SENATE BILL: Reforming Atlasian Public Health Act of 2014 (Debating)

[Southern Senator North Carolina Yankee]

TNF, if you wish to amend the Healthcare Moderanization Act, I would recommend pursuing it via independnet legislation.

[Southern Senator North Carolina Yankee]

Actually scract that, I will deem the amendment as friendly. But I would urge Cincy to condense the text down to just those passages that are being altered for the sake of space.

[Southern Senator North Carolina Yankee]

Does anyone know anything about this "paying based on outcomes" as opposed to by the number or procedures. I recall hearing about in various discussions but I have forgotten the details. Isn't that what they do at the Mayo clinic?

From what I can remember it sounded like a good way to boost quality, cut costs and reduce those unnecessary procedures we discussed, whereas most measures do one at the expense of the other like tort reform requires balancing the need to guard against mal practice whilst trying to reduce unnecessary procedures and costs and a lot of cost cutting can also come at the expense of quality and so for.

So how does this process work, can it be done on a large scale or should it be done experimentally first?

I don't know if you aknowledge that but there are alternatives to fee-for-service style of payment; there are things like a Global Budget or Bundled Payments which looks much better than the current system.

What are these and do you have an information on them?

[Southern Senator North Carolina Yankee]

Healthcare Payroll Tax and a tax on Health Insurance.

[Southern Senator North Carolina Yankee]

How is medisave is in any way different to putting a few more per cent on income tax?

I think partially it drives at the personal responsibility aspect we discussed before but I am not as familiar with the structure as Duke and Simfan are.

[Southern Senator North Carolina Yankee]

The amendment has been adopted.

[Southern Senator North Carolina Yankee]

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[Southern Senator North Carolina Yankee]

Wait, what just happened?  Did we just change the entire text of this bill into an amendment to the Healthcare Modernization Act

No, that is merely be added to the bottom of the current text in the OP as the next numbered clause.

[Southern Senator North Carolina Yankee]

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where y is the subsidy (measured in terms of full cost of public option coverage) and x is defined as household income (measured in terms of poverty line).

2. Funding for the subsidy shall be derived from the healthcare payroll tax set at 6.1% as amended by Residential Taxation Reform Act of 2014.

3. Limits and/or guidelines for premiums, co-pays, deductibles:

a. The total out of pocket payment for co-pays and deductibles for an individual and/or household for the whole year may not exceed beyond 5% of the total income of that individual and/or household.
b. This co-pay limit shall apply to all services mentioned in Part II, Section 2 of this Act.


Part II - Changes to ANHC

The New National Healtcare Act is to be amended and replaced with the following text:

Section 1: Eligibility and Benefits

1. All individuals residing in Atlasia are eligible to enroll in a plan offered by the Atlasian National Health Care Program (ANHC), which shall all entitle them to a high standard of care at a low cost.

2.The health care benefits offered by ANHC plans shall cover all medically necessary services, including at least the following:

1.Primary care and prevention.
2.Inpatient care.
3.Outpatient care.
4.Emergency care.
5.Prescription drugs.
6.Durable medical equipment.
7.Long-term care.
8.Palliative care.
9.Mental health services.
10.The full scope of dental services (other than cosmetic dentistry).
11.Substance abuse treatment services.
12.Chiropractic services.
13.Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
14.Hearing services, including coverage of hearing aids.
15.Podiatric care.
16.Contraceptive services
17.End of Life Care - Shall be limited in hospital settings up to the cost of such care when attained through a hospice setting.

3. Healthcare professionals shall be licensed according to the laws and policies of their respective regions.  Only licensed professionals shall be allowed to offer such services and only such licensed professionals will be eligible for reimbursement from the ANHC program.

Section 2: Finances

1. The levels of reimbursement to licensed professionals and medical facilities shall be determined by the CHPs, considering the cost of providing such care and ensuring the integrity and preservation of the providers.

2. The CHPs hall determine the level of premiums, co-pays and deductibles in accordance with the levels of reimbursement as established in the previous section of this act and any other limits as proscribed by law.

3. Licensed health care clinicians who perform a covered service under the ANHC, to any patient enrolled therein, may not bill the patient for the portion of the bill covered by the ANHC.

Section 3. Administration

1. The ANHC program shall be administered by the Health Directorate, made up by a Chairman and the Executives of the regional CHP boards.

2. The provision of healthcare and the administration of budgets and services shall be the responsibility of independent Community Health Partnerships (CHPs) congruent to the existing Regions, these shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one Executive and further non-executive members.

3. CHP members shall be selected by the Health Directorate and shall be a non-partisan gathering of experts in the medical, pharmaceutical, and health insurance and administration industries.

4. All boards shall be required to have an audit committee consisting only of non-executive members on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.

5. All members, directors and associated bodies shall be accountable to the Health Directorate as outlined in this section.

Part III: Coverage for Special Populations

Section 1: Coverage for Military and Veterans.

1. All active duty military personell shall be eligible for full coverage under ANHC, fully paid for by the Atlasian Department of Defense with no premiums, co-pays or deductibles.

2. All Veterans shall be eligible for full coverage under the ANHC, with no co-pays or deductibles, with subsidies for premiums as described in Part 1, Section 3 of this Act.  Cost normally associated with co-pays and deductibles shall be covered by the government through the Veterans Benefits Administration.
 
3. A “veteran” is defined for the purpose of this section as any person who served on active duty in the armed forces of Atlasia and received an honorable or general discharge.

Section 2: Pre-existing Conditions and High Risk Populations

1. A Comprehensive Insurance Equality Pool (CIEP) shall be established within the ANHC so that those with pre-existing conditions can receive affordable care without discrimination.  Those with pre-existing conditions or other factors such as age or gender which may increase risk to health or risk of health related cost shall be covered under ANHC at the same cost to the consumer as those without these conditions.

2. The CIEP shall be subsidized out of funds derived from the healthcare payroll tax to the extent necessary to achieve cost parity to the consumer.

3. The CIEP shall have open enrollment periods determined by the ANHC Health Directorate.  Those with changes in condition or subject to increased premium cost at their current insurance provider may enroll in the high risk pool program through special enrollment so long as they have maintained coverage through ANHC or another insurer prior to such change in condition.

4. A Risk Adjustment Program will be established to involve private providers with annual net income greater than $50 million. Plans with lower actuarial risk will make payments to plans with higher actuarial risk to adjust for variation in distribution of high risk patients. This program will be administered by the Health Resources & Services Administration.[/quote]

[Southern Senator North Carolina Yankee]

Amendment 61:69 by NC Yankee:
Sponsor Feeback: Origination
Status: Senators have 24 hours to object.

[Southern Senator North Carolina Yankee]

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[Southern Senator North Carolina Yankee]

The amendment has been adopted.

The President has expressed his desire to get at least something done on this before he leaves office and whilst not his first choice, our framework presented the best option that closest to being done and I am grateful for his helping shua and I to finish the text.

I would prefer to have done this a better way but there seems to be little interest in this issue and we cannot continue on with a system that was flawed to the point of nonfunctional and at the very least, the final text produced will function and rather good at that. That is not to say that it won't need further work, as well as work on anccilary issues like doctors, lawsuits and cost controls through various means.

Therefore, with the amendemnt having passed and 24 hours having long passed since the last debate, not to mention authorization from Cincy, I am opening a final vote on this legislation. Senators, please vote Aye, Nay or Abstain.

[Southern Senator North Carolina Yankee]

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where y is the subsidy (measured in terms of full cost of public option coverage) and x is defined as household income (measured in terms of poverty line).

2. Funding for the subsidy shall be derived from the healthcare payroll tax set at 6.1% as amended by Residential Taxation Reform Act of 2014.

3. Limits and/or guidelines for premiums, co-pays, deductibles:

a. The total out of pocket payment for co-pays and deductibles for an individual and/or household for the whole year may not exceed beyond 5% of the total income of that individual and/or household.
b. This co-pay limit shall apply to all services mentioned in Part II, Section 2 of this Act.


Part II - Changes to ANHC

The New Atlasian Healthcare Act is to be amended and replaced with the following text:

Section 1: Eligibility and Benefits

1. All individuals residing in Atlasia are eligible to enroll in a plan offered by the Atlasian National Health Care Program (ANHC), which shall all entitle them to a high standard of care at a low cost.

2.The health care benefits offered by ANHC plans shall cover all medically necessary services, including at least the following:

1.Primary care and prevention.
2.Inpatient care.
3.Outpatient care.
4.Emergency care.
5.Prescription drugs.
6.Durable medical equipment.
7.Long-term care.
8.Palliative care.
9.Mental health services.
10.The full scope of dental services (other than cosmetic dentistry).
11.Substance abuse treatment services.
12.Chiropractic services.
13.Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
14.Hearing services, including coverage of hearing aids.
15.Podiatric care.
16.Contraceptive services
17.End of Life Care - Shall be limited in hospital settings up to the cost of such care when attained through a hospice setting.

3. Healthcare professionals shall be licensed according to the laws and policies of their respective regions.  Only licensed professionals shall be allowed to offer such services and only such licensed professionals will be eligible for reimbursement from the ANHC program.

Section 2: Finances

1. The levels of reimbursement to licensed professionals and medical facilities shall be determined by the CHPs, considering the cost of providing such care and ensuring the integrity and preservation of the providers.

2. The CHPs shall determine the level of premiums, co-pays and deductibles in accordance with the levels of reimbursement as established in the previous section of this act and any other limits as proscribed by law.

3. Licensed health care clinicians who perform a covered service under the ANHC, to any patient enrolled therein, may not bill the patient for the portion of the bill covered by the ANHC.

Section 3. Administration

1. The ANHC program shall be administered by the Health Directorate, made up by a Chairman and the Executives of the regional CHP boards.

2. The provision of healthcare and the administration of budgets and services shall be the responsibility of independent Community Health Partnerships (CHPs) congruent to the existing Regions, these shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one Executive and further non-executive members.

3. CHP members shall be selected by the Health Directorate and shall be a non-partisan gathering of experts in the medical, pharmaceutical, and health insurance and administration industries.

4. All boards shall be required to have an audit committee consisting only of non-executive members on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.

5. All members, directors and associated bodies shall be accountable to the Health Directorate as outlined in this section.

Part III: Coverage for Special Populations

Section 1: Coverage for Military and Veterans.

1. All active duty military personell shall be eligible for full coverage under ANHC, fully paid for by the Atlasian Department of Defense with no premiums, co-pays or deductibles.

2. All Veterans shall be eligible for full coverage under the ANHC, with no co-pays or deductibles, with subsidies for premiums as described in Part 1, Section 3 of this Act.  Cost normally associated with co-pays and deductibles shall be covered by the government through the Veterans Benefits Administration.
  
3. A “veteran” is defined for the purpose of this section as any person who served on active duty in the armed forces of Atlasia and received an honorable or general discharge.

Section 2: Pre-existing Conditions and High Risk Populations

1. A Comprehensive Insurance Equality Pool (CIEP) shall be established within the ANHC so that those with pre-existing conditions can receive affordable care without discrimination.  Those with pre-existing conditions or other factors such as age or gender which may increase risk to health or risk of health related cost shall be covered under ANHC at the same cost to the consumer as those without these conditions.

2. The CIEP shall be subsidized out of funds derived from the healthcare payroll tax to the extent necessary to achieve cost parity to the consumer.

3. The CIEP shall have open enrollment periods determined by the ANHC Health Directorate.  Those with changes in condition or subject to increased premium cost at their current insurance provider may enroll in the high risk pool program through special enrollment so long as they have maintained coverage through ANHC or another insurer prior to such change in condition.

4. A Risk Adjustment Program will be established to involve private providers with annual net income greater than $50 million. Plans with lower actuarial risk will make payments to plans with higher actuarial risk to adjust for variation in distribution of high risk patients. This program will be administered by the Health Resources & Services Administration.[/quote]

[Southern Senator North Carolina Yankee]

What can be more egalitarian then making the Koch brothers and Bill Gates pay their own way?

AYE

[Southern Senator North Carolina Yankee]

THis has passed

[Southern Senator North Carolina Yankee]

Vote on Final Passage of the Reforming Atlasian Public Health Act of 2014:

Aye (6): DC al Fine, Goldwater, Lumine, NC Yankee, shua and TyriontheImperialist
Nay (0):
Abstain (0):

Didn't Vote (4): Adam Griffin, Alfred F. Jones, bore and TNF

The legislation has passed and is presented to the President for his signature or veto.

[Southern Senator North Carolina Yankee]

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where y is the subsidy (measured in terms of full cost of public option coverage) and x is defined as household income (measured in terms of poverty line).

2. Funding for the subsidy shall be derived from the healthcare payroll tax set at 6.1% as amended by Residential Taxation Reform Act of 2014.

3. Limits and/or guidelines for premiums, co-pays, deductibles:

a. The total out of pocket payment for co-pays and deductibles for an individual and/or household for the whole year may not exceed beyond 5% of the total income of that individual and/or household.
b. This co-pay limit shall apply to all services mentioned in Part II, Section 2 of this Act.


Part II - Changes to ANHC

The New Atlasian Healthcare Act is to be amended and replaced with the following text:

Section 1: Eligibility and Benefits

1. All individuals residing in Atlasia are eligible to enroll in a plan offered by the Atlasian National Health Care Program (ANHC), which shall all entitle them to a high standard of care at a low cost.

2.The health care benefits offered by ANHC plans shall cover all medically necessary services, including at least the following:

1.Primary care and prevention.
2.Inpatient care.
3.Outpatient care.
4.Emergency care.
5.Prescription drugs.
6.Durable medical equipment.
7.Long-term care.
8.Palliative care.
9.Mental health services.
10.The full scope of dental services (other than cosmetic dentistry).
11.Substance abuse treatment services.
12.Chiropractic services.
13.Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
14.Hearing services, including coverage of hearing aids.
15.Podiatric care.
16.Contraceptive services
17.End of Life Care - Shall be limited in hospital settings up to the cost of such care when attained through a hospice setting.

3. Healthcare professionals shall be licensed according to the laws and policies of their respective regions.  Only licensed professionals shall be allowed to offer such services and only such licensed professionals will be eligible for reimbursement from the ANHC program.

Section 2: Finances

1. The levels of reimbursement to licensed professionals and medical facilities shall be determined by the CHPs, considering the cost of providing such care and ensuring the integrity and preservation of the providers.

2. The CHPs shall determine the level of premiums, co-pays and deductibles in accordance with the levels of reimbursement as established in the previous section of this act and any other limits as proscribed by law.

3. Licensed health care clinicians who perform a covered service under the ANHC, to any patient enrolled therein, may not bill the patient for the portion of the bill covered by the ANHC.

Section 3. Administration

1. The ANHC program shall be administered by the Health Directorate, made up by a Chairman and the Executives of the regional CHP boards.

2. The provision of healthcare and the administration of budgets and services shall be the responsibility of independent Community Health Partnerships (CHPs) congruent to the existing Regions, these shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one Executive and further non-executive members.

3. CHP members shall be selected by the Health Directorate and shall be a non-partisan gathering of experts in the medical, pharmaceutical, and health insurance and administration industries.

4. All boards shall be required to have an audit committee consisting only of non-executive members on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.

5. All members, directors and associated bodies shall be accountable to the Health Directorate as outlined in this section.

Part III: Coverage for Special Populations

Section 1: Coverage for Military and Veterans.

1. All active duty military personell shall be eligible for full coverage under ANHC, fully paid for by the Atlasian Department of Defense with no premiums, co-pays or deductibles.

2. All Veterans shall be eligible for full coverage under the ANHC, with no co-pays or deductibles, with subsidies for premiums as described in Part 1, Section 3 of this Act.  Cost normally associated with co-pays and deductibles shall be covered by the government through the Veterans Benefits Administration.
  
3. A “veteran” is defined for the purpose of this section as any person who served on active duty in the armed forces of Atlasia and received an honorable or general discharge.

Section 2: Pre-existing Conditions and High Risk Populations

1. A Comprehensive Insurance Equality Pool (CIEP) shall be established within the ANHC so that those with pre-existing conditions can receive affordable care without discrimination.  Those with pre-existing conditions or other factors such as age or gender which may increase risk to health or risk of health related cost shall be covered under ANHC at the same cost to the consumer as those without these conditions.

2. The CIEP shall be subsidized out of funds derived from the healthcare payroll tax to the extent necessary to achieve cost parity to the consumer.

3. The CIEP shall have open enrollment periods determined by the ANHC Health Directorate.  Those with changes in condition or subject to increased premium cost at their current insurance provider may enroll in the high risk pool program through special enrollment so long as they have maintained coverage through ANHC or another insurer prior to such change in condition.

4. A Risk Adjustment Program will be established to involve private providers with annual net income greater than $50 million. Plans with lower actuarial risk will make payments to plans with higher actuarial risk to adjust for variation in distribution of high risk patients. This program will be administered by the Health Resources & Services Administration.[/quote]

[Southern Senator North Carolina Yankee]

Considering the transition has already been done, unless started otherwise, nothing in this legislation would reverse that transition. Also Part III, specifcally establishes programs for seniors, vets and the like anyway. Even when Tricare was passed in early 2013, I warned Nix and others that it would be a mistake to insert a new item into a previously completed transition.

The reason for that bore, was the decision made a few pages back to staff out the semi-releated stuff or stuff not directly connected to the public healthcare system to seperate bills because of how big this was going to get as it was. I went through your list but none was related 100% to public health like the big cajuna the New National Healthcare Act, and none of it was problematic as it relates to what we are doing here.

I was going to insert "Healthcare Reform Act of 2004"  but then I realized that only clause 1 was really applicalbe and the rest was tort reform and therefore I decided to leave that for a later bill.

The Drug Acts are likewise a seperate issue that should be consolidated and dealt with in a single seperate bill on prescription drugs.

DYCOY is our Mental Health project, there is no reason to repeal it. If anything we can no proceed with Part II of that now. And you had your chance at a consolidated mental health bill. People wanted piecemeal and that is what they have gotten.

End of Life care was left in the new ANHC in our act, and once again the rest of the Senior Care Act (80% of the text) was an amendment to the CSS, not ANHC. Considering the size of the bill, it would have been impractical to dive into that mess as well and attempt to alter that.

[Southern Senator North Carolina Yankee]

The language is somewhat weak on that front, but since everyone is starting out with ANHC to begin with, the regions can/should have time to add in additional requirements regarding what people must have at minimum.

I would point out that the previous laws did not really address the matter either, save for that first clause, which was a very vague mission statement as opposed to set requirement in my opinion.