Pre-Existing Conditions

GURPS · May 5, 2017

The Phrase ‘Pre-Existing Conditions’ Leads to the Suspension of All Thought

The moderates are abandoning the health-care bill largely because it makes it possible for states to get a waiver from the pre-existing condition regulation in Obamacare. This is being distorted as an abolition of that regulation, with the moderates either contributing to the misunderstanding or being carried along by it. Ramesh ably explained the other day why this isn’t true. But apparently all you have to do to win the debate over Obamacare repeal is say “pre-existing condition,” regardless of whether you have any idea what you are talking about. I don’t think anyone wants to go back to the pre-Obamacare status quo on this issue, but Avik Roy had a good piece at Forbes on how this problem was exaggerated during the original Obamacare debate:

First: prior to Obamacare, the vast majority of Americans with health insurance were already in plans that were required to offer them coverage regardless of pre-existing conditions.

Employer-based plans were required to offer coverage to everyone regardless of pre-existing conditions. So were Medicare, Medicaid, and other government programs like the VA. Employer- and government-based plans, prior to Obamacare, represented 90 percent of Americans with health insurance. The other 10 percent were people buying coverage on their own, on the individual market. In most — but not all — states prior to Obamacare, people buying coverage on their own could, in theory, be denied coverage for a pre-existing condition.

Forbes Piece .....

Thanks To Democrats, Pre-Existing Conditions Outweigh The Uninsured In The GOP Obamacare Deal

Larry Gude · May 5, 2017

The GOP was handed power back in 2010 and then given more in '14 and now '16 for ONE reason; repeal the ACA. Not pass the buck to the sates.

awpitt · May 8, 2017

GURPS said:
The Phrase ‘Pre-Existing Conditions’ Leads to the Suspension of All Thought

The moderates are abandoning the health-care bill largely because it makes it possible for states to get a waiver from the pre-existing condition regulation in Obamacare. This is being distorted as an abolition of that regulation, with the moderates either contributing to the misunderstanding or being carried along by it. Ramesh ably explained the other day why this isn’t true. But apparently all you have to do to win the debate over Obamacare repeal is say “pre-existing condition,” regardless of whether you have any idea what you are talking about. I don’t think anyone wants to go back to the pre-Obamacare status quo on this issue, but Avik Roy had a good piece at Forbes on how this problem was exaggerated during the original Obamacare debate:

First: prior to Obamacare, the vast majority of Americans with health insurance were already in plans that were required to offer them coverage regardless of pre-existing conditions.

Employer-based plans were required to offer coverage to everyone regardless of pre-existing conditions. So were Medicare, Medicaid, and other government programs like the VA. Employer- and government-based plans, prior to Obamacare, represented 90 percent of Americans with health insurance. The other 10 percent were people buying coverage on their own, on the individual market. In most — but not all — states prior to Obamacare, people buying coverage on their own could, in theory, be denied coverage for a pre-existing condition.

Forbes Piece .....

Thanks To Democrats, Pre-Existing Conditions Outweigh The Uninsured In The GOP Obamacare Deal

That's not entirely true about employer based plans, prior to Obamacare. Many plans required that if someone new is hired and didn't have insurance within a specified previous period of time, they would be subject to a waiting period (90 days, 6 months, a year, it varied) before the new insurance would become effective. The article, you cite, fails to mention that the GOP House bill wants anyone who has an insurance gap of 63 days or more with and/or who has pre-existing conditions, will be thrown into "high risk pools" and subject to higher premiums thus putting insurance out of reach for them.

GURPS · May 8, 2017

awpitt said:
.... will be thrown into "high risk pools" and subject to higher premiums thus putting insurance out of reach for them.

PPACA had its own high risk pool separating 'preexisting conditions from everyone else ... ONLY 115,000 people signed up for that

kwillia · May 8, 2017

awpitt said:
That's not entirely true about employer based plans, prior to Obamacare. Many plans required that if someone new is hired and didn't have insurance within a specified previous period of time, they would be subject to a waiting period (90 days, 6 months, a year, it varied) before the new insurance would become effective. The article, you cite, fails to mention that the GOP House bill wants anyone who has an insurance gap of 63 days or more with and/or who has pre-existing conditions, will be thrown into "high risk pools" and subject to higher premiums thus putting insurance out of reach for them.

I know this for a fact when I watched my mom try to find insurance coverage at the age of 63. She was a very healthy 63 year old but because she had previously documented issues here and there that were dealt with in her life time, none of it chronic, that was all used to justify a higher cost in premiums. Just because insurance companies have to offer you insurance does not mean you can afford what they offer.

Larry Gude · May 8, 2017

kwillia said:
I know this for a fact when I watched my mom try to find insurance coverage at the age of 63. She was a very healthy 63 year old but because she had previously documented issues here and there that were dealt with in her life time, none of it chronic, that was all used to justify a higher cost in premiums. Just because insurance companies have to offer you insurance does not mean you can afford what they offer.

That's right. And that's why there is so much sympathy for someone doing something about health care. The companies aren't far sighted enough to have managed this themselves and, ultimately, all the parties, docs and nurses, insurers, hospitals, politicians and patients far prefer 'the gummint' telling people what to do rather than being the one that gives on blind faith good intentions will be met with good intentions.

PsyOps · May 8, 2017

Larry Gude said:
The GOP was handed power back in 2010 and then given more in '14 and now '16 for ONE reason; repeal the ACA. Not pass the buck to the sates.

Isn't that what the constitution demands; for the states to take these issues on? If the federal government repeals the ACA on the federal level, it is repealed. The fed doesn't have the authority to tell the states they can't have their version of Obamacare.

Larry Gude · May 8, 2017

PsyOps said:
Isn't that what the constitution demands; for the states to take these issues on? If the federal government repeals the ACA on the federal level, it is repealed. The fed doesn't have the authority to tell the states they can't have their version of Obamacare.

Dude, that's ALL the GOP had to do since 2010; just repeal it. That's it.

They have not, and will not, because major constituents in the industry love the ACA. It is Too Big To Fail on a silver platter.

PsyOps · May 8, 2017

Larry Gude said:
Dude, that's ALL the GOP had to do since 2010; just repeal it. That's it.

They have not, and will not, because major constituents in the industry love the ACA. It is Too Big To Fail on a silver platter.

I absolutely agree with you on this.

Bann · May 8, 2017

Why is it a problem to require people to KEEP their coverage i.e., stay covered (as in, disenroll from 1 plan WHEN you already have new coverage)or be subject to having to be in the high risk pool,.etc. When you have the insurance already...go find a plan to cover yourself. It's the same as car insurance or homeowners - when you make a lot of claims - you pay higher premiums. Your pre-existing conditions (multiple homeowner and auto insurance claims and/or horrible driving record) will yield you higher premiums.

If I were to quit my current job, I have something like 30-60 days before I would lose my employer offered (group) health insurance. By law, my employer is required to notify me and they will give me an option to purchase COBRA insurance (which IS already very high) OR I can go purchase my own. BEFORE the deadline ...

What is wrong with that?

Hijinx · May 8, 2017

kwillia said:
I know this for a fact when I watched my mom try to find insurance coverage at the age of 63. She was a very healthy 63 year old but because she had previously documented issues here and there that were dealt with in her life time, none of it chronic, that was all used to justify a higher cost in premiums. Just because insurance companies have to offer you insurance does not mean you can afford what they offer.

I have much sympathy for people with pre-existing condition and feel bad about them having to pay for a higher cost policy.
A policy that they sometimes cannot afford.
But does it make sense to help the people with pre-existing conditions by forcing others into a higher cost premium and deductibles ,that thousands of others cannot afford? Are we creating more problems than we are solving?

Are the people with pre-existing conditions the real reason the cost of Obamacare has gone out of sight?
Have we taken on too many people who don't pay anything?
Is it right to force me and others to pay for someone else's insurance?

The Government forces me to pay for Housing, HUD,they force me to pay for food stamps so these people can eat. they force me to give them a stipend and a telephone, in some cases this award comes from cradle to grave, with the receiver giving nothing back to society other than breeding more people who have the same intent.

kwillia · May 8, 2017

Bann said:
Why is it a problem to require people to KEEP their coverage i.e., stay covered (as in, disenroll from 1 plan WHEN you already have new coverage)or be subject to having to be in the high risk pool,.etc. When you have the insurance already...go find a plan to cover yourself. It's the same as car insurance or homeowners - when you make a lot of claims - you pay higher premiums. Your pre-existing conditions (multiple homeowner and auto insurance claims and/or horrible driving record) will yield you higher premiums.

If I were to quit my current job, I have something like 30-60 days before I would lose my employer offered (group) health insurance. By law, my employer is required to notify me and they will give me an option to purchase COBRA insurance (which IS already very high) OR I can go purchase my own. BEFORE the deadline ...

What is wrong with that?

It is typically not affordable. My mom carried the health insurance for her and my dad. She had her insurance through group insurance provided by her employer. When the employer lost several contracts and had to downsize she was one of the employees let go. My siblings and I had to pitch in to help pay for her insurance via COBRA because the monthly cost was $845. That was 14 years ago.

The equivalent of COBRA today would be well over 1K a month probably closer to 2k. Family coverage COBRA would be dramatically higher. I don't know many families with 1k disposable income a month especially when using COBRA means you've probably lost your income.

The ideal of "use it more/pay more" makes sense. The reality is that it would result in a large portion of the population unable to pay for insurance... thus the "death sentence" the dems keep referring to under the current GOP proposal.

I'm surprised at how many employed folks that get their insurance through their employer don't think about how they are just one medical event from being unemployed which means immediately losing their medical insurance when they need it most.

kwillia · May 8, 2017

Hijinx said:
I have much sympathy for people with pre-existing condition and feel bad about them having to pay for a higher cost policy.
A policy that they sometimes cannot afford.
But does it make sense to help the people with pre-existing conditions by forcing others into a higher cost premium and deductibles ,that thousands of others cannot afford? Are we creating more problems than we are solving?

Are the people with pre-existing conditions the real reason the cost of Obamacare has gone out of sight?
Have we taken on too many people who don't pay anything?
Is it right to force me and others to pay for someone else's insurance?

The Government forces me to pay for Housing, HUD,they force me to pay for food stamps so these people can eat. they force me to give them a stipend and a telephone, in some cases this award comes from cradle to grave, with the receiver giving nothing back to society other than breeding more people who have the same intent.

Serious question... aren't you and I just one medical event from being in that boat you are describing? I have no pre-existing conditions at all. But the moment I get diagnosed with any form of cancer (skin, breast, colon, etc), an injury with chronic results (caused by car accident, twisted ankle, pulled back, hip, knee, etc) I will forever be expected to pay more just in case it flairs up again.

Again I will ask, what if the unexpected condition causes us to not be able to keep or job. How can we afford to pay the higher monthly coverage the higher deductibles, etc.?

And if we can't then we will go in the suffer-til-you-die boat.

That's the problem leaving many unable to sleep at night.

Bann · May 8, 2017

kwillia said:
It is typically not affordable. My mom carried the health insurance for her and my dad. She had her insurance through group insurance provided by her employer. When the employer lost several contracts and had to downsize she was one of the employees let go. My siblings and I had to pitch in to help pay for her insurance via COBRA because the monthly cost was $845. That was 14 years ago.

The equivalent of COBRA today would be well over 1K a month probably closer to 2k. Family coverage COBRA would be dramatically higher. I don't know many families with 1k disposable income a month especially when using COBRA means you've probably lost your income.

The ideal of "use it more/pay more" makes sense. The reality is that it would result in a large portion of the population unable to pay for insurance... thus the "death sentence" the dems keep referring to under the current GOP proposal.

I'm surprised at how many employed folks that get their insurance through their employer don't think about how they are just one medical event from being unemployed which means immediately losing their medical insurance when they need it most.

I do know how it is. I also know how expensive COBRA is and I don't think that's the answer either. I guess I was unclear. I meant if we (people) know we have to have healthcare coverage, then we have to plan ahead so we don't have a lapse in coverage.

There are always plans available to have some kind of coverage. (Well, maybe not under that damn Obamacare) When I was a SAHM in 2004, I was insured by Tricare and then when I got divorced at age 46, I was not entitled to coverage anymore. I had 30 or 60 days to find (and pay for) my own health insurance. OR, I could have purchased COBRA. I just started working for a small business and they didn't offer group health insurance coverage as a benefit. I worked for 5 years there so I paid a LOT of money for my own individual health insurance plan. It was over $175.00 a month and when I turned 50- it jumped to over $250.00 a month. The only way I could afford to cover myself was to choose a high deductible healthcare plan. I did what I had to do in order to have some coverage. At the same time, I used money from my house sale to open and started paying into an HSA, and kept my costs down some that way. I have enough to cover my catastrophic cap now, but over the last 8 years with my employer healthcare plan - what they cover, how much, the co-pays - the deductibles, etc. all under Obamacare have all gotten way more expensive. Those are all eating away at that money.

I also understand I could have a catastrophic event and it would put me in a hardship. Right now, as it is, I have a longterm disability policy benefit thru work, along with workmen's comp AND I bought my own AFLAC accident insurance. If I am to quit my job...I would need to plan ahead and purchase my own insurance again.

I thought the whole reason for the 30 or 60 day grace period was so that people with pre-existing conditions WERE (stay)covered...unless they let all coverage lapse...then it's on them. Otherwise, people wouldn't get insurance until they got cancer, for example. Where is the incentive to get coverage unless they NEED it? No insurance company is going to accept them, how could they?

I get that costs are high, but I think letting health insurance companies compete for business across state lines is going to drive the costs way down.

philibusters · May 8, 2017

Bann said:
I do know how it is. I also know how expensive COBRA is and I don't think that's the answer either. I guess I was unclear. I meant if we (people) know we have to have healthcare coverage, then we have to plan ahead so we don't have a lapse in coverage.

There are always plans available to have some kind of coverage. (Well, maybe not under that damn Obamacare) When I was a SAHM in 2004, I was insured by Tricare and then when I got divorced at age 46, I was not entitled to coverage anymore. I had 30 or 60 days to find (and pay for) my own health insurance. OR, I could have purchased COBRA. I just started working for a small business and they didn't offer group health insurance coverage as a benefit. I worked for 5 years there so I paid a LOT of money for my own individual health insurance plan. It was over $175.00 a month and when I turned 50- it jumped to over $250.00 a month. The only way I could afford to cover myself was to choose a high deductible healthcare plan. I did what I had to do in order to have some coverage. At the same time, I used money from my house sale to open and started paying into an HSA, and kept my costs down some that way. I have enough to cover my catastrophic cap now, but over the last 8 years with my employer healthcare plan - what they cover, how much, the co-pays - the deductibles, etc. all under Obamacare have all gotten way more expensive. Those are all eating away at that money.

I also understand I could have a catastrophic event and it would put me in a hardship. Right now, as it is, I have a longterm disability policy benefit thru work, along with workmen's comp AND I bought my own AFLAC accident insurance. If I am to quit my job...I would need to plan ahead and purchase my own insurance again.

I thought the whole reason for the 30 or 60 day grace period was so that people with pre-existing conditions WERE (stay)covered...unless they let all coverage lapse...then it's on them. Otherwise, people wouldn't get insurance until they got cancer, for example. Where is the incentive to get coverage unless they NEED it? No insurance company is going to accept them, how could they?

I get that costs are high, but I think letting health insurance companies compete for business across state lines is going to drive the costs way down.

Due to Obamacare regulations (including the biggest one of making health insurance take people with pre-existing conditions, but also things like mandating a higher minimum amount of insurance, and requiring the insurance to cover certain types of care) there is no way you could find a $250 policy anymore. If you pick a cheap policy you might be able to find a policy for $400, but probably not because you are over 50 which insurance companies use as a threshold to charge more. There are actually more limits on how much extra insurance companies can charge somebody over 50 compared to the new Republican plan.

Long story short, if somebody got laid off they may have to pay $600 per month for a health insurance which they may not be able to afford. And that may not even be for great health insurance. People who live month to month are going to let their health insurance lapse if disaster strikes because they will probably pay their rent and car before their health insurance. Its an imperfect world.

Bann · May 8, 2017

philibusters said:
Due to Obamacare regulations (including the biggest one of making health insurance take people with pre-existing conditions, but also things like mandating a higher minimum amount of insurance, and requiring the insurance to cover certain types of care) there is no way you could find a $250 policy anymore. If you pick a cheap policy you might be able to find a policy for $400, but probably not because you are over 50 which insurance companies use as a threshold to charge more. There are actually more limits on how much extra insurance companies can charge somebody over 50 compared to the new Republican plan.

Long story short, if somebody got laid off they may have to pay $600 per month for a health insurance which they may not be able to afford. And that may not even be for great health insurance. People who live month to month are going to let their health insurance lapse if disaster strikes because they will probably pay their rent and car before their health insurance. Its an imperfect world.

I get all that. I think we have to start somewhere though. As I said, being able to purchase insurance from across state lines will help open up a more competitive market - which helps to drive costs down.

Also, returning the oversight to the states to regulate is going to help a lot, too. The Federal gov't does not need to be involved in regulating or requiring healthcare coverage.

What are your suggestions? Stay with Obamacare which getting ready to cave in?

philibusters · May 8, 2017

Bann said:
I get all that. I think we have to start somewhere though. As I said, being able to purchase insurance from across state lines will help open up a more competitive market - which helps to drive costs down.

Also, returning the oversight to the states to regulate is going to help a lot, too. The Federal gov't does not need to be involved in regulating or requiring healthcare coverage.

What are your suggestions? Stay with Obamacare which getting ready to cave in?

I find it odd that conservatives are the ones supporting selling insurance across state lines. The reason why I find it odd is it seems to encroach on states right. Now in order to sell insurance to a resident of say Maryland an insurance company has to follow all of Maryland's law regarding insurance. If companies don't have to follow Maryland's law isn't that encroaching on state power. For example, when the first states recognized gay marriage, there was an argument that other states did not have to recognize those marriages as legitimate within their own state. To make them recognize the marriage was a violation of the state's power. However on this issue, Democrats and Republicans seem to have completely shifted positions.

Now in terms of what effect will being able to sell across state lines have---it depends on what state you are in. If you are in a state like New York that has a ton of regulations, you should be able to buy an out of state plan much cheaper than a plan that conforms with the NY regulations. By contrast if you live in a state with very little insurance regulation, it probably won't have that big of an effect. Which the second odd thing about the debate. The people who would benefit the most from being able to buy policies across state lines are the people who live in the states with the most insurance regulations which are the states that tend to be more liberal (like Maryland). The people who would benefit the least from being able to buy across state lines are people who live in states with the least insurance regulations which tends to be conservative states.

I disagree with you that Obamacare is getting ready to cave in. Its expensive and will just get more expensive, but it did achieve one goal which is to get more people health insurance. Basically Obamacare was a redistribution of wealth from the rich to the poor which I can understand people not liking, but it did achieve its affect as poorer people and lower working class people have more access to health care than before. Is a net positive or negative for society? Not sure. But it achieved its goal.

I think ultimately we will have to go to a model like they have Europe or Canada with a single payer system. I think the two biggest goals are to get costs under control and allow poorer and working class people to have access to health care and its probably the only method that will work. That means limiting how much hospitals can charge for stuff. Wealthy people will be able to buy their own extra health insurance, which they probably will want to as the health care access to the masses will not be of a high enough quality for them.

Bann · May 8, 2017

philibusters said:
I find it odd that conservatives are the ones supporting selling insurance across state lines. The reason why I find it odd is it seems to encroach on states right. Now in order to sell insurance to a resident of say Maryland an insurance company has to follow all of Maryland's law regarding insurance. If companies don't have to follow Maryland's law isn't that encroaching on state power. For example, when the first states recognized gay marriage, there was an argument that other states did not have to recognize those marriages as legitimate within their own state. To make them recognize the marriage was a violation of the state's power. However on this issue, Democrats and Republicans seem to have completely shifted positions.

Now in terms of what effect will being able to sell across state lines have---it depends on what state you are in. If you are in a state like New York that has a ton of regulations, you should be able to buy an out of state plan much cheaper than a plan that conforms with the NY regulations. By contrast if you live in a state with very little insurance regulation, it probably won't have that big of an effect. Which the second odd thing about the debate. The people who would benefit the most from being able to buy policies across state lines are the people who live in the states with the most insurance regulations which are the states that tend to be more liberal (like Maryland). The people who would benefit the least from being able to buy across state lines are people who live in states with the least insurance regulations which tends to be conservative states.

I disagree with you that Obamacare is getting ready to cave in. Its expensive and will just get more expensive, but it did achieve one goal which is to get more people health insurance. Basically Obamacare was a redistribution of wealth from the rich to the poor which I can understand people not liking, but it did achieve its affect as poorer people and lower working class people have more access to health care than before. Is a net positive or negative for society? Not sure. But it achieved its goal.

I think ultimately we will have to go to a model like they have Europe or Canada with a single payer system. I think the two biggest goals are to get costs under control and allow poorer and working class people to have access to health care and its probably the only method that will work. That means limiting how much hospitals can charge for stuff. Wealthy people will be able to buy their own extra health insurance, which they probably will want to as the health care access to the masses will not be of a high enough quality for them.

Encroaching on states' rights? Really? *lol*

I live in Maryland and my auto insurance co is based in Texas. So is my homeowner's insurance. I am insured by USAA.

Nationwide sells insurance across state lines. Where is this interfering with states' rights? If an insurance co wants to sell in a certain state, they will abide by THAT state's regulations. It's done (or not) all the time.

Bann · May 8, 2017

philibusters said:
I find it odd that conservatives are the ones supporting selling insurance across state lines. The reason why I find it odd is it seems to encroach on states right. Now in order to sell insurance to a resident of say Maryland an insurance company has to follow all of Maryland's law regarding insurance. If companies don't have to follow Maryland's law isn't that encroaching on state power. For example, when the first states recognized gay marriage, there was an argument that other states did not have to recognize those marriages as legitimate within their own state. To make them recognize the marriage was a violation of the state's power. However on this issue, Democrats and Republicans seem to have completely shifted positions.

Now in terms of what effect will being able to sell across state lines have---it depends on what state you are in. If you are in a state like New York that has a ton of regulations, you should be able to buy an out of state plan much cheaper than a plan that conforms with the NY regulations. By contrast if you live in a state with very little insurance regulation, it probably won't have that big of an effect. Which the second odd thing about the debate. The people who would benefit the most from being able to buy policies across state lines are the people who live in the states with the most insurance regulations which are the states that tend to be more liberal (like Maryland). The people who would benefit the least from being able to buy across state lines are people who live in states with the least insurance regulations which tends to be conservative states.

I disagree with you that Obamacare is getting ready to cave in. Its expensive and will just get more expensive, but it did achieve one goal which is to get more people health insurance. Basically Obamacare was a redistribution of wealth from the rich to the poor which I can understand people not liking, but it did achieve its affect as poorer people and lower working class people have more access to health care than before. Is a net positive or negative for society? Not sure. But it achieved its goal.

I think ultimately we will have to go to a model like they have Europe or Canada with a single payer system. I think the two biggest goals are to get costs under control and allow poorer and working class people to have access to health care and its probably the only method that will work. That means limiting how much hospitals can charge for stuff. Wealthy people will be able to buy their own extra health insurance, which they probably will want to as the health care access to the masses will not be of a high enough quality for them.

Also: you don't have to believe Obamacare is going kaput. Don't take my word for it at all. Take the word of Congress, as they are the ones calling that shot.

Hijinx · May 8, 2017

kwillia said:
Serious question... aren't you and I just one medical event from being in that boat you are describing? I have no pre-existing conditions at all. But the moment I get diagnosed with any form of cancer (skin, breast, colon, etc), an injury with chronic results (caused by car accident, twisted ankle, pulled back, hip, knee, etc) I will forever be expected to pay more just in case it flairs up again.

Again I will ask, what if the unexpected condition causes us to not be able to keep or job. How can we afford to pay the higher monthly coverage the higher deductibles, etc.?

And if we can't then we will go in the suffer-til-you-die boat.

That's the problem leaving many unable to sleep at night.

Many people who used to have insurance no longer have it because they cannot afford it. What happens to them?
Many are barely affording insurance now and increases may force them to quit it, what happens to them.

Personally I am old and have Medicaid , plus BC&BS, and I have had BC & BS for over 50 years, I don't see myself having a pre-existing condition.
Like I said. I like it that people with pre existing conditions can get insurance, but not if it causes others to have rates , premiums and Deductibles that forces them from having any.

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