[talaniman]

Appointed bureaucrats that are NOT subject to Congressional oversight

That's not true, they can only recommend, nor will ACA be defunded or repealed by this congress or the next. High hopes, wishful thinking, and delusion, not connected to reality, or fact.

[excon]

Hello again, tom:

The law gives appointed bureaucrats on the IPAB life and death powers. They can cut essential care when most needed.

What's your point?? Insurance companies used to deny coverage all the time... Apparently, THAT'S a death panel you like.

Excon

[tomder55]

That's not true, they can only recommend, nor will ACA be defunded or repealed by this congress or the next. High hopes, wishful thinking, and delusion, not connected to reality, or fact.

I will amend my comment . They are subject to Senate confirmation.

[tomder55]

Hello again, tom:
What's your point?? Insurance companies used to deny coverage all the time... Apparently, THAT'S a death panel you like.

Excon

From the Slimes.

Most insurance companies have at least a three-level appeals process. Appeals at the first level are usually processed by the company’s appeals staff or by the company’s medical director responsible for the denial. Second-level appeals are reviewed by a medical director not involved in the original claim decision. And the third level usually involves an independent, third-party reviewer, along with a doctor who is board-certified in the same specialty as the patient’s doctor.

If your appeal is elevated to the third level and the insurance company continues to deny the claim, you can then take the appeal to the state level. Processes vary by state; you can contact your state’s insurance department for details.

If you feel too frail or overwhelmed to pursue an appeal yourself, nonprofit groups like the Patient Advocate Foundation can provide guidance for free. Fee-based services like Health Proponent are also an option. The service has been experimenting with different fee structures and is joining with affinity groups, like alumni associations and the American Automobile Association, to broaden its membership.

The difference is that there is no appeal for a IPAB decision.

[talaniman]

from the Slimes.

The difference is that there is no appeal for a IPAB decision.

That's for Insurance companies.

Independent Payment Advisory Board - Wikipedia, the free encyclopedia

The Independent Payment Advisory Board, or IPAB, is a fifteen-member United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which has the explicit task of achieving specified savings in Medicare without affecting coverage or quality.[1] Under previous and current law, changes to Medicare payment rates and program rules are recommended by MedPAC but require an act of Congress to take effect. The new system grants IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency's decisions through supermajority vote.

Beginning in 2013, the Chief Actuary of the Centers for Medicare and Medicaid Services will determine in particular years the projected per capita growth rate for Medicare for a multi-year period ending in the second year thereafter (the "implementation year"). If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce Medicare spending in the implementation year by a specified amount. If it is required to develop a proposal, the Board must submit that proposal in January of the year before the implementation year; thus, the first proposal could be submitted in January 2014 to take effect in 2015. If the Board fails to submit a proposal that the Chief Actuary certifies will achieve the savings target, the Secretary of Health and Human Services must submit a proposal that will achieve that amount of savings. The Secretary must then implement the proposal unless Congress enacts resolutions made to override the Board's (or the Secretary's) decisions under a fast-track procedure that the law sets forth.[1]

There never was an appeal process for the Chief Actuary, only oversight by the congress. That remains intact. And that's only if the costs exceed preset targets. The second part of this that people ignore is Medicaid which some dufus Republican governors are opting out of. I predict though, not for long.

Two more days, whether the government shuts down or NOT!!

[excon]

Hello again, tom:

Let me see if I understand you... It's BETTER that insurance has a 3 levels appeals process, and to leave 30 MILLION people with NO INSURANCE at all.

Who do those people appeal to?

excon

[talaniman]

Who appoints the appeal board for insurance companies? Bet it ain't consumers. Bet it's not up for a vote either, except by insurance companies folks.

[cdad]

Hello again, tom:

Lemme see if I understand you... It's BETTER that insurance has a 3 levels appeals process, and to leave 30 MILLION people with NO INSURANCE at all.

Who do those people appeal to?

excon

I think you may have missed the point. I believe what Tom was saying was about the lack of having the ability to appeal. At least under the old system there was a process that could be had and steps could be taken. Now there will be none.

Another thing that many people don't realize is that the States have been carrying the sick on their own insurance. Ones like medical and tenncare etc. They absorbed the ones that fell through the cracks for getting insurance because the person wasn't able to get it through the normal means. Now under Obamacare they can be deleted from those rolls and sent to insurance companies that can't refuse them. And when they see how much they are actually going to have to pay they are either going to freak out or die because they can't afford the meds nor the deductables that they will now inccur.

[speechlesstx]

How many super majority votes do you think congress is going to have to override IPAB?

[paraclete]

The OP says the democrats have an aversion to reality but given the current empasse I would say all parties have a serious aversion to reality. They want to play their petty games without reference to the outcomes. You really do need to get a serious respect for reality over there and do something about the political system that can create these empasses. Whatever you may think it is not democracy in action unless you have a mechanism that can resolve the empasse such as an immediate election in both houses and for the presidency so that you can get everyone on the same page

[tomder55]

whatever you may think it is not democracy in action

We have a constitutional republic by deliberate design of the founders . They did not want to be held hostage to the changing whims of majorities.

I believe what Tom was saying was about the lack of having the ability to appeal. At least under the old system there was a process that could be had and steps could be taken. Now there will be none.

exactly

[excon]

Hello again, dad and tom:

At least under the old system there was a process that could be had and steps could be taken. Now there will be none.

I understood.. You think it's better that the insured have a good appeal process, instead of everybody HAVING insurance - even if it has NO appeal process.

I DON'T think that's better.

Excon

[tomder55]

So the government compels everyone to be covered... and then when they need the care;it can be denied... great plan

[excon]

Hello again, tom;

and then when they need the care;it can be denied

In the legal world, EVERYTHING the government does is appealable.

Excon

[talaniman]

so the government compels everyone to be covered ...and then when they need the care;it can be denied ... great plan

That not what the law says but the flaw in the plan is it requires congress to act. That's the glitch. Congress acting responsibly.

They might though, after the war between the TParty and rational republicans comes to an end.

One more day guys. Will we celebrate the new law, or the shutdown? One is already here and the other looms large.

[tomder55]

Rational republicans?? You mean the 'French Republicans' .

[speechlesstx]

That not what the law says but the flaw in the plan is it requires congress to act. That's the glitch. Congress acting responsibly.

They might though, after the war between the TParty and rational republicans comes to an end.

One more day guys. Will we celebrate the new law, or the shutdown? One is already here and the other looms large.

Depends on who you ask...

Researchers at Pepperdine University’s Graziadio School of Business and Management conducted the survey, which found that 48 percent of business owners support at least a temporary government shutdown, compared to 42 percent who say policymakers should hurry and strike a deal. Of the poll’s 1,387 respondents, more than 90 percent own businesses with no more than 200 workers.

Half of respondents said they could get behind a shutdown for up to a month, and nearly a third would support shuttering the government for up to three months.

If we have a shutdown, small business owners split the blame equally. Also, 63% of small business owners want a 1 year delay and 47% want full repeal while 24% want it as is. But Dems have a mandate to push on over the cliff!

[excon]

Hello again,

I don't know what you mean by a "temporary" shutdown. Do you mean that you'll GIVE UP after a few days, or do you think Obama will give up after a few days??

excon

[excon]

Hello again,

Do you mean that you'll GIVE UP after a few days, or do you think Obama will give up after a few days??

ANYBODY??

Helloooooo... Is anybody there?

Excon

[speechlesstx]

I'd like to think there could be a reasonable compromise.