Posted on 08/20/2010 9:20:43 PM PDT by Libloather
Well, you know the particular case, I’m limited to the information in your post which appeared to say that they weren’t going to be able to OBTAIN insurance when COBRA ran out, as opposed to not being able to AFFORD insurance. They are, after all, able to pay for their COBRA coverage.
Not being able to obtain insurance after COBRA runs out, because of pre-existing conditions, is the more common situation, and there’s no reason for anyone in that situation to end up uninsured if their friends steer them the right way.
The HIPAA program requires every company in the state that writes personal coverage to offer coverage to those who exhaust their COBRA. Generally, they offer their two most popular policies, including one HMO. So, we’re not necessarily talking about a high deductable. Those on COBRA are generally already paying the entire cost of the coverage plus a few percent in administration charges. My HIPAA coverage was about twenty percent more than my COBRA cost because I stayed in the PPO. The HIPAA coverage started the day COBRA ran out. No six month wait to get in a high risk pool.
Again, though, the timing is critical.
There’s a little bit of history here:
This program is Obamacare’s effort to standardize state high risk pools. Those pools covered individuals who had no insurance and whose health status was such that no insurance company would write coverage for them. These individuals were generally on MedicAid, or spending their own resources for care (which in many cases means they’ll eventually be on MedicAid).
Because these folks are, or soon will be, filing claims far in excess of the premiums they pay, they’re guaranteed money losers for insurance companies who avoid them like the plague. So the states got into the middle of this and decided to help underwrite the loss so that these folks could have some coverage. They don’t have unlimited resources, so they structured the programs to reduce the big hit from those who didn’t buy insurance, then ran to the pool as soon as they got sick. Without some kind of front end delay, they’d have been inviting people to game the system.
I agree that there’ll be some folks who won’t get care, can’t qualify for the public programs, and won’t spend their own money for their health care. They’re very much in the minority, though. The more common story is those who go broke while they’re waiting for the pool eligibility to kick in.
This is an interim situation. When OCare is fully operational, the folks who would have been in the pools will be mandated to get insurance, and the pools will disappear. At that point we go to “community rating” which, essentially, means you’ll be paying for them in higher premiums.
Unless... somehow... the country comes to its senses and gives this thing the death it deserves.
Ping
Well you can certainly raise it in this polite company. It’s the classic issue that everyone trying to find a better way deals with. The two usual proposals are empowering the consumer or putting the government in charge.
While there’s some examples like laser eye surgery and cosmetic surgery that seem to indicate that when individuals do the paying, costs stay down, that solution assumes an informed consumer base that, in reality, doesn’t exist.
The alternate approach is government studies, edicts, etc. The individuals who make those decisions are more likely to have political or financial motives that may not coincide with the desires of the average patient, though. A correlary to the “edict from on high” approach is something like “results based medicine” in the form of a series of rules based on research in our educational institutions.
It’s a really interesting issue to me, but after about ten years of study, I have more questions than answers. I do have an ideal, though, which involves a large patient base that cares enough about its own health that it gets agressively involved in issues about costs. Sadly, I think that’s mostly a dream.
For later
There are precious few people for whom this plan actually makes sense, and those people are going to require significant medical care. Anyone with a preX that doesn’t require lots of care are much better off signing onto a group plan and waiting the year for coverage of the preX.
Yeah, the plan in question is for the state’s high risk pools, which primarily consist of those who don’t have, and can’t get, coverage because of their health status.
Incidentally, for anyone who currently has group coverage and moves to another group (primarily employment change issues), HIPAA mandates that there be no pre-existing condition exclusion. When you’ve served the waiting period once, that’s it for life if you’re aware of the law and follow its requirements. You go from employer provided group insurance, to COBRA (upon layoff), to individual coverage that the insurers are manadated to write (when COBRA is exhaused), then back to an employer policy with no P.E. exclusion when you get rehired.
Cool! The more the public understands what the actual current situation is, and the lameness of the ObamaCare “solutions”, the better the chance that they’ll vote to dump the whole thing.
And I’ve had the same frustration as you with seeing people get shafted as a result of the unwillingness of anyone in the insurance field, or employers, to tell them about their HIPAA rights. In my case, the standard application for individual coverage contained a section where you indicate that you want “shall issue” coverage if they decline the application. The insurance company declined coverage then, when I called asking where the alternate coverage was, claimed they hadn’t noticed I’d requested it and had since lost the application. Lots of games being played.
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