" For, lo, the winter is past, the rain is over and gone; the flowers appear on the earth; the time of the singing of birds is come, and the voice of the turtle is heard in our land. " Song of Solomon

November 11, 2009

H.R. 3962

EDIT: There seems to be some confusion as to the bill numbers...I am referring to HR3962, not HR 3200...hence I've included some additional information below for clarification.

EDIT: HR3962 was passed by a 220 yes/215 no vote in the House on November 7, 2009. The yes vote consisted of 219 democrats and one republican, and the no votes were 39 democrats and 176 republicans, as reported by the NY Times. You can read their post here:


EDIT: I have copied and pasted the text of sec. 202 of HR 3962 as posted at the Library of Congress website, which ends in .gov in case there is any question in any one's mind as to the accuracy of the text. Here is the link to the .gov site--


My post concerns section 202c.


    (a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered 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:
        (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 a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.
    (b) Grace Period for Current Employment-Based Health Plans-
      (1) GRACE PERIOD-
        (A) IN GENERAL- The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 201, including the essential benefit package requirement under section 221.
        (B) EXCEPTION FOR LIMITED BENEFITS PLANS- Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:
          (i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).
          (ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.
          (iii) Such other limited benefits as the Commissioner may specify.
        In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division.
      (2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE- During the grace period specified in paragraph (1)(A), an employment-based health plan (which may be a high deducible health plan, as defined in section 223(c)(2) of the Internal Revenue Code of 1986) that is described in such paragraph shall be treated as acceptable coverage under this division.
(c) Limitation on Individual Health Insurance Coverage-
      (1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.
        (A) paragraph (1) shall prevent the offering of excepted benefits described in section 2791(c) of the Public Health Service Act so long as such benefits are offered outside the Health Insurance Exchange and are priced separately from health insurance coverage; and
        (B) this division shall be construed--
          (i) to prevent the offering of a stand-alone plan that offers coverage of excepted benefits described in section 2791(c)(2)(A) of the Public Health Service Act (relating to limited scope dental or vision benefits) for individuals and families from a State-licensed dental and vision carrier; or
          (ii) as applying requirements for a qualified health benefits plan to such a stand-alone plan that is offered and priced separately from a qualified health benefits plan.

Subtitle B--Standards Guaranteeing Access to Affordable Coverage


Here begins my post..........................

Do not miss this point:

Page 94—Section 202(c)
prohibits the sale of private individual health insurance policies, beginning in 2013, forcing individuals to purchase coverage through the federal government.

As a concerned citizen I most certainly agree we need to do something about the cost of health care in our nation. Forty years ago the cost to deliver a baby in the hospital, including several days stay was $50. The doctors fee was about the same. Thirty eight years ago the $50 had risen to $150...tripled. Even then people were able to pay for their expenses out of pocket-- without health insurance coverage. Today that is not the case. That same event today would be in the tens of thousands of dollars. Cost is the issue and addressing the cost issue will go farther in fixing the problem than regulating insurance companies.

None of us likes it when the 'evil' insurance companies deny people coverage or refuse to pay for a procedure. And if the cost of medical care wasn't so high, we'd tell those insurance companies that they could take their business where the sun doesn't shine. But we can't financially afford to be without them--why?..because of the high cost of health care. That high cost is the issue.

I recently received an email from my Tennessee congressman, Phil Roe. He is a doctor with more than 30 years experience in health care, so he has first hand knowledge of what is going on in the world of health care and insight from the perspective of being a medical professional.

He spent last week going through H.R. 3962 --which was recently passed by the U.S. House--a nearly 2,000 page bill, and he shared several items of concern.

One of the items that I find of serious concern--that I imagine few people are aware of--is this:

Page 94—Section 202(c) prohibits the sale of private individual health insurance policies, beginning in 2013, forcing individuals to purchase coverage through the federal government.

So..in 2013 no one will be allowed to buy private health insurance. Is this what you want? For real?? We will be losing the privilege, the right to buy health coverage where we choose, and be forced to buy it from the federal government..no exceptions.

In an editorial titled “The Worst Bill Ever,” the Wall Street Journal (WSJ) described this new legislation as “… destructive on every level—for the health-care system, for the country's fiscal condition, and ultimately for American freedom and prosperity.”

While I am not a fan of the WSJ, I must concur and say they are spot on. If this bill passes, we are in BIG trouble. Not only will our health care system suffer, we will suffer fiscally, possibly even financial collapse, and worse, we will give up one of our precious freedoms--the right to choose our health care coverage.

If this bill passes, and Uncle Sam is the only game in town, and he stinks, what then?? People..once we go there, there's no going back. Liberty lost is rarely regained. And then only with rebellion, revolution and almost always blood shed and anarchy.

I and hoping and praying that this bill will be defeated. Yes, we need to fix some things in our system so that working people can afford medical care. But H.R. 3962 is not the answer.

FYI--If I understand correctly, Congress will have the choice to purchase private insurance. And I am assuming that the non-government insurance will be available through your place of employment, should it choose to offer coverage. Be aware, also that the majority of those pushing for a government option have this agenda: they want a single payer system, and knowing that we'd never go from here--where we are currently--to there--a single payer system--they are hoping that adding a government option will be a stepping stone to the eventuality of a single payer system. This is not my opinion-- many of the democrats openly voice that their real desire is a single payer system, they make no bones about it. Is that your desire? I don't think I want to depend on the federal government alone.

Here's how I'd fix it:

Reduce the age to be eligible for Medicare to 55.
Increase the income/asset limit to a higher amount, qualifying more people for Medicaid.

What you have left is the middle to upper income people, most of which already get their insurance via their employer.

That would fix the insurance problem...though it does nothing to address the high cost of medical procedures.

But then H.R. 3962 isn't really aimed at addressing the high cost of medical procedures is it...it's more about regulating the insurance industry, with the real goal to eventually do away with it.
"....there have been many times when I have shed bitter tears, when if I had understood the situation better, I would have celebrated my good luck instead."


I am not a doctor and all information, suggestions, etc are my personal opinion only.