Posted on 05/07/2017 1:33:44 PM PDT by taildragger
Posted by May 6, 2017 Action, Protecting America - Protecting our Freedom, Something YOU can do
Let me begin this post by saying I am a licensed Independent health insurance broker with 10 years of experience mostly in the Medicare, Group & Individual insurance markets. I represent my CLIENTS and myself, not one particular company or lobbying organization. My goal is to have happy customers and to be able to make a living with products that are valuable and affordable to people so they will want them.
The House GOP congress recently passed a bill to repeal and replace Obamacare this past week. It is called the AHCA or “American Health Care Act”. Partisan politics has once again reared its ugly head and the Democrats are using scare tactics and outright lies (much like they did to pass Obamacare) to try and dissuade people from supporting this bill. Much has been made about “Pre-Existing Conditions” and how this bill would supposedly not protect those consumers. This is an outright LIE. I will explain what Pre Existing condition really means, who it applies to and what options are available pre Obamacare, during Obamacare and if this bill passes the senate, post Obamacare under this new bill.
What are “Pre Existing Conditions” and who does this apply to?
The Democrats with their overtly theatrical rhetoric would have you think that Pre Existing Conditions applies to everyone with a hangnail and that those mean Republicans will have every person in the country re-evaluated for hangnails and thrown off their current insurance plan if a hangnail is found. This is of course not true.
First of all, Pre-Existing conditions don’t even apply to about 85% of consumers. If you are one of the following, then the new law will NOT affect you AT ALL:
Thats the majority of people in the country. So the majority of people in the country will NOT be affected by the Repeal & Replace of Obamacare’s Pre Existing Conditions law.
So that begs the question. Who will be affected by these changes and how?
People who will be affected by the Pre Existing Conditions changes
The people that will be affected by these changes are people who:
This would be people who are under 65, not veterans and not disabled and they allow their current insurance to expire and then do not get new coverage within 63 days.
What happens to these people if they allow their insurance to expire and don’t new coverage in 63 days?
So whats next for these people? Do they get sent to Mars? Do we let them die in the streets? Of course not.
These people will be eligible for High Risk Pool Insurance through their state, backed the federal government. If they wait more than 63 days to get coverage and are denied new coverage due to a Pre existing condition they will get a letter telling them how to apply for the high risk pool plan to get guaranteed insurance. So alas, they will NOT be left out in the cold to die like the Democrats would like you to believe. Will they pay more for this coverage had they not waited? They might, depending on their states rules. Some states have subsidies based upon income to help people afford the high risk pool plan premiums. They might also have broader access to doctors and hospitals then if they were stuck in their old HMO so there could be a silver lining there as well. High risk pool plans were largely successful Pre Obamacare. The problem was there were only 33 states that offered them so 17 states did not have this option before. All 50 states will have this option under the Republican plan.
What is a Pre Existing Condition?
So what is a Pre Existing condition anyways? Its definitely not a hang nail. Its not even high cholesterol. The only Pre existing conditions underwriters take into account when deciding the issue coverage or not are conditions like Diabetes or Cancer for example. Some companies will insure conditions like Epilepsy, others won’t. Some companies will issue a policy covering everything except the Pre existing condition or some companies may have a waiting period for the Pre existing condition to be covered. In any case, there will always be the high risk pool plan options if people get denied. Nobody will ever be left in the cold. Also its important to remember that people with Diabetes and Cancer and other serious conditions cannot be denied coverage if they already have insurance. They cannot be kicked off their current plans and they cannot be denied by an insurance company if they do not allow their current plan to lapse more than 63 days without a new plan. Also remember this NEVER applies to folks on Medicare, Medicaid or Tri Care or with VA benefits or anyone obtaining insurance through their employer. Pre Existing conditions never apply to those people.
What other changes are in this law? Will it help or hurt anyone?
Now that we have covered Pre Existing Conditions, what else is in this bill and how will it affect people?
Conclusion
In conclusion this bill stops robbing Peter to pay Paul. It is much more fair in its pricing laws and it ensures every American has access to health insurance without a heavy emphasis on redistributing wealth and rewarding bad behavior. This bill rewards responsible behavior while still protecting our most vulnerable.
How about an overview on how the Seniors are going be the pot of gold that will pay for this plan or am I wrong here?
Define Seniors, those still in the work force under group plans or self employed purchasing insurance or Retired on Medicare which gets the $700 billion back Obama stole?
Retired with SS and still under the Company health plan.
What is a Senior in your view?
They way I see it and easy to see and has been, no affect.
Basically your insurance coverage ends every year.
Under Obamacare your plan may not be offered the following year and or your insurance carrier may not be offering any plans in your area the following year.
So, when your existing coverage ends (as it does every year), a new plan and/or company may be compelled to take you on board regardless of pre-existing conditions, but they may charge much higher premiums.
This is as it was before Obamacare as well. Insurance companies changed their plan offerings from year to year ... and sometimes left a market altogether, leaving people (or their employer) to find a new carrier with similar plans and similar prices. Sometimes the changes were small but other times they were profoundly different in coverage and/or price.
I did not see this addressed in the article.
posted link not working.
maybe cached link will work for a while:
The article seems to imply that preexisting conditions are due to careless behavior. In many cases, preexisting conditions are just a bad genetic draw and the victim could have done nothing to prevent it. How many people are going to be shuffled off into these high-risk insurance pools with unaffordable premiums so that a bunch of people can save a few bucks a month on their medical insurance? Preexisting conditions coverage was about the only good thing of Obamacare. Don’t throw the baby out with the bathwater.
Yes, I got some message that makes me think it is being read / re-posted so much they don’t have the bandwidth for all the demand at the moment...
Is this a seperate retiree group plan or is it identical to current employees? My guess is your Group Plan will start to see the freemarket reforms that will potentially lower the rate of cost increases for starters. Do they offer more plans that do not have all the obamacare "Qualified Plan" bells and whistles? Perhaps, depending on when the bill passes, your enrollment period, and how soon new policy types can be drafted by the insurers. Team Trump is also noting lower cost, does that mean your policy prices go down? One can hope, again, we are reverting back if you will to policies not much different than before Obama screwed them up. I don't have an answer to the expansion of Direct Primary Care to other than group plans as a tax free event with HSA dollars, that is a must IMHO. I have a message out to someone who might know I'll try to update you when I find out...
What services did taking away Medicare dollars do to seniors and what will putting dollars back do pursuant to law?
I have heard others talk about this, (Congressman) and I get the impression you'd pay your normal policy cost they can't deny that, but above and beyond Pre-Existing is where the High Risk Pool kicks in. I don't know what the $ cut off levels are, but their are large numbers being floated to help those effected pay or in some cases maybe help for all of it. A lot of moving parts of this, I am waiting for a really good synopsis and or wonk like Betsy McCaughey really get into how this works, especially the roll over to the State Level.
At some point, my guess is the states compare their ideas and pretty much mimic best practices other than what might fit their states more specific needs.
I don't know the services specifically, but many have pontificated that Ezekiel Emanuell's whole life systems was being implemented and Seniors were effected and not in a good way. 700 billion is a lot services, to be "nudging" the system not to spend on real people.
Medicare kicks in at 65, so there aren’t many “seniors” to pay anything but the Medicare costs, which, by the way are rising every year.
However, there is no such thing as a free lunch.People over 65 use the healthcare system more than any other group, so they will have to pay more as their costs mount. A healthy 25 year old should pay cheap premiums because they don’t have many visits to the doctor every year. Hopefully, younger people today will not smoke, become obese, or have other unhealthy habits that now plague our older generation.
A lot of ado about nothing at this point in time. The Senate still has to come out with their version and then on to the conference committee. I suspect more changes before there is a final bill.
If you have an IM plan already, you're all set.
If you have a group plan, you're all set.
If you have Medicaid or Medicare, you're all set.
If you have a hangnail, psoriasis, shingles or are overweight, you're probably all set.
If you haven't had insurance, or never had insurance, can't join a group and have a terminal or very expensive condition like hemophilia, cancer, AIDs, are a brittle diabetic, and finally decided to apply for insurance....you're probably going into a high risk pool.
How many people are going to be shuffled off into these high-risk insurance pools
Probably about 1% of the those in the total individual market.
with unaffordable premiums
So who told you they would be unaffordable premiums....and why shouldn't you pay more....it's not insurance, and you're going to be making $100,000 plus claims every year. To qualify for health insurance, you have to have good health to insure in the first place.
so that a bunch of people can save a few bucks a month on their medical insurance?
That "bunch of people"... hundreds of millions, most of the market (healthy insurable people) may well see their premiums cut by 50 to 70%.
Preexisting conditions coverage was about the only good thing of Obamacare.
Covering preexisting conditions is no longer insurance. Insurance covers unknown future risk.
(Hello, I just wrecked my car and my house is on fire...I'd like you to insure them)
“Yes, I got some message that makes me think it is being read / re-posted so much they don’t have the bandwidth for all the demand at the moment...”
that’s what it looked like to me, too.
Points well made. I am waiting for the liberals to demand that they can sign up for auto insurance after they wreck their car.
It will happen.
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