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.
Unfortunately, except for a few religious groups, those have been made illegal.
They are still around in many jurisdictions. People under 30 or people with a hardship exemption could buy them without getting dinged with the tax. I haven't seen anything on how catastrophic/short term coverage is treated in the new healthcare bill.
Just fine.
It didn't sustain the pools that existed before Obamacare
Of course it did.
what will change now?
Who knows, it's only the first version of the bill, just out of the House.
Please describe how a proper pool is done?
I already did, several times, go back and look.
But those that are there will cost a lot.
Yeah, I said that.
Far more than can be funded by premiums alone.
Yeah, I also said that.
I did. Couldn't find it.
It would appear that your idea of the high-risk pools are as unclear as Congress'.
Insurance rates went up ~50% for 2017 in downstate Illinois. What happened in 2015 - 2016 to justify this increase if it wasn't pre-existing conditions? Chicago gunshot victims? The state not paying the expanded medicaid bills?
No.
First, an insurance broker represents the buyer, NOT "a product" He's an independent agent.
tossing anyone with a pre-existing condition out of the so-called "healthy" pools
Nobody gets "tossed out" unless they stop paying premiums.
Here's what they all tell me: Pre-Existing conditions aren't an issue for BC/BS.
That's part of the propaganda, conflating and equating "preexisting conditions with uninsurable"
Let's assume that the "4% of American's have pre-existing conditions" argument is true.
It's probably more than that, but they're otherwise insurable.
That means 96% of American's covered by private insurance are "suffering" some form of financial penalty for those that have a pre-existing condition today....Also not true.
No, but in a GI state, 99% of them are suffering jacked up premiums due to covering the "uninsurables". (those with guaranteed $100,000+ annual claims)
According to the folks I talk to who do the accounting for and manage healthcare plans pre-existing conditions affect premiums for everyone else by pennies to a few bucks per month per policy holder.
Probably true, but the 1% of "uninsurables" rack up about 50% of the claims...never mind the mere "preexisting conditions". Once again, interchanging the two terms.
You cover the pre-x with a pre-x exclusion policy provision, for a period and otherwise write the client for all other coverages...unless they're truly "uninsurable".
What really affects the cost of health care? Uninsured. No surprise. Those who have no coverage and show up in emergency rooms - the most expensive place to receive health care.
"Free healthcare" This isn't an insurance issue, it's a provider issue. "Cost shifting" is a practice that needs to be banned. Hopefully Dr Price will effect the ban through either rulemaking or legislation.
Government regulation. Again, no surprise.
Socialist practices creeping into public policy have long since damaged or destroyed "free markets" like ObamaCare, HillaryCare, and KennedyCare. Until the ACA, some states survived and were allowed to actually sell real insurance, with full underwriting and no restrictions. Those states had the best coverage and lowest premiums.
Defensive medicine. Really? Who'd have thunk it! Doctors who have to order every test under the sun to avoid a lawsuit.
Litigation...Malpractice Insurance
All under the same heading...."Tort reform"...True, it needs to happen, but it's not an insurance structure issue.
Are the "chronically ill" or those with pre-existing conditions really the ones driving up the premiums for the "healthy" folks?
Probably not much, depends on the nature of the pre-x. But then again, do bad drivers ramp up your car insurance....Hell Yeah!
you're being led to believe are there when everyone who has a pre-existing condition is kicked out of your insurance pool
NOBODY GETS KICKED OUT OF A POOL!
The HRP is only for very ill new-applicant "uninsurables" who are dying, or have very expensive conditions...and finally decided to get insurance, and who will have annual claims in the $100,000 plus range.
I have just three words for ya: Told ya so.
And I have just three words for you:
It worked before.
(that's how insurance works)
MS and NH...etc.
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I presume you're talking about high risk pools unless you changed what you were talking about mid-stream?
High risk pools have been tried in 5 or so states. In each state, the high risk pools went belly up. Why? because the premiums were so high that they were unaffordable.
With everything else that our Government throws money at like, oh say EDUCATION the lesson we've learned is that the more Government subsidizes something, the more it COSTS.
Eight billion dollars of subsidies spread out across fifty states is a pittance. Having said that, all it will do is drive the cost of the high risk pools UP HIGHER. Insurance companies like State Universities for example, will simply hoover up the "free money" and then take as much as they can get from those with pre-existing conditions --- assuming they get very many to sign up in the first place.
My preference is simple: Get Government OUT of the healthcare business, period. Make Healthcare insurers compete for business at a pure capitalistic level and this problem solves itself.
Capitalism's a beautiful thing that way. It solves every problem it takes on unimpeded by excessive government interference and regulation. Works every time it's tried too.
Five!??? Get real!
There were HRPs in 35 states. Want me to name them:
Alabama, Kentucky, Oklahoma, Alaska, Louisiana, Oregon, Arkansas, Maryland, South Carolina, California, Minnesota, South Dakota, Colorado, Mississippi, Tennessee, Connecticut, Missouri, Texas, Florida, Montana, Utah, Idaho, Nebraska, Washington, Illinois, New Hampshire, West Virginia, Indiana, New Mexico, Wisconsin, Iowa, North Carolina, Wyoming, Kansas, North Dakota
In other words, a majority of the states had one. Every HRP was created by its state legislature, and as a result was unique, unless copied from another state. Some states did a great job, some had lots of internal opposition and subsequently, their compromised efforts failed.
Why? because the premiums were so high that they were unaffordable.
Most had premiums of 150 to 200% above standard healthy rates, but after all, the patients were likely to have claims of $100,000 per year. those premiums are a drop in the bucket compared to the claims benefits they would receive.
Medical HRPs have been around for decades, way before Kennedy or Hillary came on the scene, and they did everything they could to destroy them. HRPs are also used in P&C lines.
Eight billion dollars of subsidies spread out across fifty states is a pittance
Actually the latest crop of HRP was federally funded with a million dollar grant per state as seed money.
My preference is simple: Get Government OUT of the healthcare business, period. Make Healthcare insurers compete for business at a pure capitalistic level and this problem solves itself.
Actually the HRPs are supposed to be a private sector entity, supported by all the carriers. It is a free market approach to allow the insurers to accurately assess risk.
Would Kennedy/Kassebaum cover those aging off their parent’s plan? They’re coming off group coverage and have prior credible coverage.
I don’t know that yet.
That is a good question for either an insurance broker, or better yet the office of the Superintendent of the Department of Insurance in your state.
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