The other thread about President Obama telling the Catholics how pay for BC, got me thinking.
Under the new “Obamacare” law, who and how are required benefits determined?
Who? The President, Congress, Supreme Court, or a new bureacracy?
How? Must they show some kind of cost-benefit analysis? Purely public opinion?
Are they required to raise taxes if it’s provided by a government insurance plan like Medicare and Medicaid?
If insurance companies are going to provide a new benefit, do they petition state insurance departments for an increase in premium that could vary state by state?
Can insurance companies make the copay higher for the new benefit?
Under the new “Obamacare” law, who and how are required benefits determined?
Who? The President, Congress, Supreme Court, or a new bureacracy?
How? Must they show some kind of cost-benefit analysis? Purely public opinion?
If I recall from looking thru the bill I believe there is supposed to be some level of cost-benefit as well as effective medicine analysis…and yes by a whole new bureaucracy.
As far as “Who decides”…well the government. I’m fairly certain this will be a branch of the government as it is in any other country and thus will be controlled by the government.
Furthermore “benefits that must be provided by the employer” is also decided by the bill and the government has mostly set that out already as well as cost associated with it if you do not comply.
Furthermore “benefits that must be provided by the employer” is also decided by the bill and the government has mostly set that out already as well as cost associated with it if you do not comply.
So, with regard to my question, Obamacare is a list of benefits to be covered and not a process for approving/disapproving benefits?
As far as “Who decides”…well the government. I’m fairly certain this will be a branch of the government as it is in any other country and thus will be controlled by the government.
But will new benefits be approved by executive order (cabinet decision) or does it require Congressional approval.
Could the Supreme Court get involved?
So, with regard to my question, Obamacare is a list of benefits to be covered and not a process for approving/disapproving benefits?
Again, my understanding and I’m no expert. The health care act creates a “Minimum level”. This is a list of benefits that MUST be covered by any health care plan that is to be considered an acceptable health care plan by the US government.
The “List of benefits” to be covered will be created by an entity with in the government, created by this health care bill.
You can have plans that don’t meet these benefit levels or you can have plans that exceed these levels. However if you have a plan that exceeds them to a certain level there will be fines and additional taxes to pay. If you’re an employer and you are offering a plan that does not meet the minimum levels you will have fees to pay as well.
But will new benefits be approved by executive order (cabinet decision) or does it require Congressional approval.
Could the Supreme Court get involved?
I think the idea is loosely based on a similar system as many EU countries. In the UK for instance they have NICE. Basically a medical board that decides what benefits are “Cost effective” and under what conditions. Technically neither congress nor the administration has “Control” over these decisions…but since it will be congress funding whatever board is making the decisions clearly it can’t be a “No strings attached” situation.
This appears to work ok in the UK, but American history dictates that anything can be used as a political tool, glorified or demonized. I just can’t see any board really remaining apolitical in the US under the current political mentality.
1.Suppose a new president wants to get rid of BC as a mandated benefit. Can he do it by executive order or would it involve Congress?
If he went throughtghe proper channels, could tehh Supreme Court rule his action unconstitional?
New president wants to add dental care? Same questions as above.
Create four benefit categories of plans plus a separate catastrophic plan to be offered through the Exchange, and in the individual and small group markets: – Bronze plan represents minimum creditable coverage and provides the essential health benefits, cover 60% of the benefit costs of the plan, with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for families in 2010);
There will be a lot of folks who get this plan, because it has the lowest premium, go to the doctor and then not pay their 40%.
Who gets burned in that case the doctor or the insurance exchange?
Is the insurance exchange going to get re-imbursed by some entity (not the patient)?
My guess is that like any other creditor, the Dr. has to deal with it. I would be surprised if it were set up any other way. But I can’t cite you a specific section that says that.
1.Suppose a new president wants to get rid of BC as a mandated benefit. Can he do it by executive order or would it involve Congress?
If he went throughtghe proper channels, could tehh Supreme Court rule his action unconstitional?
I’m not a constitutional attorney but since the congress passed the bill and a president signs it it becomes law. I don’t think executive orders can over turn law only extend them and my guess would be yes, it would go to the supreme court and the executive order would be over ruled.
2. New president wants to add dental care? Same questions as above.
My guess on this would be yes, since it’s an extension of the law. However the president can’t fund it, congress must. So he may sign an executive order for dental care, but congress could say, “Sorry you can’t spend any money on dental care” and that would be that.
My guess is that like any other creditor, the Dr. has to deal with it. I would be surprised if it were set up any other way. But I can’t cite you a specific section that says that.
The Doctor’s office will just bill the insurance exchange a higher amount so when they pay the 60%, the doctor gets what he needs. The Dr. won’t go after the patient. Expect medical inflation to be extremely high initially. The exchanges will have to increase premiums drastically to compensate.
You’re saying that the president can unilaterally expand benefits but cannot contract them? That doesn’t seem right.
There is no federal funding of this involved, right now.
If BC or dental is added (or deleted) as a mandated benefit, me and you as private citizens (or companies) are required (or not) to purchase that. The government is not paying. They are mandating “we” pay for it.
You’re saying that the president can unilaterally expand benefits but cannot contract them? That doesn’t seem right.
I could be wrong but that is only what executive orders allow.
If BC or dental is added (or deleted) as a mandated benefit, me and you as private citizens (or companies) are required (or not) to purchase that. The government is not paying. They are mandating “we” pay for it.
Yes, and that’s the problem with the mandate. It enters new territory and that is why it’s being challenged.