BS: Question for Mudcat Lawyers

Subject: BS: Question for Mudcat Lawyers
From: CarolC
Date: 30 Jul 09 - 04:24 PM

My sister and I are having a little debate about the health care bill that is being propose in the US House of Representatives. My sister says there is language in the bill that would make private insurance illegal. Here is the relevant section of the bill:

SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.

(a) Grandfathered Health Insurance Coverage Defined. --Subject to the succeeding provisions of this section, for the purpose of establishing acceptable coverage under this division, the term "granfathered health insurance coverage" means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:

(1) Limitation on new enrollment. --

(A) In General. --Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) Dependent Coverage Permitted. -- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) Limitation on changes in terms or conditions. --Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

(3) Restrictions on premium increases. --The issuer cannot vary the percentage increase in the premium for all enrollees in the same risk group at the same rate, as specified by the commissioner.


The part she says would make private insurance illegal is this part:

Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1

I have tried to explain to her that that one line has no force of law if it is taken out of context as she (and apparently some lawyers who work for "Business Investment Weekly") is doing, but somehow I don't think my word alone is going to cut it with her. I would be very interested in what the lawyers here in the Mudcat have to say about how laws work and whether or not one single passage like that has the force of law when taken out of context.

My reading of the passage is that it is a part of a list that helps to define what is meant by the term "grandfathered health insurance coverage" and that it has no meaning whatever when taken out of that context. My sister is insisting that that one line alone has the force of law, independent of the context she is taking it out of.

What say you, Mudcat lawyers?

Subject: RE: BS: Question for Mudcat Lawyers
From: pdq
Date: 30 Jul 09 - 04:32 PM

It's good to see the actual text of this bill discussed.

Those who crafted the bill try to get people to believe that "whatever you want, well, that's what it does, just trust me".

Subject: RE: BS: Question for Mudcat Lawyers
From: GUEST,Goodnight Gracie
Date: 30 Jul 09 - 05:24 PM

I am an employee benefits attorney in the U.S. This section of the bill, if enacted, would grandfather the right to continue individual private health care coverage. It does not address the right to obtain individual private health care coverage. And certainly does not make individual private health care coverage illegal.

Subject: RE: BS: Question for Mudcat Lawyers
From: CarolC
Date: 30 Jul 09 - 08:59 PM

Thanks!

Anyone else?

Subject: RE: BS: Question for Mudcat Lawyers
From: M.Ted
Date: 30 Jul 09 - 09:50 PM

The language simply defines what would constitute "existing coverage"--in other words it
says, when this bill refers to "grandfathered coverage" this is the coverage we're talking about--

The line you are talking basically says that someone whose coverage on an insurance policy starts on or after the first day of Y1, is not grandfathered, which is logical, and didn't really need to be pointed out, because being "grandfathered" means that they were included because they were covered *before* the Y1 started--

Subject: RE: BS: Question for Mudcat Lawyers
From: Amos
Date: 30 Jul 09 - 09:59 PM

It also provides against "grandfathered" insurance plans adding new enrollees after the grandfathering under shelter of the grandfathering. Those who are covered on the "grandfather" terms may add dependens but new enrollees to a plan are subject to the later, un-grandfathered provisions, which are not described here.

A

Subject: RE: BS: Question for Mudcat Lawyers
From: CarolC
Date: 31 Jul 09 - 10:15 AM

Thanks!

Any more lawyers?