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.
The changes would affect people who “...allow their current insurance to expire and do not secure new coverage within 63 days...”
People who had coverage thru thair employer, who then lose their job, will have a couple months to get new insurance, either individual or through a new employer.
Agree. They are taking services away from seniors already including effective drugs. On doc gave me cheapest injection for macular. New doc, with heart, gave me one that cost him 400% more, seems to work better and ate the difference.
It brings me to tears just to write about it.
Actually, before Obamacare, celiac disease (the gluten problem) was a routine basis for exclusion.
Healthy people are falsely called “high risk” pool.
Lies.
This was already the law, this was before Obamacare, so what did Obamacare bring to the table? That you could avoid buying health coverage until you got sick? I bought 3 months of very expensive COBRA coverage so there would be no gap in my coverage when my circumstances changed.
So they are going back to the old PCIP plans. AZ had that, and I was trying to get into it until Obastardcare caused them to scrap the plans.
Now for you on here claiming that it is a scam. I was without insurance, I was DENIED health insurance through a common provider because of my condition. Out and out denied because of my health-and NONE of it was because of life style. I have heart problems as a result of lung problems I have had since 3 years old. Also back problems which no longer bother me. So I went to the PCIP plans since that was the way you were to do it. Then came Obastardcare.
Now, since the wife and I are in the grey area of the income level, we could not afford Obastardcare and have been without any since the POS was passed. My premiums under Obastardcare would are 1070 per month for just myself. And with a income of just over 40 grand a year..to hell with it.
When I was about to sign up for the PCIP plan, I had the quote of 134 bucks per month for a 1400 dollar deductable up to 15 grand and 100% after that. It would have been a good plan but like I said.
I got one year to go for medicare. To hell with all of it now since I havent got that much time and will get on medicare and get a supplement along with that.
Very succinct.
I've been paying home insurance premiums ever since I bought my first house (30 years ago) and have yet to file a home insurance claim of any type. I've been paying auto insurance even longer than that and while I've had a fender bender or two, the claims don't even come close to the premiums I've paid during all those years.
But I'm not crabbing or bitching about the fact that my premiums have gone to pay for other people's claims (or insurance company profits). I'm not looking for a refund for all those years I paid into the system without taking anything out.
What I did get for those premiums over the years was peace of mind that if something catastrophic did happen with my house or my car, that I would be covered. That's the essence of insurance. You purchase it in the hopes that you never have to use it. The insurance company sets the rates so that they are able to pay out claims and rightfully take in a little profit for assuming all that risk and providing that peace of mind to others.
That's the same mindset I have towards health insurance. I'm not keen on people opting out of purchasing insurance while they are young and healthy and then expecting us to suddenly let them into the insurance pool with no penalty once they get older and sick. It's the moral equivalent of waiting for your house to catch fire or for a hurricane to hit before "purchasing" insurance.
Personally, I think there should be an insurance option where you pay for your own routine medical care out of pocket and only file a claim for a major event, like a surgery, having a baby, or getting treated for a major issue like cancer or heart disease.
I don't expect my car insurance company to pay for my oil changes, tune-ups and brake jobs, etc. I don't expect my home insurance company to come paint my house, put a new roof on and whatnot.
So why is it so different with health insurance? Why must every doctor's visit for a stubbed toe, sprained ankle or case of the sniffles be covered by insurance? That is really what is driving our health care costs so high. People in the emergency room for poison ivy, bee stings and other nonsense that used to be dealt with at home with a little rubbing alcohol and soapy water.
If all the routine stuff was paid out of pocket, then two things would happen: Overall health care cost would go down for everybody and there would be much less trivial visits clogging up our system, freeing up doctors to concentrate on people with real problems.
Insuring pre existing conditions makes as much sense as buying a life insurance policy for a dead person and expecting it to pay out
Great post.
What about those who are going off their parents' insurance who have those conditions?
Probably about 1% of the those in the total individual market.
Your guess? I know at least half a dozen young people who are in this boat, including my son.
it's not insurance
That's exactly right. Medical insurance was not designed to be pure insurance. Part of its purpose is a cost-sharing arrangement where everyone pays a small surplus to cover costs of those who have catastrophic claims. It is more efficient than allowing the government to collect taxes and run a huge bureaucracy to administer treatment programs.
hundreds of millions, most of the market (healthy insurable people) may well see their premiums cut by 50 to 70%.
50 to 70 percent? Right. If we see 10% reductions in premiums, we'll be lucky.
Covering preexisting conditions is no longer insurance. Insurance covers unknown future risk.
It was never intended to be a pure insurance contract.
That "bunch of people"... hundreds of millions, most of the market (healthy insurable people) may well see their premiums cut by 50 to 70%.
Let's look at the math here. By moving 1% of the individual market into a HRP hundreds of millions -let's say 200m - will see their premiums cut by 50% to 70%.
The average premium for an individual is over $3,600 per year, so a 50% savings would be at least $1,800 x 200m people. That's $360B in annual savings.
We now allocate that expense to the 1% of individual market that has pre-existing conditions (because we've not done anything to reduce medical costs, just shifted them into a HRP). The individual market is about 10% of the population, or 32M people, and one percent of that is 320k.
So we now see that the cost savings of $360B will be shifted to the 320k HRP enrollees.
That's $1.125M per HRP enrollee per year.
How's that going to work?
Auto insurance is a good example but not for the reason that you cite. To drive, all states require the driver to carry at least liability insurance. Most states require auto insurers to insure a certain amount of high-risk drivers in order to sell insurance in the state. There is a limit to how much they can cherry-pick the best customers. Why? It was decided that for society as a whole, it is better for everyone to have to pay a little bit more for auto insurance than to have someone suffer a catastrophic loss due to an uninsured driver.
If they can work, group. They might be able to get an HSA and catastrophic care account with a pre-x exclusion clause, otherwise, HRP or MediCaid.
Medical insurance was not designed to be pure insurance.
Of course it was. The high risk pool isn't insurance.
Your guess?
No, that's the way it works out. Probably higher in your town.
Part of its purpose is a cost-sharing arrangement where everyone pays a small surplus to cover costs of those who have catastrophic claims
Yeah. That's what insurance does. For those who start off healthy.
our guess?
Why would premiums go up if claims go down. The two are directly tied together.
It was never intended to be a pure insurance contract.
Of course it was. It's just that it's been so screwed up for the last 20 years. (Ted Kennedy, Hillary Clinton) Now they're trying to get it back to where the decision making is done by the patient and the doctor.
catastrophic care. I would love that. pay cash for the rest of it.
And, since my employer pays a portion of my healthcare, can we figure out a way to put that into an HSA that I can pull from?
If, after all of these years, my employers had contributed to an HSA as much as they had to cover me for “group insurance”, I wouldn’t need insurance for the most part. Just that catastrophic cancer/massive health failure care.
It made the provisions you mentioned at the state level, federal law. Reasonable state provisions for preexisting conditions, pre-Obamacare, may not be binding on other states.
The point being that in either case - health or auto - the insurance model breaks down if people are allowed to game the system and wait until they have a catastrophe and then sign up for insurance and expect the insurance companies to pay for it. This makes everyone’s rate goes up in order to subsidize someone who refused to buy insurance.
I meant to ping you on #32 since it was your argument. Insurance has a social contract aspect that you seem to ignore.
And if your state chooses not to establish a high risk pool?
You sure about that? I lived in both states and don't remember it being that way.
According to Kaiser, pre-ACA only 5 states had guaranteed issue, and PA and TX weren't included.
There is, it's called an HSA (health savings account) It's like an IRA, tax-free, but you can use it for medical expenses (at your discretion) the accompanying policy is a catastrophic care policy (high deductible)
Why must every doctor's visit for a stubbed toe, sprained ankle or case of the sniffles be covered by insurance?
You can still tell them you will be paying cash, and you want the bill lowered accordingly. They have much less paperwork that way.
That is really what is driving our health care costs so high.
Maybe, but mostly it's other people who pay nothing and you getting gouged for it. (cost shifting) The practice should be banned completely.
People in the emergency room for poison ivy, bee stings and other nonsense that used to be dealt with at home with a little rubbing alcohol and soapy water.
Exactly!
Hopefully Tom Price will nip that in the bud, and require providers to send such foolishness to the in-house "free clinic" which costs a hell of a lot less than the ER.
If all the routine stuff was paid out of pocket, then two things would happen: Overall health care cost would go down for everybody and there would be much less trivial visits clogging up our system, freeing up doctors to concentrate on people with real problems.
I agree completely.
And most of that can be changed at both the federal and state level with new public policy guideline directives from the various departments of health and human services.
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