped on the band wagon to be able to compete for the more qualified employee. Over the years it has become expected with an offering of a decent job. Individuals who do not have insurance are not necessarily lazy. In fact the opposite is true. The truly lazy individual knows how to get everything necessary to have a comfortable life by working the system. The reason reform is needed for those individuals like ourselves who involuntarily become unemployed, can not afford the outrageous premiums for insurance and then because of the length of time between coverage can not be covered or have preexisting conditions that will have to be paid for out of pocket for at least a year. Been there. For all of you that have good ideas on how this reform can be executed for the benefit of all please send them to your congressman. MAC has made some very good points.
December 7th, 2009 at 4:08 pm
Does anyone know why we set up funding for Puerto Rico and other territories in this thing??
Pg 265, 266 & 267
“IN GENERAL.—The cap amount specified in this paragraph—for Puerto Rico is $3,700,000,000
increased by the amount (if any) elected under subparagraph (C); or (ii) for another territory is the portion of $300,000,000 negotiated for such territory under subparagraph (B).”
December 7th, 2009 at 4:20 pm
Lajeli, I guess because Puerto Rico is a territory of the US, we have to pay for them too. 3 billion, 700 million $$. The Government wants control over them too.
When I get accused of being cynical, or mad, or whatever, let me say this: I AM. When one really gets down to read this THING, oh, my gosh. It is the BIGGEST take over of our freedoms that has ever come down the pike.
CJ, I agree. First the very small (such as my company)will go, then the 50 to 200 employee companies, and pretty soon, all we will have left is BIG business and BIG Unions. And the Unions will wind up owning all of them. (Just like GM) And this IS NOT political, BAFFELED, it is fact. I have studied this thing from day one, the Baucus bill before the House bill, then the House Bill, now the Senate bill……….it is all a first step to complete Government take over of our lives. Kiss Freedom good-by.
December 7th, 2009 at 4:34 pm
Just a few things that jumped out at me:
Employers will also be required to provide benefits to part-time employees pg 273
They lower the cafeteria/flex maximum amount per year on pg 325 and I am not sure but it looks like they limit flex reimbursement to prescription only and insulin instead of otc medication
Pg 337 raises individual income taxes to pay for the plan
Pg 339 adds a special tax on the sale of medical devices to help pay for the plan
December 7th, 2009 at 4:41 pm
CJ, you say “For the reoord, we do not offer health insurance to our employees, we were priced out of the market. Therefore, I am uninsured. Do I or my co-workers look at this as my salvation? No, we look at it as a major burden that will lower our standard of living drastically.”
I agree with your concern here because when your company is forced to provide coverage or pay fines, they will have to get the money from somewhere. There is no profit to take it from so your company will likely cut wages and or jobs to meet the requirements of the bill.
It’a a disaster in the making. So much for an economic recovery…with this bill, we can kiss jobs good-bye
December 7th, 2009 at 4:43 pm
JAGGER, do you know if any funding will come from Puerto Rico or will the monely flow be one-way?
December 7th, 2009 at 5:22 pm
I think the Puerto Ricans pay income tax, just like we do.
This bill will cut DOWN the benefits of the HSA plans. They will no long allow the purchase of OTC drugs, which means they will have to be paid for with TAXED dollars. As will any medical device (such as crutches, monitors, etc.) so, not only are we being taxed to pay for other people’s insurance policies, we have to use after tax dollars on much of the stuff that was covered with before tax $$ before.
Does everyone realize these taxes start immediately (assuming the bill passes by midnight, Dec 31) but no benefits will start until the year 2014. THe only up side to that is, if we can put Republicans in the House and Senate in 2010, then replace Obama with a Republican President in 2012, we can probably undo a lot of the harm this bill would cause.
December 7th, 2009 at 5:37 pm
Thanks JAGGER
I too, wish we will correct in 2012 the mistakes we made in 2008…hopefully, it won’t be too late
I am opposed to more limits on the FSA plans and think that they are part of the answer in solving the health care crisis…just imagine being able to roll-over pre-tax dollars form year to year in order to cover medical costs. The really healthy, younger people could begin setting aside small amounts of money now, and buy a small, catastrophic only plan and erally save some money. Someday, when they start needed more health care, they will have some moeny saved just for that purpose. If that turns out not to be enough, maybe tap that ol 401K account for more to cover health care. insurance companies still sell policies but with less daily management so at lower costs to provide. Not using insuarance for routine medical issues will drive the costs of those down to an affordable level and make health care available to almost everyone. Have the gov’t give HUGE tax breaks and incentives to hospitals that provide lower cost care to the indigent and to charities who help subsidise the costs of premiums for catastrophic care…Cut the care-giver’s costs to avoid raising prices to off-set those who can’t pay 100%
We could also lessen the restrictions on generic drugs to make them availble cheaper and faster. Offer govt grants to cover all or part of the costs of health care training in all fields of study to increase the supply of providers (at all levels) which will also drive down costs and make care more available to more people. Let med students pay off student loans by working in free clinics and donating hours to long-term health care facilities and hospitals…
There are so many GOOD ways to reform health care but our govt wants to feed the problem by making the middle man bigger and putting more waste between the doctors and patients…it’s just so crazy!!!
December 7th, 2009 at 5:40 pm
Lajeli,
I do know that in Puerto Rico, when the funds run out, that gov’t office closes. The Puerto Rico Department of Insurance closes each year long before the end of the year due to funding issues. In 2006, it closed at the end of June and did not open again until January. It closed in 2008 late in the year but clearly before the year was complete. I am not quite sure how this practice will roll over into the cash bleed that gov’t healthcare will become. We will have to have committees, new bureaucracies, oversight officials, and a whole host of various gov’t employees to pretend this lead balloon can actually fly who will work endlessly to keep their own jobs, no matter what sacrifices the American worker makes.
This makes me wish that IQ Testing and proof of accounting acumen be required for all nominees to public office. Oh, wait … testing is biased and might damage the politicians’ delicate sensibilities; we can’t have that!
Wouldn’t it be great if our elected officials actually had to be good at their jobs in order to keep them? “What was that, Fairy Godmother? I can’t understand you through all that laughter.”
December 7th, 2009 at 6:00 pm
Lajeli, You are SO right. I laid out a reform plan, very very! similar to what you state here. It makes so much more sense. Throw in a really low cost accident policy for the young people and they are all set, without much (throw it away! money) pain.
I am convinced (just my opinion, mind you) that the Government is only interested in making sure they get SOMETHING passed (to make History!) and they think they can expand in in conference to most anything they want. Their main agenda is Control. Obama sees himself as Chavez!! That is my opinion. If the GOP does not get WITH IT, and Obama is re-elected in 2012, we can expect to see legislation to abolish term limits.
December 7th, 2009 at 6:49 pm
I have read the 2000+ pages of the proposed health care bill. And sorry to say, I do not see the savings materializing or cost to the individuals or companies lowering. In fact, in years 11 thru 15, the costs go out of sight!!!! How about a couple of simple fixes: 1. allow insurance companies to compete across state lines (no more individual state level regulations); 2. add federal provision that says insurance companies can not drop or fail to cover pre-existing conditions; 3. set up a government plan that deals with unisured people through the existing hospital system and limit coverage to preventative and life threating (similar to an Urgent Care). The present system covers non-insured people because everyone goes to the ER for coverage anyway, so everyone is getting some form of medical coverage. And 4. add Torit reform to limit the ambulance chasers and allow doctors to get back to doctoring, not covering their behinds medicine.
December 8th, 2009 at 8:58 am
I read these comments and find myself more frustrated every day. The effect of Health Care reform on the average employed and unemployed citizen will be felt for years to come. If, as presented, the reform is to provide coverage for the uninsured, then set up a fund to secure the necessary monies. That sounds pretty simple in my opinion. They (government) have Medicaid for those who qualify due to income levels, they have Medicare for those who qualify, why not revamp Medicaid/Medicare to provide for those who didn’t qualify previously. I don’t believe that pushing reform through on the backs of employers will be the solution. How they (government) manage the current programs is really the issue. Remove the fraud and they could save (re-direct) millions yearly. That’s the system that is broken; not the healthcare providers giving service to the insured/uninsured.
December 8th, 2009 at 9:26 am
I happen to work for an employer that is exceptional. However, overall, I believe that the business world is incredibly lost! Our pay systems for semi-small, medium & large business are backwards. We reward top level executives for very little work–for contributing very little to the bottom line. Look around. What are your top executives doing? Often, they are being paid for a mere ‘title,’ and leadership is pitifully lacking. It’s a sad sight to see that we scrutinize employees who hardly make enough money to stay above poverty, while we stand by and watch top executives play a round of golf on company time–regularly, among other things. Much of the seeping loss in our business economy is due to waste. We can start at the top. I agree, lets pay an honest day’s pay for an honest day’s work, but I’m in favor of seeing the true reality, not only the man-made reality with which we’ve learned to live. It’s an injustice NOT to expect to provide a better quality of life for employees, who do the work that creates the revenue. If we merely provide a wage (barely enough to live, much less pay for healthcare, dental care, and a few of the amenities that our executives often enjoy and take for granted), then we’re merely promoting modern-day slavery. Lets remember the value of hard work and move back to the era of servant-leadership. These are the Biblical principles upon which our country was founded. Jesus washed his disciples’ feet. He labored along side of them. He taught them. He didn’t sit in His office, and send them to do the work. We’ve adopted the attitude of entitlement at the top. The higher up you go, the more money you make, and the less you contribute to the bottom line. Who ever thought that would work–and for how long?
December 8th, 2009 at 10:10 am
Affordable and realistic healthcare access should be available for everyone. This bill just further penalizes the middle class and does not expand access or lower costs for them. It seems Obama thinks middle class Americans are rich and should be penalized for working.
December 8th, 2009 at 10:34 am
We already provide time and space for nursing mothers to pump their breast milk. It’s something ALL employers should be doing without being told to. It’s a fact that babies who nurse are healthier than those who don’t and that translates into less lost time for mothers and fathers to care for sick children.
December 8th, 2009 at 10:58 am
WAKEUPCALL…………. The difference is, in America, (at least the America I grew up in) anyone who REALLY wanted to has the opportunity to become one of the rich, who as they grew older could work less and less depending upon how responsibily they handled their finances. Along the way, they would use part of their wealth to care for those who wanted to but could not provide for themselves. Not a perfect system, yes, but so much better than the government taking all our money and deciding who gets it and who does not. Health insurance is not a right. No one in American, that seeks it, is without the means to care when they have an accident, or gets sick. Doctors are not a THING. They are human beings, who found a way to get educated to help their fellow human beings and provide themselves and their families with a living. They should not become slaves of the government which wants to use the doctor’s talents as the government sees fit. I totally agree with Vivian. There are much better ways to address this issue.
December 8th, 2009 at 11:01 am
Did anyone watch Glenn Beck last night? Quite the eye opener. Proof of what many of us have suspected all along. Oh, my gosh. Where do we go from here?
December 8th, 2009 at 11:54 am
what website does a person go to to read this proposed healthcare bill.
December 8th, 2009 at 12:10 pm
Library of Congress has the bill listed. You can use the search engine on their site.
December 8th, 2009 at 12:14 pm
Thanks so much everyone for making this a Republican V Democrat discussion. (as usual this was started by the Reps). And as usual nothing helpful was discussed, just more bashing.
December 8th, 2009 at 12:51 pm
Look what the government (all parties) has done to the public school system and look how they consistently overspend and under budget; do we really want these people in charge of our healthcare?
The standard line for pharmaceutical companies is they charge what the market will bear meaning that they can charge whatever the American public is willing to pay to be healthy. This is one reason why there is such disparity between what they charge in other countries and what we pay in America. That being said, we must also look at the overall cost of health insurance and note that the single most significant cost is the prescription drug charges. This is not the out of pocket cost, this is the actual cost charged to the insurance companies for the drugs no matter what the client co-pay may be. If we truly want to make healthcare affordable for every American, we have to insist on parity in the global marketplace for our medications.
The next step should be to require real answers to real questions. If the government healthcare is set up to make healthcare more affordable to everyone, does this mean the hospitals can no longer charge $24.95 for two Tylenol and $199.00 a box of 4×4 gauze pads? Before any excuses are made, let us remember that we were told those bloated costs were set up to offset the cost of people who don’t have insurance. If insurance is made “affordable” and “available” to everyone … doesn’t that necessitate the elimination of those types of bloated and userous costs?
I’m not seeing any regulation or demand for parity within the medical marketplace. You can lead a horse to water but you cannot make him drink; you can lead a congressman to knowledge but you cannot make him think. How can we trust a health plan that the congressmen themselves will be exempt from? Why wouldn’t they want their family on the great government health monstrosity? How telling is that?
December 8th, 2009 at 1:01 pm
Leslie, I am sorry you didn’t find anything helpful. I learned some things here and read some really great suggestions that would help reform health care in this country–made by peopl who actually live with the problems everyday and not like those who haven’t used the current system and don’t know first-hand what it is like.
I don’t see this as a democrat vs republican discussion…maybe because I am neither??
JAGGER, I think you are right about the control issue. Our federal government was never, ever meant to have this kind of power. Its involvement in industry is way over the line already. I think there are multiple motivations for this…history maybe but don’t foget creating a dependency on government. I agree with the following quote and wish this type of leadership had been more popular instead of just being more accurate:
“I believe in freedom to manage and accountability to make sure everybody learns,” said Bush. “It’s what I call challenging the soft bigotry of low expectations.”
Teaching the next generation that we expect them to fail and that success is only possible with the giant (and extremely expensive) safety net of government is a travesty. Government is too big now and if it cut spending on “low expectations” programs, we would all rise to a higher level.
December 8th, 2009 at 1:04 pm
As any business owner knows, there is a cost-benefit for all actions involving building your business. If the cost of doing business outweighs the benefits of being in business, you will lean toward shutting your doors, and/or look for more investors, and/or change marketing strategies, and/or cut labor (largest cost to employers) and/or change business all together.
When the impact of healthcare reform is felt by the employers as a cost, then they need to see the benefit of remaining in business and growing their businesses. We already have an unemployment nightmare, we don’t need to add to it through impacting employers so significantly that they make adverse decisions affecting the people who work for them.
December 8th, 2009 at 1:07 pm
Lisa M, yu are really hitting the core issue here when you say “The standard line for pharmaceutical companies is they charge what the market will bear meaning that they can charge whatever the American public is willing to pay to be healthy.” but you have missed the fact that the presence of insurance companies changes the price the market will bear. No one would pay $300 for a 30-day prescription but they will pay $30 and let their insurance company cover the difference. This disparity is the true number one reason helth care in the United States is unaffordable. Simple economics…if they charged what the market would bear, the most they could get for that same prescription is much, much lower (maybe $50). This would force the drug companies to control their costs in order to allow for the lower price…maybe a few less commercials about why their product is better than a generic?? maybe less high-dollar compensation for the top level executives…think about your own company and what would happen if you could chage 6x what the customer would pay because a thirp party would step in and cover the difference? Can you see how waste would creep in and costs would increase to match the price you are charging?
December 8th, 2009 at 1:08 pm
right on the mark Vivian…thank you
December 8th, 2009 at 1:48 pm
http://docs.house.gov/rules/health/111_ahcaa.pdf
This is the link to the bill as introduced by Congress to the Senate.
Here is one that provides a comparison between the House and Senate versions.
http://www.kff.org/healthreform/upload/housesenatebill_final.pdf
The best thing we can all do is to be informed, contact our legislators and voice our concerns. If the legislators don’t hear from you, they will think you are satisified with the job they are doing to iron all the details out.
December 8th, 2009 at 2:48 pm
Lajeli,
The consumer also has a high responsibility when using their insurance to purchase prescription drugs … another topic not honestly or ethically covered in the oh-so-brilliant Government Heath Plan Monstrosity. If your co-pay is only $5 at any pharmacy, do you look further? The insurance company may say that they will only pay up to $75 for that drug … the employee pays the $5 co-pay and leaves, then the real money starts adding up, the pharmacy sends a bill to the insurance company for $90.00 and the insurance company sends them, $75.00 (the maximum allowed payment). At the end of the year, the insurance company adds up all their costs for everyone on your plan and based on their particular matrix and your overall costs to them, they will quote your rates for the following year.
Here’s the real kicker; the consumer (employee) could have shopped for a wholesale pharmacy that offers discounts and charges the insurance company less. Instead of them charging the employee $5 and the insurance company the maximum, these wholesalers charge the consumer their $5.00 co-pay and bill the insurance company the actual cost with minimal markup, perhaps charging only $55 rather than $75+. This savings multiplied by the average number of prescriptions filled by all employees and participating family members can add up to millions, depending on the size of your company. That number can significantly alter your company’s quote for coverage costs the following year.
The average healthcare cost increases for group coverage was 30% in 2009. The number one contributing factor that led to the increase was PRESCRIPTION DRUGS COSTS.
Again, this is not addressed in the Great Government Health Plan Monstrosity. Gee, I wonder why … who do the pharmaceutical lobbyists eat lunch with these days?
December 8th, 2009 at 3:16 pm
Lisa, I agree that consumers have a responsibility here but there are far too many transactions for the average consumer to keep up with. Most people are not “in the know” about how prescription drug coverage works nor do they want to be. For the consumer to take ownership of their own health care, it needs to be simplified; something government hasn’t been able to do in decades. What percentage of the population knows how to do what you describe regarding shopping for wholesale pharmacy? Most go to the pharmacy closest to them or with the pharmacist they know and trust. How many consumers really have that time to invest? Factor in that the insurance company is willing to step in amanage all that for you (for a fee of course). Patients don’t focus on the costs because they are protected from doing so by the insurance companies. Drug companies don’t focus on cost control because the insurance companies will pay what the consumer won’t. If there were no third party payer for prescription drug coverage, the consumer would be faced with a flat rate only comparison and the drug companies would have to become price competitive. Doctors try to help patients but are trapped by insurance cost cutting rules and requirements. We have created a monster that the average consumer does not know how to control. One experience I had with cutting costs gone wrong was the dreaded “step-therapy” plan. An insurance company tries to control costs by forcing doctors to prescribe meds based on price and not health conditions…on the flip side, doctors prescribe 30 days worth of meds, the patient throws the pills away without taking anything, calls the doc and says the meds make them sick. The doc then prescribes a different med which the patient also throws away and so on until the insurance company ends up accepting what the doc and patient wanted in the first place. There is no way THAT doesn’t waste money! I have a family member in the health care industry who had to spend hours arguing with an insurance company over testing a patient; the cheaper test would have been potentially fatal to the patient due to the dies involved but the insurance company wouldn’t authorize the more expensive test as long as there was a cheaper test available… Doctors go to med schol and know what to do. Insurance company reps are not qualified to make these decisions but still try to anyway and they base it on costs, not what is best for the patient. It’s just crazy
December 8th, 2009 at 3:48 pm
I agree, bean counters and congressmen open to lobby favors and PAC money should NOT be allowed to make any decisions about healthcare, they’re eminently under qualified.
December 8th, 2009 at 3:58 pm
yep, exactly, eminently underqualified
December 8th, 2009 at 4:20 pm
And sadly, hearing aids are still not covered for people over the age of 21 but the cost of medical devices will go up due to taxing to pay for this bad bill…what a slap to seniors!
December 9th, 2009 at 2:00 pm
Jenny T.
I don’t believe nursing is covered under ADA as a lactating mother is not disabled. However, we have had this lactation regulation in CA for several years and it is not a problem. For some reason, I have only had to use it in the last year. I bought a free-standing, lovely room divider and a charming matching velvet chair for less thatn $500. I put them in our locker room, but not a good place because it was musty. I found another unused office (most of the time) and put it in there. The biggest issue is getting a lock on the door. However, it’s a good law and has not been overly onerous for us.
December 9th, 2009 at 4:37 pm
Jagger, I also watch Glenn Beck. I wish more would; he says it the way it is! The many different things he has exposed are so sad and scarry. The whole thing is a bunch of malarkey and needs to be voted down!
December 10th, 2009 at 12:04 pm
If a man cheats on his wife is he a murderer? I have to wonder… it seems that Glenn Beck thinks so…he’s said it many times about many men. So, needless to say, I take everything he says with a grain of salt. I logged onto the site to read comments regarding the health care issues and I have to say that I agree with Vivian. Do I agree that I have to pay for someone else’s insurance? No, but I am one of those that makes noise with Congress and express my opinions to my representative. I also know that I am helping a mother, who has worked ALL of her life, pay medical bills that are hundreds of thousands of dollars. When she was stricken with cancer her insurance bailed on her. I read in someone’s comments that Americans need to work hard and handle their finances… well most Americans do. My mother did until this happened. By the way she is a Director of Nursing and she paid for her degrees out of pocket..no student loans. But it doesn’t make her exempt from the issues at hand. Whew! Anyway, that was MY vent…you can agree or disagree… doesn’t matter a whit to me. Now what were we talking about?