The Tale of the Lemon Aide Stands

This is the story of Sally, a young girl with a dream: to make a living by quenching the thirst of the hot, parched masses with her wonderful, home-made lemon aide. It took her awhile to get started, but she saved her money, bought the ingredients and equipment that she needed to make her lemon aide, and set up her stand.

Her lemon aide was delicious, and with the high temperatures caused by global warming there were certainly enough thirsty people out there, so it wasn't long before there was a constant flow of customers coming for her sweet concoction. At 50 cents a cup, she was doing okay!

One day, another young girl, Michelle, showed up at her stand. "I don't think that it's fair that you make people pay for your lemon aide," Michelle told Sally. "Not everyone has the money to buy it. I'm going to open a stand next to yours and give it to people for free."

"SEC. 100. PURPOSE; TABLE OF CONTENTS OF DIVISION; GENERAL DEFINITIONS.
(a) Purpose-
(1) IN GENERAL- The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending.
(2) BUILDING ON CURRENT SYSTEM- This division achieves this purpose by building on what works in today's health care system, while repairing the aspects that are broken.
(3) INSURANCE REFORMS- This division--
(A) enacts strong insurance market reforms;
(B) creates a new Health Insurance Exchange, with a public health insurance option alongside private plans;
(C) includes sliding scale affordability credits; and
(D) initiates shared responsibility among workers, employers, and the government;
so that all Americans have coverage of essential health benefits."
------ from the text of HR 3200 as found on the website:
http://thomas.loc.gov/
(Bold letter feature later added by ME!)

"Well, it's a free country," Sally replied. "I'm not afraid of a little competition. You can open a stand."

"Okay, I will," Michelle told her. "There's just one problem: I don't have the money to start a stand. I will need you to pay for it."

Sally thought for a moment. "Well, I guess I can do that," Sally said. "It's certainly a noble idea, and business has been really good for me. Sure! Let's do it!"

Some ideas for paying for health care reform are: Tax part of employer contributions to health insurance; impose Medicare tax on state and local government employees; tax sugary and alcoholic drinks; change or eliminate Flexible Spending Arrangements; and modify Health Savings Accounts. The latest idea put forth by Democrats suggest a graduated surtax for couples earning $350,000+, to include a 5.4 percent surtax on people with income over $1 million.

So Sally raided her piggy bank and gave Michelle the money that Michelle needed to start her lemon aide stand. Michelle had a few customers come to her stand, but it seemed that the people at Sally's stand had better lemon aide (Sally was using the secret recipe that had been handed down to her from her great-grandmother, and she used only the finest ingredients, with a couple of secret ingredients for good measure.) Most of Michelle's customers simply whined and complained about the disparity, and other customers got in line at Sally's stand.

"I have another request," Michelle announced the next day. "Your lemon aide seems to have something that mine doesn't, and that's not fair! I want you to use MY recipe from now on."

Sally looked at Michelle's recipe. Grandma's secret ingredients weren't there. Sally took a sip of Michelle's lemon aide to get a taste. It was not nearly as sweet as Sally's, and it was a little watery. But in the fiery heat of a CO2 warmed globe, it still quenched her thirst, so Sally agreed to use Michelle's recipe. Since she was having to pay for ingredients at both stands, Sally actually was relieved a little when she realized that Michelle's recipe would save her some money.

"And it has to be EXACT!" Michelle demanded. "Don't be changing ANYTHING, do you hear me? Oh, and you can only service your old customers; if you get any new customers, you have to send them to me!"

"SEC. 101. REQUIREMENTS REFORMING HEALTH INSURANCE MARKETPLACE. (a) Purpose- The purpose of this title is to establish standards to ensure that new health insurance coverage and employment-based health plans that are offered meet standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections.
(b) Requirements for Qualified Health Benefits Plans- On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:
(1) Subtitle B (relating to affordable coverage).
(2) Subtitle C (relating to essential benefits).
(3) Subtitle D (relating to consumer protection).
(c) Terminology- In this division:
(1) ENROLLMENT IN EMPLOYMENT-BASED HEALTH PLANS- An individual shall be treated as being `enrolled' in an employment-based health plan if the individual is a participant or beneficiary (as such terms are defined in section 3(7) and 3(8), respectively, of the Employee Retirement Income Security Act of 1974) in such plan.
(2) INDIVIDUAL AND GROUP HEALTH INSURANCE COVERAGE- The terms `individual health insurance coverage' and `group health insurance coverage' mean health insurance coverage offered in the individual market or large or small group market, respectively, as defined in section 2791 of the Public Health Service Act.
SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.
(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:
(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 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."

"SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.
(a) Establishment-
(1) IN GENERAL- There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.
(2) CHAIR- The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.
(3) MEMBERSHIP- The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:
(A) 9 members who are not Federal employees or officers and who are appointed by the President.
(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.
(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint.
Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act.
(4) TERMS- Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members.
(5) PARTICIPATION- The membership of the Health Benefits Advisory Committee shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children's health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee.
(b) Duties-
(1) RECOMMENDATIONS ON BENEFIT STANDARDS- The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the `Secretary') benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
(2) DEADLINE- The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.
(3) PUBLIC INPUT- The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.
(4) BENEFIT STANDARDS DEFINED- In this subtitle, the term `benefit standards' means standards respecting--
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and
(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5)."

"SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.
(a) Duties- The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS- The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.
(2) HEALTH INSURANCE EXCHANGE- The establishment and operation of a Health Insurance Exchange under subtitle A of title II.
(3) INDIVIDUAL AFFORDABILITY CREDITS- The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.
(4) ADDITIONAL FUNCTIONS- Such additional functions as may be specified in this division.

(b) Promoting Accountability-
(1) IN GENERAL- The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange."

So Sally modified her recipe and made her lemon aide to match the lemon aide offered by Michelle. Some of her old customers stopped by. "A dollar!" Mr. Jones exclaimed. "Why did you raise the price?"

"Well, you see," Sally explained. "My costs have gone up. I'm not just paying for lemons and sugar for my lemon aide; I'm having to pay for Michelle's lemons and sugar, too."

Mr. Jones grumbled, pulled out a dollar, and took a sip of Sally's lemonade. "Hey! What's going on? This doesn't taste the same!"

"I had to change my recipe," Sally answered. "I had to make my lemon aide match Michelle's."

"Well, why should I pay more for the same stuff, when I can get it for free?" Mr. Johnson murmured. "I'm going over there."

As the weeks wore on, Sally watched sadly as all of her old customers went to Michelle's stand. Business at Michelle's stand was ten times what it had been at Sally's. The lines were long for the free lemon aide, and it took Michelle some time to service all of the customers. Some of her customers got discouraged and left, but most waited around for the free, but watery, lemon aide.

As the last customer left for the day, Michelle came to Sally. "I need some more money. Business has been great, and I'm out of lemons and sugar!"

Sally opened her piggy bank and three quarters tumbled out. "Is that all you got?" Michelle asked. "I need more than that! You're going to have to sell your bicycle!"

"I can't," Sally told Michelle. "I already sold it to get the money that you needed last week."

Even the Congressional Budget Office reports that the current proposals would cost $1 trillion and only reduce the number of the uninsured by $16 million.

"What am I supposed to do now?" Michelle asked.

"I don't know," Sally answered. "But I'm done; I'm taking my stuff and going home!"