Thursday, October 31, 2013

‘Substandard” Health Plans

“If you had one of these substandard plans before the Affordable Care Act became law, and you really liked that what  we said, under the law,  you have got to replace them with quality, comprehensive coverage.”

President Barack Obama,  Boston Political Rally, October 30, 2013

In Boston yesterday,   President Obama blasted health insurer “bad apples” by saying these insurers were offering “substandard” plans.  By “substandard,”  he meant those 19  million existing health plans that did not contain the 10 “essential benefits” his administration considered “standard”.

These “benefits” include:

1.    Outpatient care—the kind you get without being admitted to a hospital

2.    Trips to the emergency room

3.    Treatment in the hospital for inpatient care

4.    Care before and after your baby is born

5.    Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy

6.    Your prescription drugs

7.    Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.

8.    Your lab tests

9.    Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.

10.  Pediatric services: This includes dental care and vision care for kids

The  Administration’s Message

Never mind if  you do not need or want  these  benefits.  Never mind if they do not apply to you, your family, or your health situation. Never mind if you can afford them or not.   Your pre-existing plans that do not have them are kaput. According to the law,  insurers will have to cancel them, and you will have to shop around on or state exchange websites to replace those substandard plans.

Message Raises These Questions

What does this message imply?


·         Health insurers are dishonest and unscrupulous in offering policies that do not cover everything clinical and preventable.  Calling some insurers “bad apples”  implies insurers are not honest and above board in their dealings with the public.  Insurers are the "demons" of our health system.

·         Government and only government knows what standards should  apply to  the electorate and their families. After all, it was the first President, George Washington, who said at the first Constitutional Convention  “Let us raise a standard to which the wise and honest can rise.”

·         Insurers conned millions of honest Americans into buying plans that they knew did not meet government standards and that  they dishonestly  knew to be inadequate.

·         Citizens who bought these plans and who pay monthly for them must be protected as set forth in the Patient Protection and Affordable Care Act.   It is our patriarchal duty to protect citizens against the unscrupulous in the health care industry.

·         If the premiums and deductibles are “unaffordable. “ it is the function of government to step in and provide subsidies to make them affordable.

·         Because of lack of consumer wisdom and knowledge, freedom of choice of health plans outside of government approval of plans on the exchanges is no longer an option.

Tweet: Insurers must cancel all “substandard” health plans that do not contain 10 essential benefits mandated by the health law.

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