Health Care Reform and the Ombudsman Role

9 September 2009

OO has been following the progress on health care reform all summer.  Nope, you won’t find me in the chaos of a town hall meeting, but you will find me reading Senator Max Baucus’ “Gang of Six” proposed framework as it changes and progresses into something worth serious consideration.

Quoting from the framework PDF: “In 2010, states would be required to establish an ombudsman office to act as a consumer advocate for those with private coverage in the individual and small group markets.  Policyholders whose health insurers have rejected claims and who have exhausted internal appeals would be able to access the ombudsman office for assistance.”

Most likely this would be an expansion of the existing National Long Term Care Ombudsman Program administered state by state and supported with federal funding.

A major problem with the proposal as it exists today are the fines and penalties to American’s who exercise their “freedom of choice” not to participate in a health care insurance program.  I’ve emailed my view on this to Washington advocating instead a “pay as you use” feature instead of fines, taxes or penalties; and this would be linked to computer systems and auditing in the framework linked to W-2 or SSN for tracking.

Let’s see what happens as America may finally catch up to the rest of the world and have coverage for all Americans finally.