For those of you who love to read government documents, please review the attached document which is meant to explain only one very minuscule part of ObamaCrapCare. After reading it, please enlighten all of us with your knowledge.
We especially like the words "all similarly situated individuals", what the blue blazes does that mean? Does it mean the person next to me has to be in the same chair? The same building? The same state? Of the same weight, BMI, height? So it goes with governmenteez. You need another dictionary to understand what they are trying to say.
Obamacrapcare will be written in this non-English, government speak language that you need attorneys to understand and tell you how you must act. We guess that is good for the authors, it is called job security!
By the way, if the left is always screaming about "getting the government out of the bedroom", "away from my body", or whatever other caterwauls they want to express. Why are they so welcoming of a program that is very involved in your body. If you want to stop smoking or lose weight or get in better shape, that is a personal choice and the government should not have anything to say about it.
Oh darn, we forget. It is OK to control things the left wants. It is OK for them to force you into programs like the "wellness" programs because "it will be good for you." It is OK to say you can only drink a 16 ounce drink because "colas increase weight and this will be "good for you." It is OK to force restaurants to show the calories and such in their menus because "it will be good for you" even though most Americans don't understand the information.
The next time we hear a lefty saying "why doesn't the government......" we are going to ask them, "why can't you do..." Isn't it time for personal responsibility rather than laying it off on the government?
Conservative Tom
Final ACA wellness rules issued
May 31, 2013
On May 29, the U.S. Departments of the Treasury, Labor (DOL) and Health and Human Services issued final regulations amending the 2006 HIPAA nondiscrimination wellness regulations to implement the employer wellness program provisions of the Affordable Care Act. The final rules retain the two categories of wellness programs – “participatory wellness programs” and “health-contingent wellness programs.” The final rules do not deviate extensively from the proposed regulations issued in November 2012, although the content has been reorganized to more clearly set forth the requirements for each type of wellness program. The participatory wellness program rules are basically unchanged from the current 2006 regulations – participatory wellness programs comply with the HIPAA nondiscrimination requirements as long as the participant does not have to satisfy any additional standards and participation in the program is made available to all similarly situated individuals, regardless of health status. However, the final rules update and expand on the requirements for health-contingent wellness programs, which condition a reward on a participant’s satisfaction of a standard related to a health factor.
Under the final rules, there are two types of health-contingent wellness programs – “activity-only” programs and “outcome-based” programs. An activity-based wellness program provides a reward if an individual performs or completes an activity related to a health factor, but it does not require the individual to satisfy any specific health outcome. Examples include walking or exercise programs in which a reward is provided just for participation, or rewards for taking a health risk assessment without requiring any further action. An outcome-based wellness program requires an individual to either attain or maintain a specific health outcome – for example, not smoking or achieving certain results in biometric screenings – in order to obtain a reward.
All health-contingent wellness programs must meet five requirements:
1. Eligible individuals must be given an opportunity to qualify for the reward at least once per year.
2. Generally, the reward may not exceed 30% of the total cost of employee-only coverage (including both the employee and employer portion of the cost of coverage). If dependents are permitted to participate, the reward can be calculated on the basis of 30% of the cost of coverage in which the employee and any dependents are enrolled. In the case of a program designed to reduce or prevent tobacco use, the maximum reward amount is 50% of the total cost of coverage. The reward limit is cumulative for all health-contingent wellness programs.
3. The program must be reasonably designed to promote health or prevent disease.
4. For an activity-based wellness program, the full reward must be available to all similarly situated individuals by offering a reasonable alternative standard for obtaining a reward if it is either unreasonably difficult due to a medical condition to satisfy or medically inadvisable to attempt to satisfy the otherwise applicable standard. A wellness program can require verification from a physician that an individual’s health factor makes it unreasonably difficult or medically inadvisable to attempt to satisfy the regular standard.
For an outcome-based wellness program, the full reward must be available to anyone who does not meet the standard based on the initial measurement, test, or screening. The alternative standard cannot be a requirement to meet a different level of the same standard without additional time to comply – for example, if the initial standard is to achieve a body mass index of less than 30, the reasonable alternative standard cannot be to achieve a BMI of less than 31 on that same date, but it might be reasonable to require the individual to reduce his or her BMI by a smaller amount over the course of a year or other realistic period of time. If the individual’s physician joins in the individual’s request for an alternative standard, the physician can be involved in setting (and adjusting) a second alternative standard, consistent with medical appropriateness.
An alternative standard is not reasonable under either type of program unless the time commitment required to satisfy the standard is reasonable. If the alternative standard requires completion of an educational or diet program, the employer must assist the individual in finding the program, and the individual cannot be required to pay for the cost of the program. The alternative standard must accommodate the recommendations of an individual’s personal physician as to medical appropriateness.
5. The availability of a reasonable alternative standard to qualify for the reward must be disclosed in all materials describing the terms of the wellness program. For an outcome-based wellness program, a similar statement must be included in a notice that the individual did not satisfy the initial outcome-based standard. Sample language is provide in the final rule.
The final rules apply to both grandfathered and non-grandfathered group health plans in both the insured and self-insured markets and are effective for plan years beginning on or after January 1, 2014. Plan sponsors and issuers should review their current wellness programs and health plan communications in light of these final rules.
Used with permission by McDermott Will & Emery LLP.
The idea is that if you will participate in a diet/exercise program to improve your health (lose weight, reduce cholesterol levels, blood pressure, stop smoking, etc.), you can save 30-50% on the cost of your insurance. The purpose of the regulation is to define what programs do/do not qualify for these discounts on insurance.
ReplyDeleteThe healthier people become, the less they need to go to the doctors/hospitals, and the less health care will cost them and the rest of us. Are you okay with that? Nobody is forced to participate in these programs. If someone wants to be unhealthy, die early, and pay more during their whole life for health insurance than those who participate, that is their choice. I hope you realize that their choice imposes costs on the rest of us.
To answer your question, the term “similarly situated individuals” is defined in DOL Reg. § 2590.702(d). Distinctions may generally be drawn between participants and beneficiaries, different classes of participants (upon lines justifiable on the basis of bona fide business or related criteria, e.g., hourly-salaried, full-time or part-time, locations, date of hire, length of service, different occupations, etc.), and presumably between participants and non-participants.
--David
You write, "Isn't it time for personal responsibility rather than laying it off on the government?"
ReplyDeleteTom, I have some ideas about "personal responsibility." You are not responsible for your genes or what happens to you beyond your control. However, you are responsible for what you put in your body. That accounts for most obesity in this country. Furthermore, you are responsible for the consequences of your obesity (and resultant diabetes, cancer, high blood pressure, stroke, heart attack). And, if you die as a result, you are responsible for leaving your children at a young age without a parent. You are responsible for extra work you create for other employees at your workplace, because you were home sick so much of the time. And, when you are at work, you are responsible for your mediocre performance caused by your poor health.
You are responsible for the burden your high medical costs put on the health care system, which affects the access and costs of medical services for the rest of us. You are responsible for your decision to not participate in a wellness program that would help reduce all these consequences of your unhealthy lifestyle on yourself, your family, your fellow workers, and the rest of society. And if you are in an Obamacare exchange, you, and the others like you in the pool, are responsible for the insurance company being able to justify to HHS a premium increase of more than 10% next year because of the excessive claims you are all submitting. You see, my friend, you have the freedom from the "big bad government" to make these personal choices, but they don't just affect YOU. The negative consequences boomerang on a lot of other people. As a Libertarian, you have a responsibility to consider the effects that the exercise of your freedom has on the freedom of others around you. That is a fundamental principle of the Libertarian philosophy in which I believe.
I say "you" here, but I don't mean you personally. I am using the generic "you."
--David
So, David, I assume that you have no problem with people who live in tornado zones or flood zones or hurricane zones paying more for their insurance, even though they have NO control over the weather. Right?
ReplyDeleteI do not buy your idea that if you exercise, eat well you will not get sick. I know of someone who is 6'2, weighs 170 pounds, works out daily, eats well and has heart disease and diabetes. All the credits in the world will not bring him back to good health.
I have another person who was about the same body type and he died from cancer. Never smoked a day in his life, worked out ate well and still died.
I know millions who have died and their genes caused it. Exercise, eating right will not do anything.
So these people get benefits from the government at lower cost and they died pre-maturely because they exercised. That makes no sense.
What about the freedom to do with YOUR body, what YOU want to. Isn't that also freedom?
weather, but you can control where you live, if you are not institutionalized.
ReplyDelete"I do not buy your idea that if you exercise, eat well you will not get sick."
I don't buy that, either. I told you that I had a $60,000 claim this year. It was a problem with my pancreas. I keep my body in good condition with exercise and Schwarzbein diet. Read my note. You are not responsible for things outside your control.
"Exercise, eating right will not do anything."
That is false. It is no guarantee you won't die young from some cause, but it is a statistical fact that people who are obese, smoke, drink excessively, etc. have more health problems and a higher mortality rate on average. If we are going to have an intelligent discussion on this topic, you can't begin by denying obvious facts.
"So these people get benefits from the government at lower cost and they died pre-maturely because they exercised. That makes no sense."
Sure it makes sense. We are talking about the comparative health care costs of different groups. Those who maintain a healthy lifestyle cost the government less than those who have an unhealthy lifestyle. We are talking about group statistics here, not individual exceptions within each group.
"What about the freedom to do with YOUR body, what YOU want to. Isn't that also freedom?"
Read my note again. The last thing I said is that you have the personal freedom to abuse your own body as you choose (even to the point of suicide), but the negative consequences of your choices extend to other people around you in many ways. I gave you several examples. That was the key point of my note, which you did not even address.
--David
Humm, the first paragraph of my last note somehow got chopped off. Here it is...
ReplyDeleteSo, David, I assume that you have no problem with people who live in tornado zones or flood zones or hurricane zones paying more for their insurance, even though they have NO control over the weather. Right?
Bad analogy. If they choose to live there, that does not cause any increase in my homeowners' insurance premiums. Not so with Obamacare, if they are in my exchange pool. Their behavior affects me (and others, as I explained). BTW, you can't control the weather, but you can control where you live, if you are not institutionalized.
Again David, you don't understand insurance. Every year there are tragedies (tornadoes, hurricanes, floods etc) which DO raise your household premiums! Even if you don't live in the effected area, your insurance rates do go up. So are you going to say that the insurance companies should have their income cut! Maybe we should outlaw all insurance companies!
DeleteMy homeowners' insurance doesn't go up any more in years with big natural disasters than any other year. I did a quick fact-check on this. My premium is about the same today as it was in 2007 (less than 5% difference). There have been plenty of natural disasters in the U.S. in the last 6 years, but none here in Washington state. We don't get tornadoes, hurricanes, floods, etc., and I imagine that's why my premium increases very slowly (mostly with inflation). The people who DO get their premiums raised are those who live in these areas, as the insurance company assesses its risk exposure and adjusts premiums accordingly. Same with healthcare exchanges.
ReplyDeleteAnyway, you are still not responding to my central point that "you have the personal freedom to abuse your own body as you choose (even to the point of suicide), but the negative consequences of your choices extend to other people around you in many ways." This includes Obamacare, if you are in my exchange pool.
--David
Do you have a national insurance company or regional or local?
ReplyDeleteEncompass says they operate in 41 states...
ReplyDeletehttp://www.encompassinsurance.com/independent-insurance-agent/AgentList.aspx
How far do you want to paddle up this tributary? I don't want to talk about this. I want you to reply to my main point that "you have the personal freedom to abuse your own body as you choose (even to the point of suicide), but the negative consequences of your choices extend to other people around you in many ways."
--David