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Summary of Health Plan

Discussion in 'US Health Care Reform' started by Darryl, Mar 23, 2010.

  1. hawkeyegirl

    hawkeyegirl Approved members

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    Do you really think that the secretary will not determine that band-aids and tampons fall under that exemption? Really, they're the definition of "generally purchased by the general public at retail for individual use." Doesn't seem like it would take the Secretary long to make that determination. I think it's disingenuous to act as if they're going to be taxing our band-aids and tampons, when, in fact, that seems really, really unlikely to me.

    And, again, it doesn't appear to me that medication falls under this provision at all.
     
  2. Brensdad

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    AGREED.

    Now, back to the law..
     
  3. Brensdad

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    How much scrutiny did it get before it became law? Something like 72 hours...over a weekend, right?

    And then it went to reconciliation, where it was changed, and then signed into law about 36 hours later.

    To compare the scrutiny applied to the Healthcare Bill to the scrutiny applied before the Iraq war is not a winning point for proponents of the new law. The link I've provided shows the calls for war with Iraq based in their use and possession of WMDs began during the Clinton Administration and was approved by Congress in a bi-partisan vote after a great deal of debate. Even then, president Bush offered to cease any military operations if Saddam and his sons would just leave Iraq. Many, many top Democrats are listed in the article with very specific recommendations about Iraq's WMD program. The argument that they were lied to is just phony, because they saw the same intelligence George W. Bush did.

    So, the Senate voted 77-23 to authorize war against Iraq, a vote which included members who knew of the WMDs well before Bush was ever president, and the House approved 296-133. By comparison, the previous war with Iraq was supported 250-183 in the House and 52-47 in the Senate. And that was the "popular" war in Iraq.

    http://archives.cnn.com/2002/ALLPOLITICS/10/11/iraq.us/

    Now let's compare that to how the Healthcare Bill was voted on:

    "The vote was 220-207, as majority Democrats prevailed despite 32 defections and no Republican support. The same bill had passed the Senate earlier in the day 56-43, with all voting Republicans and three Democrats voting "no."

    http://news.yahoo.com/s/ap/us_health_care_overhaul

    Now, if we want to continue to avoid the technical arguments I've proposed about the actual law, I am happy to do so. But attempts to avoid my arguments about the bill by shifting the debate to the war add nothing to the debate. And in this case, it actually illustrates that the scrutiny applied to the law was nil.

    Hopefully this evidence will discourage further attempts so we can focus on the law and the things I view as shortcomings in the law itself.
     
  4. Brensdad

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    I sure hope so, but it hasn't happened yet. This Bill gives a LOT of power to the Secretary of HHS, and we'd better hope that whomever is in office likes this bill as much as the supporters of it do.

    "A medical device, according to the U.S. Food and Drug Administration (FDA), is an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is:
    • recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them,
    • intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in human or other animals, or
    • intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes.
    as defined by the Federal Food, Drug, and Cosmetic Act, 21 United States Code [321] (h). Medical devices are regulated by the FDA Center for Devices and Radiological Health (CDRH)."

    http://www.fda.gov/RegulatoryInform...sIandIIShortTitleandDefinitions/ucm086297.htm

    "In vitro" and "reagent" mean it will apply to all medicines and other OTC supplies.

    http://en.wikipedia.org/wiki/Medical_device

     
  5. hawkeyegirl

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    Well, let's at least give the Secretary a week or two before we start howling about our tampons being taxed. ;)

    And I am unconvinced that "medical devices" means all medicines and other OTC supplies. Not that I'm giving a lot of credence to Wiki as a source, but it's definition of "medical device" that you linked to clearly differentiates them from "pharmaceutical drugs." I'm similarily unconvinced by Wiki's definition of in vitro and reagent. They should be construed together, as they are not seperated by a comma, and this appears to be the sort of thing they're talking about. In plain language, drugs aren't medical devices, at least until I see the FDA defining them as such.
     
    Last edited: Mar 31, 2010
  6. Brensdad

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    If you look at the first link I provided, it's a link to the FDA's site, and you will find the same information. I provided the Wiki link because it was a little easier to navigate.

    A reagent is a reagent. It doesn't matter who defines it, the meaning of the word is unchanged. You have to understand that I live and breathe in a world of government rules and regulations, and I know how these things work. In any event, you can look at 201(h) yourself and see all of the regulated items.

    Here is the definition straight from the FDA:

    (h) The term "device" (except when used in paragraph (n) of this section and in sections 301(i), 403(f), 502(c), and 602(c)) means an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including any component, part, or accessory, which is--
    (1) recognized in the official National Formulary, or the United States Pharmacopeia, or any supplement to them,
    (2) intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or
    (3) intended to affect the structure or any function of the body of man or other animals, and which does not achieve its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of its primary intended purposes.

    http://www.fda.gov/RegulatoryInform...sIandIIShortTitleandDefinitions/ucm086297.htm

    I'm not HOPING that these things will be taxed, I'm just saying that it's very clear that, as the law exists now, those things are taxable.

    Perhaps if it hadn't been rushed through the Secretary would have had a little more time to mull it over.;)
     
  7. swellman

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    I am almost sure you are wrong here.

    I am almost sure that pharmaceuticals are NOT classified as medical devices. Pharmaceuticals are not reagents. Can someone re-post the part about pharmaceuticals being taxed as medical devices. I will get a definitive answer from a subject matter expert.
     
  8. hawkeyegirl

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    Perhaps you should understand that I, too, have read and interpreted a statute or two in my time, and I know with 100% certainty that the ONLY thing that matters is how words are defined within the statute, NOT what you or wikipedia think the definition is. In the first link you provide, to the FDA Regs, "drug" is defined right above "medical device." There would not be two definitions if they were considered the same thing. It's a basic principle of statutory construction. Even if drugs were considered a subset of "medical devices" (which they're not), they would use the word "drug" and not "in vitro reagent".

    Here is the definition of "drug":

    And then, read paragraph (3) in the definition of "device" here (bolding mine):

    Kind of exempts drugs from being classified as medical devices. I don't know what source you got this argument from, but they're wrong.

    ROFL. Regulations aren't magically in place the second a bill passes, no matter how not "rushed" :rolleyes: through it is.
     
    Last edited: Mar 31, 2010
  9. Brensdad

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    Well, here's what the law says:

    "A medical device, according to the U.S. Food and Drug Administration (FDA), is an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is:
    • recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them,
    • intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in human or other animals, or
    • intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the
    So, the law is saying that it defines "an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article" as a medical device.

    Your point about in vitro reagent used as one word is well-taken, I must have missed that. So if I'm correct now (LOL), then test strips, glucose strips, and anything used to measure a result (reagent) outside of the body (in vitro) is then taxable.

    And I never use Wiki as a source, I just added it as an extra because I wasn't sure if my link from the FDA would be clickable once it was embedded in the forum.
     
  10. Brensdad

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    You win this time Batwoman, but I'll be back! :D

    Except for that last part. I still think it was rushed.
     
  11. hawkeyegirl

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    Nick, you cross-posted while I was editing. Look at my edited post.
     
  12. hawkeyegirl

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    Maybe we can just keep cross-posting with each other to confuse other readers of the thread! :D
     
  13. wilf

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    It's either that or start cross-dressing.. :D
     
  14. Flutterby

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    Ok, Wilf, thats two times you've mentioned cross-dressing, I'm beginning to wonder.. are you trying to tell us something?:D
     
  15. frizzyrazzy

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    woah..that's a whole 'nother hot topic forum.
     
  16. Becky Stevens mom

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    I want to see some pictures! I'll play some ABBA:)
     
  17. Illinifan

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    3 weeks later and our HR director finally sent this to all employees today:

    President Obama signed the Patient Protection and Affordable Care Act into law, which is designed to expand insurance coverage to nearly 95 percent of Americans by the end of its implementation in 2018. The historic healthcare overhaul will extend health coverage to 32 million Americans, expand the government Medicaid programs for individuals who cannot afford coverage, impose new taxes, and prohibit insurance companies from limiting or denying coverage to people with pre-existing medical conditions.

    The Health care reform bill will have an impact in many facets. Following is a summary of the key employer health plan impacts as we understand today that will take affect for XXXXXX?s January, 1, 2011 plan year.

    ? Dependent children can now be covered up to age 26 if a covered employee?s child lacks access to other employer coverage
    ? Health plans will be required to eliminate lifetime benefit maximums and restrict annual limits. The XXXXXX health plans, with the exception of the High Deductible Health Plan, do not contain in network lifetime benefit maximums.
    ? Health plans would be prohibited from imposing pre-existing condition exclusions for covered children under age 19. The XXXXXX health plans do not contain pre-existing condition exclusions.
    ? Reimbursements from a healthcare flexible spending account (FSA)or health savings account (HSA) for over the counter medications will be prohibited unless prescribed by a doctor
    ? There will be increased penalties for non qualified healthcare savings account distributions. The current penalty is 10% and will be increased to 20%.
    ? Cost sharing for certain preventive services will be prohibited such as services being subject to deductibles and copayments

    Other provisions in the bill are expected to be implemented each year and all provisions should be implemented by 2018. The Company intends to be fully compliant with these new health care provisions, will continue to monitor the updates we receive, and communicate any additional information as it becomes available. Should you have any questions about how these provisions will impact the XXXXXX health plans, please feel free to contact me with any questions.
     
  18. susanH

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    i called Highmark yesterday about my college graduating son. his commencement is may 15th. i was told the 'extension to age 26' won't take effect till 2014 and they are terminating him. period. the HR department at work knows absolutely nothing more than that either.

    i understand, from a previous post in this thread, that the change will go into effect within 6 months, not 4 years:rolleyes:. however, that still leaves him in a gap. i know administration of this redtape nightmare takes time, but you'd think a force as big and strong and involved as Highmark Blue Cross/Blue Shield would have a portion of their crap together on it by now.

    i am hopeful we can put cobra in place within the next month.

    so the plan's timing is almost, but not quite beneficial for us/him.
     
  19. Darryl

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    The coverage through age 26 does begin 6 months after the bill's enactment:
    http://www.healthreform.gov/reports/keyprovisions.html
    HR should be able to describe the theory under which this provision does not apply to you.

    With regard to the "gap" that on the surface may affect this year's graduating college students, perhaps if due to incompletion of a Spring course requirement, the course was marked "Incomplete" and graduation was deferred until the Fall, an employer might be forced to cover the child through age 26. Who is to say, but I wouldn't be surprised if a LOT of this year's Spring term graduations get delayed for one reason or another until the Fall ;)
     
  20. Austinian

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    Wow,
    I was hoping to come to this forum and thread to find out more information re. my diabetic son. Unfortunately, it seems everyone here is in the dark as well.

    Brensdad seems to hit the nail on the head - thanks for sharing your insights and information. It's been almost two months since the signing, and I can find no further "official" information regarding the bill - just the flurry of news reports that came out in March.

    Others need to have their lips, which seem to be surgically attached to our president?s %ss, removed so they can actually start thinking and reasoning based upon the facts at hand.

    I apologize for the directness, but blind partisanship on both sides of the coin seems to be what's driving our nation and our government into complete ineffectiveness. And, as of this week, I and my family are now part of the "uninsured". Here's my story - any help or guidance would be welcome...

    My son was diagnosed Type 1 5 years ago. He is now 15, and a healthy, athletic, intelligent young man.

    18 months ago, I accepted a great new position with a smaller firm. The firm did NOT have a group plan, but was "in process" of acquiring one as it is growing. I quickly realized how hard it was going to be to get my son covered (boy, is it easy to take things for granted!), and so was able to get continuation of coverage through Cobra. 18 months to find a new solution!

    Unfortunately, this began a string of applications, and subsequent denials, for health care for him. The three other family members were always accepted, but in order to begin the new insurance, I would have to cancel Cobra, thus leaving my son out in the cold

    The deadline for finding coverage was fast approaching. Facing reality, we resigned ourselves to prepare to accept one of the offers that covered the rest of us. Then, The Health Care Reform bill passed! Yay!! To be honest - I cried like a baby when I read about the exclusion of pre-existing condition denials. My son was going to be covered! (at least By September).

    So, we called up the agency that handles many of the other guys at my work, the agency that we are looking into for providing a group plan, and stated that we wanted to go ahead and accept their earlier offer. Back when we applied with them, they had actually sent us cards and billed us for the first month's coverage. We had to petition to get at least part of that back after we decided initially not to go with them.

    They said that since we were just over the 60 day acceptance limit, we would have to re-apply. No problem - I had zeroxed the 25 page application the first time around and kept a copy. I pulled out the copy, updated the dates, and sent it in, expecting no problems. Sadly, this was not the case.

    We received a letter within two weeks stating that ALL of us had been denied -
    * Me, for having used a Flonase/generic ONCE in the past 12 months (Allergy nose spray).
    * My Wife for having listed her last Menstrual cycle as having been SIX weeks prior to the application rather than the customary FOUR (actually a typo - she had another one during the course of re-applying, I just didn't bother to change the date).
    * My Older son for Playing soccer, and having visited the emergency room twice during the previous year (too high a risk).
    * And of course my younger son for having type 1.

    I was floored. This was the same ACTUAL application they had just approved in December!
    I of course appealed, sent in letters from my doctor, corrected my wife?s info, and included my older son's athletics physical results (in INCREDIBLE shape!), after which two weeks passed and we received ANOTHER letter of denial for all but my wife, which didn't help because they don't insure just dependants.

    After many, many angry phone calls, I had one rep for the company, in a moment of candidness, say "To be honest Mr.____________, our underwriting policies have had to be revamped in lieu of the recently signed Health Care Bill and its impending implications. I'm very sorry".

    Basically - now that companies may have to accept my son eventually, they are going to avoid the issue by just denying coverage altogether, for whatever reason they can drum up. I have received the same letter (for the most part) from two other companies in the preceding 3 weeks. Thank you very much, big government

    Basically - we are screwed.

    I tried applying for the Texas High Risk Pool. No go - we are ineligible, because my company pays as a benefit a portion of its employee?s health insurance costs. This constitutes a form of "employee-provided health care" and thus makes us ineligible. My small company would have to stop making this available to ALL of its employees in order for it to be in compliance. Everyone there has an individual plan, paid for up to 80% by the company. To convert to a group plan, it would cost both the company and the employees almost 50% MORE per year, something no can afford.

    And now, I'm wondering how ANY of these wonderful provisions in the reform bill are going to be implemented?!? If I WERE to somehow get insurance for the three of us now, and when I try to add my D son in September, what's to stop them from just saying, "Uhh, no". What regulations have been enacted, or will be, by that time? How will they be enforced? What sort of litigation or legal representation will I have to engage in order to make the insurance company comply???????

    So -
    No individual Health care
    No Group Health care
    No High Risk Pool
    Too high of an income for Medicaid, etc.
    And not a lot of hope for September 23rd.

    My son has signed up to go on a 10 day mission trip with World Changers to go and renovate impoverished neighborhoods in southwest Texas. He'll be replacing roofs, rebuilding rotted house supports, painting, cleaning up condemned lots/homes, etc. He has done this the last two summers, and I'm very proud of him for his desire to help those in need.

    But dare I risk letting him go? What if he required a visit to an emergency room? Or, had complications due to D and the hard work schedule??

    I am seriously depressed, disillusioned, and to be honest, angry (as if you couldn't tell)
     

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