Dismantle Monopolized Healthcare Insurance

Health
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Title: "Public Ownership and Ethical Oversight of Healthcare Insurance Act "

Preamble:
To ensure equitable access to healthcare, protect consumers from predatory practices by private insurance companies, and promote transparency and fairness in the medical insurance industry, this legislation seeks to transition privately owned health insurance companies to publicly owned cooperatives. The Act establishes a system modeled after community-oriented healthcare sharing organizations, emphasizing accountability, ethical standards, and affordability for all citizens.

Section 1: Definitions

  1. Predatory Insurance Practices: Actions by insurers that involve unjustified denial of claims, excessive premiums, or prioritization of profit over patient care.
  2. Public Cooperative Insurance Model (PCIM): A nonprofit, community-based insurance model where participants share the costs of medical expenses transparently and equitably.
  3. Transition Oversight Authority (TOA): A governing body tasked with ensuring smooth and ethical transitions of private insurers to public cooperatives.

Section 2: Prohibition of Predatory Practices

  1. Insurance companies must demonstrate compliance with transparent claim adjudication and payment policies.
  2. Penalties for non-compliance include fines, operational suspension, and mandatory transition to public ownership under PCIM.

Section 3: Public Ownership Transition Process

  1. Mandatory Transition Criteria:
    a. Documented evidence of consistent claim denials or profit-driven malpractice.
    b. Failure to meet a minimum medical loss ratio (MLR) of 85%, where 85% of collected premiums are spent on direct patient care.
  2. Transition Oversight:
    a. The TOA will oversee the acquisition and restructuring of identified insurance companies.
    b. Employees will be offered roles within the public cooperative system to minimize disruptions.
  3. Valuation and Buyout:
    a. Private insurers will be appraised by independent auditors.
    b. Fair market value will be paid, with funding sourced from a public healthcare equity fund supported by progressive taxation.

Section 4: Structure of Public Cooperative Insurance Model (PCIM)

  1. Community Participation:
    a. Members contribute monthly fees based on income brackets.
    b. Surplus funds are reinvested into improving services or reducing member contributions.
  2. Ethical Oversight Board:
    a. Comprised of healthcare professionals, patient advocates, and community representatives.
    b. Ensures fairness in claims processing and decision-making.
  3. Transparency Requirements:
    a. Annual publication of financial reports detailing income, expenses, and claims payouts.
    b. Open meetings for members to review and influence policy changes.
  4. Federal Support:
    a. Initial funding for infrastructure development and marketing.
    b. Subsidies for low-income members to ensure universal participation.

Section 5: Integration with Existing Healthcare Systems

  1. PCIMs will collaborate with Medicare, Medicaid, and private healthcare providers to ensure seamless service delivery.
  2. Members may opt out of PCIM participation if they have alternative healthcare coverage.

Section 6: Encouragement of Community-Oriented Models

  1. Existing healthcare sharing ministries (e.g., Medishare, Christian Care) will be recognized as models for fostering ethical, member-driven operations.
  2. Partnerships may be established to integrate best practices into the PCIM framework.

Section 7: Accountability and Legal Remedies

  1. Consumers will retain the right to appeal denied claims to an independent review board.
  2. Class-action lawsuits may be filed against any remaining private insurers engaging in predatory practices.

Section 8: Implementation Timeline

  1. The TOA will be established within 90 days of enactment.
  2. Transitions of qualifying private insurers must begin within one year and be completed within three years.
  3. Full operational readiness of PCIMs nationwide will occur within five years.

Section 9: Funding and Budget

  1. A federal healthcare equity fund will finance the initial phases, supported by progressive income taxes and penalties on insurers for violations of this Act.
  2. Long-term funding will be sustained through membership contributions and reinvested savings.

Section 10: Sunset Clause

  1. This Act will be reviewed by Congress every 10 years to ensure continued relevance and effectiveness.

Conclusion:
This bill provides a roadmap for dismantling exploitative private insurance practices while establishing a fair, transparent, and publicly accountable healthcare insurance system. By drawing inspiration from successful community models, it ensures that healthcare remains a fundamental right rather than a commodity.