http://news.firedoglake.com/2009/11/19/bro... /

"Jon Walker has gone line-by-line through the Senate health care bill and the CBO analysis, so I won’t replicate his concerns here. In short, he believes the Senate bill has poor risk adjustment, meaning that the insurance companies will be empowered to still game the system, just in different ways; he’s appalled at the creation of nationwide insurance plans, which could easily lead to the gutting of state-based insurance regulations; and he lists several other problems, including the opt-out that states could enact before reform, the 1-year implementation delay, the bad “free rider” provision for employers, and others. I do want to highlight one and expand on it a bit.

6) Incredibly Low Actuarial Value – The minimum actuarial level of the lowest level qualified health insurance is 60%. This level is far too low. This is even lower than the requirement in the Senate Finance Committee bill, which was 65%.

Let’s try to untangle the wonk-speak here. Nicholas Beaudrot does the best job of that. Basically, the bill defines down what qualifies as “insurance,” such that insuring Americans has less meaning and value.


Previous thread on the 70% actuarial value in the House bill...

http://www.democraticunderground.com/discu...

"...The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families..."