This blog is written by Mr. Steven C. Schurr, Esq. and focuses on health care law matters that pertain to food and drug law, regulatory compliance, privacy rights, insurance coverage, state and federal disability coverage, patient advocacy issues, and mental health coverage and treatment.

Sunday, April 30, 2017

MacArthur Amendment to the Federal Healthcare Law

Below is the congressional link to the recent proposed Amendment related to healthcare reform.  It is only a draft document at the present.  There has been no official action on the bill. Amendment.pdf

Amendment to H.R. 1628 Offered by Mr. MacArthur

The eight page amendment would allow a particular state to request waivers to 1.) charge the elderly more for premiums, 2.) to consider pre-existing conditions when offering plans, and 3.) to offer plans that do not cover all of the Affordable Care Act's Essential Benefits.  The Essential Health Benefits are:
Essential Health Benefits. A qualified health plan must provide the following: ambulatory (“one-day”) patient services, emergency services, hospitalization, maternity and newborn care, “mental health and substance use disorder services, including behavioral health treatment”, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness and chronic disease management, and pediatric services including oral and vision care. 
A state's application for a waiver would be approved by default if, among other things, it declares:
"(B) The application specifies how the approval of such application will provide for one 2 or more of the following: 
(i) Reducing average premiums for 4 health insurance coverage in the State.
(ii) Increasing enrollment in health 6 insurance coverage in the State. 
(iii) Stabilizing the market for health 8 insurance coverage in the State.
(iv) Stabilizing premiums for individuals with pre-existing conditions.
(v) Increasing the choice of health plans in the State."
On major problem that I see is that any specification in the application for the waiver as to how the granting of the waiver would accomplish any of the above five goals would be pure conjecture and would not be evidence based.  Hence I view the above requirements for approval of the waiver as merely an ostensible (stating or appearing to be true, but not necessarily so) justification for its application.  In practical effect, if a state requests a waiver, they will receive it, at least under the current administration.

Thursday, April 6, 2017

Answers to FAQs Re: Obamacare, Prepared for Congressional Staff

Below is a link to FAQ regarding the Affordable Care Act.  35 pages. "This report provides resources to help congressional staff respond to constituents' frequently asked questions about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the ACA's provisions."
Patient Protection and Affordable Care Act
(ACA): Resources for Frequently Asked
Questions by Angela Napili, Senior Research Librarian, Congressional Research Service