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Started By
Message
So everyone understands the issues with "pre-existing conditions" correct?
Posted on 5/4/17 at 8:09 pm
Posted on 5/4/17 at 8:09 pm
Quick primer ... it's pretty basic but no one ever talks about it.
The problem with pre-existing conditions is that people have learned to job the system.
My wife has been in HR for years negotiating deals with the big boys for employee subsidized coverage. She's so good at it she was actually hired, this year, by one of the big boys ... the biggest of the big boys when it comes to health insurance.
So here's what she says is the problem with pre-existing conditions.
Every since ACA (Obamacare) was passed and put into motion people quickly learned that they can go without coverage for a problem, put it off, wait until the last minute and then buy insurance and demand coverage and care after paying the first premium on the policy.
So what happens is, and evidently this is especially happening in the 50-65 low income age group ... they know they have problems after decades of bad lifestyles - they wait until the last minute, buy the policy and expect to be covered and taken care of after basically making one or two premium payments.
Some examples?
The big costly ones are joint and hip replacements. There is literally a racket going on in that classification of ailment.
There are late to the game cancer claims - and the cancer care industry is a racket unto itself. They've got it down to a science - once you have coverage they will keep you alive just long enough to drain every penny from your ACA guaranteed policy and they'll take your house, every asset you have, and even any money your kids might throw at the cancer.
She says we would be amazed at how many people file first time claims for Type II diabetes ... within 60 days of starting coverage. The average new policy holder they've seen over the past few years have had diabetes for years, have it on their record/history, but ignored it until they started going blind or their kidneys are failing or their feet are being amputated ... so they've made two premium payments totalling $1,500.00 and that was subsidized. They've got a $10k deductable on a 70/30 plan and the insurer is being forced to pay-out $100s of $1000s in claims ... it is undoable. It cannot be done.
So there is a big big problem with the pre-existing condition stuff that is always going to be unfixable unless Uncle Sugar subsidizes the insurance companies for each and every citizen being allowed into the system.
It's an impossible task. There is no solution. It cannot be done.
The problem with pre-existing conditions is that people have learned to job the system.
My wife has been in HR for years negotiating deals with the big boys for employee subsidized coverage. She's so good at it she was actually hired, this year, by one of the big boys ... the biggest of the big boys when it comes to health insurance.
So here's what she says is the problem with pre-existing conditions.
Every since ACA (Obamacare) was passed and put into motion people quickly learned that they can go without coverage for a problem, put it off, wait until the last minute and then buy insurance and demand coverage and care after paying the first premium on the policy.
So what happens is, and evidently this is especially happening in the 50-65 low income age group ... they know they have problems after decades of bad lifestyles - they wait until the last minute, buy the policy and expect to be covered and taken care of after basically making one or two premium payments.
Some examples?
The big costly ones are joint and hip replacements. There is literally a racket going on in that classification of ailment.
There are late to the game cancer claims - and the cancer care industry is a racket unto itself. They've got it down to a science - once you have coverage they will keep you alive just long enough to drain every penny from your ACA guaranteed policy and they'll take your house, every asset you have, and even any money your kids might throw at the cancer.
She says we would be amazed at how many people file first time claims for Type II diabetes ... within 60 days of starting coverage. The average new policy holder they've seen over the past few years have had diabetes for years, have it on their record/history, but ignored it until they started going blind or their kidneys are failing or their feet are being amputated ... so they've made two premium payments totalling $1,500.00 and that was subsidized. They've got a $10k deductable on a 70/30 plan and the insurer is being forced to pay-out $100s of $1000s in claims ... it is undoable. It cannot be done.
So there is a big big problem with the pre-existing condition stuff that is always going to be unfixable unless Uncle Sugar subsidizes the insurance companies for each and every citizen being allowed into the system.
It's an impossible task. There is no solution. It cannot be done.
9
Posted on 5/4/17 at 8:12 pm to scrooster
Bingo
Posted on 5/4/17 at 8:12 pm to scrooster
Lots of truth there, except the part about no solutions.
Posted on 5/4/17 at 8:16 pm to scrooster
quote:
It's an impossible task. There is no solution. It cannot be done.
There is a solution. Grandfather in all current conditions at the end of the next open enrollment. After that, if you fail to remain enrolled in a QHP or sharing ministry, you will be responsible for a 3% copay for each month you were uninsured in the previous 3 years (with the first 3 months waived).
That way, the insurance pool is protected from people trying to cheat, but responsible people who happen to have problems keep their access. Also functions as a one time amnesty.
To make insurance more affordable, repeal the marriage penalties and allow non-exchange individual plans to exclude "essential" benefits, with the policyholder specifically acknowledging each exclusion.
Posted on 5/4/17 at 8:18 pm to scrooster
True but on the flip side if there were no protection for pre-existing conditions insurance companies can use that provision to ban withhold payment for legitimate reasons.
Say you were in a car accident and had a back or hip injury in your 30s then at age 60 your hips were bad an needed replacement insurance could claim it was secondary to that previous injury and not cover it.
But overall the healthcare system is all kinds of screwed up. We need people to have skin in the game. We should be able to charge copays for all of these BS wasteful ED visits which are not emergencies
Say you were in a car accident and had a back or hip injury in your 30s then at age 60 your hips were bad an needed replacement insurance could claim it was secondary to that previous injury and not cover it.
But overall the healthcare system is all kinds of screwed up. We need people to have skin in the game. We should be able to charge copays for all of these BS wasteful ED visits which are not emergencies
This post was edited on 5/4/17 at 8:20 pm
Posted on 5/4/17 at 8:22 pm to Bestbank Tiger
quote:
There is a solution. Grandfather in all current conditions at the end of the next open enrollment. After that, if you fail to remain enrolled in a QHP or sharing ministry, you will be responsible for a 3% copay for each month you were uninsured in the previous 3 years (with the first 3 months waived).
Sounds very similar to what the Republicans just passed in the House.
Problem is it still makes economic sense to a lot of people to gamble, go without, then when they need it just pay the 3% surcharge over 3 years.
Its basically a more convoluted mandate without calling it a mandate.
This post was edited on 5/4/17 at 8:23 pm
Posted on 5/4/17 at 8:22 pm to bonhoeffer45
quote:
Lots of truth there, except the part about no solutions.
Uh, and the whole cancer conspiracy BS
This post was edited on 5/4/17 at 8:24 pm
Posted on 5/4/17 at 8:23 pm to scrooster
quote:
The problem with pre-existing conditions is that people have learned to job the system.
Always and forever, so let's stop pretending that some unicorn bill is going to fix things. We should go straight to single payer catastrophic with a total separate free market system. Also, for the free market portion - require doctors to list pricing just like pretty much everyone else that provides a service.
Posted on 5/4/17 at 8:25 pm to scrooster
quote:
So everyone understands the issues with "pre-existing conditions" correct?
what if you've had health insurance all your life...how is the "preexisting" condition handled?
Posted on 5/4/17 at 8:25 pm to rds dc
quote:
require doctors to list pricing just like pretty much everyone else that provides a service.
This would require the "free" market for health insurance to be "regulated" on a strict indemnity basis.
But single payer, private delivery, with a private supplemental industry is how a lot of countries do it.
Posted on 5/4/17 at 8:26 pm to AU_Right
It's covered.
Posted on 5/4/17 at 8:33 pm to bonhoeffer45
quote:
Problem is it still makes economic sense to a lot of people to gamble, go without, then when they need it just pay the 3% surcharge over 3 years.
3% for each month. So 33 months = 99% of what the policy would have covered falls to you. 96% the second month, 93% the third, eventually 3% and at the end of 3 years the condition stops being a PEC unless you lapse again.
Not a mandate at all, as there is no coercion.
But you also have to repeal the marriage penalty and give people the ability to opt out of EHBs. That way being uninsured is a choice, rather than being priced out by bad government policies.
Posted on 5/4/17 at 8:39 pm to CrimsonTideMD
quote:
Uh, and the whole cancer conspiracy BS
Ummmm, except my first wife is a Nurse Practitioner in the cancer industry and even she admits that it's a racket.
Sure, some cancers, if caught early enough, are almost curable. I've had family members have to deal wit that .... colon, breast, prostate, skin, etc. Catch it early enough and you've got a chance. Pancreas, brain and some of those ... you're done.
These days some of the lung cancers so they can beat if caught early enough. The small cell, what they used to call oat cell, you're done ... they can only extend your life and not by much.
But they have it down to a science and the ex swears she's starting to have real guilt issues with how the cancer industry works these days. They literally are built around the model to give a patient hope, extend lives until all resources are exhausted, and then they pull the plug so to speak ... tell you there is nothing else they can do.
Now she is a chemo NP so she's not necessarily involved with the experimental clinics that you see so many commercials for.
But when you visit one of those the first thing they want is big money up front and promisaries on your assets. The question is, how long do you want to hang on? How much debt do you want to saddle your loved ones with to try to slow down the inevitable.
And the problem is, if you don't ... there are very few legal painless ways to check out of your own free will.
The cancer lobby is incredibly strong at preventing legal assisted suicide.
Posted on 5/4/17 at 8:40 pm to Bestbank Tiger
You understand this is through reconciliation and is not (despite what you're being fed) repeal and replace. There are limits on what can be done and when the pendulum swings it will go back to Obamacare.
It's all a shite show and the only winners will be the insurance companies. And congress of course, who are exempt anyway
It's all a shite show and the only winners will be the insurance companies. And congress of course, who are exempt anyway
Posted on 5/4/17 at 8:41 pm to Bestbank Tiger
quote:
Not a mandate at all, as there is no coercion.
It is a carrot and stick arrangement to get people to buy insurance. Which is what the mandate seeks to accomplish.
If you do not have continuous coverage we will mandate that insurers charge you more money if you ever do want it.
The goal of which is to make the harm great enough that it convinces people to buy and carry insurance not just when they get really sick. The same purpose of a direct mandate and penalty.
And to be clear, I am not against this iteration altogether once you get the level of stick needed right. It is just a less efficient way to do it then a straight mandate. You could force the same behavior by just upping the penalty a lot and doing the rest of what you said.
Though I do think you vastly over-estimate what those tax changes and reducing benefits would do to help people afford insurance. Setting aside whether that is the right way to go over alternatives?
This post was edited on 5/4/17 at 8:43 pm
Posted on 5/4/17 at 8:48 pm to roadGator
quote:
It's covered.
Exactly.
Posted on 5/4/17 at 9:01 pm to AU_Right
quote:
what if you've had health insurance all your life...how is the "preexisting" condition handled?
You're covered ... and that provision was needed because asshat Insurance providers did, for years, play loose with the rules when people were forced to switch providers for whatever reason.
And THAT is how this all should have been handled. If you've been paying, and for whatever reason you are forced to change providers, pre-existing conditions should be covered. Insurance companies asked for a lot of this grief themselves ... but it's the tactics listed in my OP that are causing everything to fail.
Man, I heard this story today about a woman and her daughter, 14 years difference in age, who defrauded the provider, through the ACA, by using one policy for both their coverages and when finally busted instead of paying a price the Obama administration stepped-in and strong arming the provider .... it's a long story, I gotta be careful but it's just unreal how the system is being jobbed and taken by the same people who have been shaming the social welfare system for decades.
Posted on 5/4/17 at 9:07 pm to bonhoeffer45
quote:
Lots of truth there, except the part about no solutions.
you mean to cover everybody?
the only solution is to either "pony up" & just call it what it is - welfare
or, to not pay for it and some people lose "free" coverage
but why should people who are buying insurance be priced into oblivion?
Posted on 5/4/17 at 9:07 pm to bonhoeffer45
quote:
If you do not have continuous coverage we will mandate that insurers charge you more money if you ever do want it.
Not mandate, just allow.
The insurers would be fools to not avail themselves of it, but they could reduce the amount or the time period or just let people sign up.
quote:
Though I do think you vastly over-estimate what those tax changes and reducing benefits would do to help people afford insurance. Setting aside whether that is the right way to go over alternatives?
Letting people opt out of EHB requirements would mean the old plans are legal again. I had a $100/no plan that excluded contraception. I liked it because it was affordable, had a good provider network, and covered 100% after I hit my deductible. Humana liked it because I paid into the system every month and never took anything out. ACA compliant plans are more expensive with less coverage. The people who had the old plans chose them because they were a better deal.
There's also the broader effect - by forcing people with the old plans out of the insurance market, you have less ability to spread the risk. Get that money back into the pool and you'll have more consumer choice, fewer uninsured, and lower premiums.
If you look at insurance broker data, you'll see that the real explosion in premiums didn't coincide with guaranteed issue and community rating, but with EHBs forcing affordable insurance plans off the market. (The same thing appears with sharing ministries, which have guaranteed issue and community rating but not EHBs, and are much more affordable.)
Posted on 5/4/17 at 9:07 pm to scrooster
quote:
Man, I heard this story today about a woman and her daughter, 14 years difference in age, who defrauded the provider, through the ACA, by using one policy for both their coverages and when finally busted instead of paying a price the Obama administration stepped-in and strong arming the provider
This doesn't even make sense really.
How were they defrauding people this way?
And you do realize that for a lot of people, the reason they don't have insurance is because they can't afford it right? The subsidies were not well aligned and the mandate not that punitive.
For other people, they are being irresponsible, I agree with that. But they are doing it because the incentivizes are such that it makes economic sense to them.
Pay a $750 penalty(or none this year since Trump de-enforced it) or buy a $250+ a month policy with $8000 deductibles. $750 or $3000.... It is a no brainer.
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