Pre-existing conditions

[Nice Guy Eddie 13,528]

It’s become the political touching-the-third rail issue.  Say you’re against it and it’s as if you like to kick dogs and small children.   However it’s not a substainable item for healthcare coverage because it incentivizes some people to not buy insurance until they have an expensive healthcare issue.  Then they jump back into the market when it benefits them.  This is one reason premiums are so high.

It may be necessary to continue coverage for pre existing conditions for a certain period as we adjust to the ACA and perhaps permenantly in a few select circumstances  but I don’t believe it’s economically feasible forever.    As long as you maintain insurance coverage with minimal breaks, insurance should be required to cover pre existing conditions.  That’s it. 

However if you decide to not protect yourself, there might be consequences including non coverage.  It’s harsh but should other policy holders take the risk while that person did not?   I would hope there are charitiable groups that would help a dying person but it doesn’t mean the person should be guaranteed free healthcare, relatively speaking, for extremely expensive treatment.

full disclosure,  I’m for the ACA in terms that it makes people responsible.  Now I’m ok if someone wants to opt out of the ACA but that means the consequence is opting out of future pre existing condition coverage.   If you jump back in, then you only get basic coverage for X number of years.    Then full coverage starts.

Tldr: pre existing condition coverage is the same as letting people bet on a football game with 5 seconds remaining on the clock but giving them the pre game odds.  

 

[Onboard 2.0 9,083]

3 minutes ago, Nice Guy Eddie said:

It’s become the political touching-the-third rail issue.  Say you’re against it and it’s as if you like to kick dogs and small children.   However it’s not a substainable item for healthcare coverage because it incentivizes some people to not buy insurance until they have an expensive healthcare issue.  Then they jump back into the market when it benefits them.  This is one reason premiums are so high.

It may be necessary to continue coverage for pre existing conditions for a certain period as we adjust to the ACA and perhaps permenantly in a few select circumstances  but I don’t believe it’s economically feasible forever.    As long as you maintain insurance coverage with minimal breaks, insurance should be required to cover pre existing conditions.  That’s it. 

However if you decide to not protect yourself, there might be consequences including non coverage.  It’s harsh but should other policy holders take the risk while that person did not?   I would hope there are charitiable groups that would help a dying person but it doesn’t mean the person should be guaranteed free healthcare, relatively speaking, for extremely expensive treatment.

full disclosure,  I’m for the ACA in terms that it makes people responsible.  Now I’m ok if someone wants to opt out of the ACA but that means the consequence is opting out of future pre existing condition coverage.   If you jump back in, then you only get basic coverage for X number of years.    Then full coverage starts.

Tldr: pre existing condition coverage is the same as letting people bet on a football game with 5 seconds remaining on the clock but giving them the pre game odds.  

 

So yer saying if it ain't good for Vegas it ain't good for America ?

[horncyclist 1,391]

If only there was some way to prevent people from gaming the system, a mandate perhaps. Maybe an individual mandate. You could enforce it with a penalty....err...tax.

[Nice Guy Eddie 13,528]

1 minute ago, Onboard 2.0 said:

So yer saying if it ain't good for Vegas it ain't good for America ?

Insurance and gambling are about risk mgmt.  pre existing conditions is removal of risk.  or close to it.

[Onboard 2.0 9,083]

1 minute ago, Nice Guy Eddie said:

Insurance and gambling are about risk mgmt.  pre existing conditions is removal of risk.  or close to it.

Sounds like stem cell and gene therapy are the long term answer for potential removal of those pre existing conditions, than you get over population of course.

[DanRydell 799]

Who are you arguing with?

Nobody is advocating for requiring coverage of pre-existing conditions without requiring everyone to be insured except for Republicans who are lying and have no actual intention of protecting people with pre-existing conditions.

[TwiceHorn 31,566]

Well health coverage really should not involve risk in the same sense as casualty insurance. That has been the first mistake we have made. 

 

It should spread risk among the population but cannot be tolerated to avoid it entirely. And there has to be some form of rationing and yes death panels.  Aetna already is a death panel. 

[Onboard 2.0 9,083]

Just now, TwiceHorn said:

Well health coverage really should not involve risk in the same sense as casualty insurance. That has been the first mistake we have made. 

 

It should spread risk among the population but cannot be tolerated to avoid it entirely. And there has to be some form of rationing and yes death panels.  Aetna already is a death panel. 

So you pay into the plan for decades, and then the company says tough shit we ain't covering your illness ?   

[Nice Guy Eddie 13,528]

3 minutes ago, Onboard 2.0 said:

So you pay into the plan for decades, and then the company says tough shit we ain't covering your illness ?   

At some point yes.  Should a 105 year old get a heart transplant?   The 105 year old shouldnt be surprised by the news.  Be clear on what is and isn’t covered at each age, how it’s determined and if there is an appeal process.  

[ndawg 1,242]

I don't want families earning $50,000 per year to go back to choosing between $600/mo premiums or racking up more debt, even if that $600 is less than what the premiums would be without pre-existing coverage.

In this case, we're better off talking about the outcomes we want to see rather than the means. Most people want heathcare to be cheaper, better, and available to more people. The insurance business model exerts minimal pressure on cost, at the expense of harming quality and making health care exclusive to those who can fork over the money for premiums and patient portions. It frankly sucks for health care.

There was a good intention behind ACA's mandate -- if we force everyone to buy in to the system, but use tax credits to ensure everyone can afford it, everyone ends up paying the least amount necessary to cover everybody. This doesn't have to be a zero sum game, though. I think we can increase health care quality while simultaneously expanding coverage and reducing cost, if our politicians actually solved problems instead of leveraging the present dissatisfaction to galvanize voters.

[Onboard 2.0 9,083]

3 minutes ago, Nice Guy Eddie said:

At some point yes.  Should a 105 year old get a heart transplant?   The 105 year old shouldnt be surprised by the news.  Be clear on what is and isn’t covered at each age, how it’s determined and if there is an appeal process.  

No, of course they shouldn't.  I guess I'd say how do they determine coverage ?  Age would definitely be a first determinant (as it should be), but the disease itself might also play into the scenario, rate of success of recovery, etc.

[Horn Under a Bad Sign 20,514]

Republicans race to back protections for preexisting conditions, after trying for years to gut the law that created the protections:


 

Quote

What began over the summer as a halfhearted attempt by Republicans to push back against Democratic attacks on the issue of health care has exploded into a full-throated reversal of their positions, particularly on protections for sick Americans.

In Missouri, Republican Senate candidate Josh Hawley has been hammered by the woman he hopes to unseat, Democrat Claire McCaskill, for being among the attorneys general who have asked a federal court to render unconstitutional the Affordable Care Act, or Obamacare, which compelled insurance companies to cover those with preexisting conditions.

“You don’t go to court and get rid of important protections when there is no backup, when people will be in a free fall,” McCaskill said in a debate Thursday night. Hawley has responded by citing the illness of his young son as fueling his understanding of the importance of such protections.

In Texas, where he is trying to beat back a well-financed challenge by Democratic Rep. Beto O’Rourke, Sen. Ted Cruz said in a debate Tuesday that he would “protect preexisting conditions.” Cruz forced a government shutdown in 2013 over his effort to repeal Obamacare.

The GOP about-face is not just playing out in Senate races. Wisconsin Gov. Scott Walker, a Republican seeking a third term, has insisted that he supports maintaining the popular ACA protections, even if he is also backing the lawsuit that would end them.

https://www.washingtonpost.com/politics/republicans-race-to-back-protections-for-preexisting-conditions-after-trying-to-gut-the-law-that-created-the-protections/2018/10/19/0da3dc36-d3ab-11e8-b2d2-f397227b43f0_story.html?fbclid=IwAR2GTn_1GJ7htw7vlU24ASt2h_PNUkidN-SoZrW7_2uMOWnwIH3h6ESo94w&utm_term=.20e977e15ae7

[Nice Guy Eddie 13,528]

The GOP is becoming the party of the white, lower-middle class.   No surprise that they will gravitate towards issues like covering pre existing conditions and healthcare assistance.  

[Js1 85,603]

 

[Incredulity 11,683]

4 hours ago, horncyclist said:

If only there was some way to prevent people from gaming the system, a mandate perhaps. Maybe an individual mandate. You could enforce it with a penalty....err...tax.

Biggest problem being O never had the balls to enforce the mandate.

Now R’s have stripped it down even more.

The whole thing was such a half-measures cluster fuck it really cannot be honestly evaluated.

[Francisco 2.0 32,431]

6 hours ago, Nice Guy Eddie said:

At some point yes.  Should a 105 year old get a heart transplant?   The 105 year old shouldnt be surprised by the news.  Be clear on what is and isn’t covered at each age, how it’s determined and if there is an appeal process.  

[Satchel 6,949]

11 hours ago, Nice Guy Eddie said:

Insurance and gambling are about risk mgmt.  pre existing conditions is removal of risk.  or close to it.

If insurance companies won't cover the increasing number of diabetic children, who should? 

[Nice Guy Eddie 13,528]

9 minutes ago, Satchel said:

If insurance companies won't cover the increasing number of diabetic children, who should? 

I’m not saying that health insurance shouldn’t cover people that get sick.   

[TwiceHorn 31,566]

11 hours ago, Onboard 2.0 said:

So you pay into the plan for decades, and then the company says tough shit we ain't covering your illness ?   

Pay into what plan?  Insurance policies roll over every year.  I have never had a health insurance plan for a decade, or even five years.

Not sure where you got that from my post.

Health insurance should be viewed as insurance insofar as it spreads risk and cost among a pool of subscribers, but not much beyond that.

[TwiceHorn 31,566]

9 hours ago, Js1 said:

 

Not to defend republican hypocrisy, but while repealing the ACA would diminish some preexisting condition limitations, the ACA is not synonymous with preexisting condition limitations. 

One can want to repeal the ACA and still maintain preexisting condition limitations.  That's a stupid tweet.

Only 10 states had no preexisting condition limitation before the ACA.  Thirteen states prohibited them entirely.  And the rest excluded coverage for a limited time.

Edited October 21, 2018 by TwiceHorn

[Captainant 27,828]

11 hours ago, Nice Guy Eddie said:

Tldr: pre existing condition coverage is the same as letting people bet on a football game with 5 seconds remaining on the clock but giving them the pre game odds.  

It's almost like commodifying our healthcare is a fundamentally flawed idea since everyone is incentivized to be individually selfish from insurers to care providers to patients. Making that into a market where the people with shareholders and a financial interest have all the power is just asking for an abuse of that position at the cost of sick people who only want to be healthy. 

[Incredulity 11,683]

Compounded by an almost complete opacity in costs.  Never in my experience  has the cost of a medical service been presented beforehand.

 

[ChiTownDoc 21,175]

On 10/20/2018 at 11:04 AM, Nice Guy Eddie said:

The GOP is becoming the party of the white, lower-middle class.   No surprise that they will gravitate towards issues like covering pre existing conditions and healthcare assistance.  

LMAO

[Onboard 2.0 9,083]

On 10/20/2018 at 11:20 PM, Incredulity said:

Compounded by an almost complete opacity in costs.  Never in my experience  has the cost of a medical service been presented beforehand.

 

The grandparents would write down every single thing given to or done to each other when they had hospital says. They caught literally thousands of dollars in double billing and false charges every time they were in the hospital.

[Incredulity 11,683]

1 hour ago, Onboard 2.0 said:

The grandparents would write down every single thing given to or done to each other when they had hospital says. They caught literally thousands of dollars in double billing and false charges every time they were in the hospital.

This too.

There was about a grand of "extras" on my first childs birth that I questioned and were removed.  Lactation Consultation, meals never served, .....

[JimmyHoffa 1,188]

On 10/20/2018 at 10:01 AM, horncyclist said:

If only there was some way to prevent people from gaming the system, a mandate perhaps. Maybe an individual mandate. You could enforce it with a penalty....err...tax.

 

What a great idea! 

Now tell that to the family of 5 who are paying $3500 a MONTH for shitty health insurance. 

That said the issue is very complex and not something that can be easily discussed on a message board. 

 

One thing that everyone should be able to agree on is the system is fucking broken. The ACA is working for some and also bending over a hell of a lot more who are paying $3500 a month for coverage they aren't even using who a few years ago were paying $1000 a month or less for better coverage pre ACA. 

The ACA isn't a total failure and has absolutely helped people but it didn't do a damn thing to fix the actual problem with healthcare and that is the cost of care issue. The problem is the individual market is so small compared to the group market it's difficult for the insurance companies to swing a big enough stick to reduce inflated costs and hold doctors, hospitals, drug companies responsible or at least get everyone on the same page (or at least in the same book). 

[Longhorn_Fan68 33,900]

wtf is a pre-existing anything? 

[Johnny Sack 8,397]

On 10/20/2018 at 10:01 AM, horncyclist said:

If only there was some way to prevent people from gaming the system, a mandate perhaps. Maybe an individual mandate. You could enforce it with a penalty....err...tax.

We do that and we can all save $2500 and keep our doctors.  That’s what I heard.  

[Johnny Sack 8,397]

On 10/20/2018 at 11:04 AM, Nice Guy Eddie said:

The GOP is becoming the party of the white, lower-middle class.   No surprise that they will gravitate towards issues like covering pre existing conditions and healthcare assistance.  

It is?

 

[Longhorn_Fan68 33,900]

did you just own yourself?

[Satchel 6,949]

Here’s a look at what the Trump administration is doing on health care ahead of the midterm elections:

Pre-existing conditions

The Trump administration on Monday announced a new policy that would allow states to pursue “alternatives” to insurance plans that don’t meet all requirements under the Obama-era law. In Trump's plan, states could use federal money to subsidize cheaper insurance plans that offer less coverage. Republicans call them “innovative” solutions that will improve competition; critics deride the options as “junk insurance.”

Democrats have swiftly seized on the issue and circulated warnings on social media that such a policy would open the floodgates to insurance plans that deny people coverage based on a previous diagnosis.

https://abcnews.go.com/Politics/trump-administration-stand-health-care-pre-existing-conditions/story?id=58686718

[bad_teammate 13,225]

8 hours ago, Satchel said:

Here’s a look at what the Trump administration is doing on health care ahead of the midterm elections:

Pre-existing conditions

The Trump administration on Monday announced a new policy that would allow states to pursue “alternatives” to insurance plans that don’t meet all requirements under the Obama-era law. In Trump's plan, states could use federal money to subsidize cheaper insurance plans that offer less coverage. Republicans call them “innovative” solutions that will improve competition; critics deride the options as “junk insurance.” 

Democrats have swiftly seized on the issue and circulated warnings on social media that such a policy would open the floodgates to insurance plans that deny people coverage based on a previous diagnosis.

https://abcnews.go.com/Politics/trump-administration-stand-health-care-pre-existing-conditions/story?id=58686718

We will innovatively waste tax dollars on insurance that does nothing! insurance companies who will be collecting the premiums and rejecting all coverage love it!

[pepper brooks 580]

On ‎10‎/‎20‎/‎2018 at 9:56 AM, Nice Guy Eddie said:

It’s become the political touching-the-third rail issue.  Say you’re against it and it’s as if you like to kick dogs and small children.   However it’s not a substainable item for healthcare coverage because it incentivizes some people to not buy insurance until they have an expensive healthcare issue.  Then they jump back into the market when it benefits them.  This is one reason premiums are so high.

It may be necessary to continue coverage for pre existing conditions for a certain period as we adjust to the ACA and perhaps permenantly in a few select circumstances  but I don’t believe it’s economically feasible forever.    As long as you maintain insurance coverage with minimal breaks, insurance should be required to cover pre existing conditions.  That’s it. 

However if you decide to not protect yourself, there might be consequences including non coverage.  It’s harsh but should other policy holders take the risk while that person did not?   I would hope there are charitiable groups that would help a dying person but it doesn’t mean the person should be guaranteed free healthcare, relatively speaking, for extremely expensive treatment.

full disclosure,  I’m for the ACA in terms that it makes people responsible.  Now I’m ok if someone wants to opt out of the ACA but that means the consequence is opting out of future pre existing condition coverage.   If you jump back in, then you only get basic coverage for X number of years.    Then full coverage starts.

Tldr: pre existing condition coverage is the same as letting people bet on a football game with 5 seconds remaining on the clock but giving them the pre game odds.  

 

a reasonable take on this issue.  Ultimately, people make health insurance an emotional issue.  The market makes it nothing more than a financial instrument like any other insurance.  

[JimmyHoffa 1,188]

24 minutes ago, bad_teammate said:

We will innovatively waste tax dollars on insurance that does nothing! insurance companies who will be collecting the premiums and rejecting all coverage love it!

 

Actually it's much worse that that. The plans that Trump is allowing to be sold are similar to what the individual market looked like pre ACA. That included underwriting by the insurance companies and limited benefits. In fact many of the plans that I have seen so far are pretty identical for the most part to the pre ACA individual market. 

With one very big difference- Rates are shitty. Not as high as ACA plans but not nearly as big of a discount you would expect for being on a plan that has limited benefits and health questions asked to qualify. 

What will occur is only the sick people or those that qualify for a subsidy will be left on the ACA which will of course increase premiums, however the great majority of those that qualify for a subsidy don't pay a dime of that increase. Who does you ask? Well of course the tax payers just pick up the larger percentage of the premium that continue to go up each year by increasing the subsidy that lowers their premiums. 

Again it won't be next year or 2 years but there is going to be an entire revamping of the system in the next 5-10 years as it is fucked. The ACA just sped up the process. 

 

And finally for the headline readers that like to freak out about a topic by only read one line of an article (if that) These plans won't affect anybody on the ACA or their coverage for pre existing conditions it will only offer some premium relief for the very small population that is healthy and makes over the subsidy limit that can't afford the massive ACA rates they are stuck with since they make to much money to qualify for a subsidy. 

[bad_teammate 13,225]

1 hour ago, pepper brooks said:

a reasonable take on this issue.  Ultimately, people make health insurance an emotional issue.  The market makes it nothing more than a financial instrument like any other insurance.  

Yes, people tend to get emotional about sickness and death. And that's a good thing.

[Captainant 27,828]

1 hour ago, pepper brooks said:

a reasonable take on this issue.  Ultimately, people make health insurance an emotional issue.  The market makes it nothing more than a financial instrument like any other insurance.  

Yeah, go figure that I don't like the idea of my dad getting put into a shitty skilled nursing facility because its inconvenient to someone's bottom line. Healthcare should NOT be a commodity. It's not something that you can ever really have negotiating leverage as a consumer, because your life is LITERALLY in their hands. 

[bad_teammate 13,225]

"It's really unfortunate that the poor get all mad about being ground up into flour as grist for the financial market machine. I wish they would realize how beautiful and efficient the system of their subjugation and suffering looks from outside its reach." - Very Smart Capitalists

[Incredulity 11,683]

5 minutes ago, Captainant said:

Yeah, go figure that I don't like the idea of my dad getting put into a shitty skilled nursing facility because its inconvenient to someone's bottom line. Healthcare should NOT be a commodity. It's not something that you can ever really have negotiating leverage as a consumer, because your life is LITERALLY in their hands. 

Price transparency and competition for customers(patients) are about the only thing that will decrease cost and increase efficacy long term.

Right now we have pretty much the worst of all things.  Tons of regulation, oligopolies, and no price transparency.

And NO I am not in favor of complete lack of regulation, if an insurance company sells an insurance product they need to honor the policy they have sold.

[Newdoc 3,453]

As already addressed, cost and price obscurity is a huge issue. Persive incentives to providers is a huge problem. And our country is full of unhealthy sick people being fed diets of unhealthy foods without much incentive for exercise or weight control.

We are in the fast track to self destruction when there are no real fixes in the works. The real solution to our out of control health care expenses is not insurance reform or even cost containment (although it is desperately needed). The real solution lies in preventing people from needing sick care in the first place.

[bad_teammate 13,225]

2 minutes ago, Newdoc said:

We are in the fast track to self destruction when there are no real fixes in the works.

There are plenty of people out there who want to change it, but the popular will doesn't exist to support them.

- Healthier school lunches.
- Food pantry programs in poor areas.
- Regulation of sugar water sizes at restaurants.
- Nutrition labeling at restaurants.

We should look to what Chile is doing and follow suit. Treat junk food basically like cigarettes. Remove all kid-attracting marketing and packaging from junk food.

[Nivek 16,992]

19 hours ago, Johnny Sack said:

We do that and we can all save $2500 and keep our doctors.  That’s what I heard.  

You lost your doctor?  Amazing, how my family and extended family kept ours even given the fact that we all use different doctors and are dispersed across the country. 

[Celery Man 21,004]

moving over from the beto thread, tagging @cactusflinthead

addiction is a really hard thing to treat effectively.  Some people are going to fail over and over again, and a lot will never succeed.  But you can take someone who is about to explode like a societal dirty bomb fucking up everything around them, and that person can completely get their shit back together and go about paying taxes, producing goods and services, buying homes, etc etc.  We should really evaluate what we can do to help people recover.

I'm saying the above from my own experience which has been documented a bit here and there over the past several years.

[cactusflinthead 27,606]

4 minutes ago, Celery Man said:

moving over from the beto thread, tagging @cactusflinthead

addiction is a really hard thing to treat effectively.  Some people are going to fail over and over again, and a lot will never succeed.  But you can take someone who is about to explode like a societal dirty bomb fucking up everything around them, and that person can completely get their shit back together and go about paying taxes, producing goods and services, buying homes, etc etc.  We should really evaluate what we can do to help people recover.

I'm saying the above from my own experience which has been documented a bit here and there over the past several years.

Thank you. 

I recently went on the hunt for insurance independent of my employer. I discovered a few things. First of which is that you are summarily fucked if you are trying this. One of the dozens of agents that texted,called, and emailed me let slip that it is a requirement that your employer pay a minimum of 50% of what it costs. If you make too much for a subsidy, you are screwed. It's either work for someone else or you are going to pay all of it. 

Among the first questions they asked was if I had any pre-existing conditions or substance abuse. Well,  the wife has high blood pressure and some cholesterol stuff, but no substance abuse among us. 

Then I thought back to when I was looking around for some counseling for my daughter. Having a mom that does have substance abuse problems and mental illness issues is generally not something that you want to ignore. Coverage from the health insurance program was nonexistent. Didn't care. Paid for it. 

Now, how much does it cost us as a state, nation, and our respective municipalities to house, incarcerate, or hospitalize our substance abuse patients and mental health....victims? patients? Pick a noun. I don't give a shit. 

Bottom line. You and I are going to pay. Either to lock them up or give them some assistance. 

And I don't think that the Republicans give a damn about it. All they want to know is if you have more money than they do. Fuck the poor. I see that all too many times here. 

I am not bereft of options. But, there damn sure are those of us with the choice of jail or the hospital to be dealt with for their mental health or substance abuse issues. 

And Johnny Sack doesn't want to pay a dime for it. Yet, he will no matter what. It's either jail or the doctor. 

 

[Celery Man 21,004]

Yeah, I would assume that I would run into problems if I had to shop for insurance, despite having a clean bill of health and several years sober.

[Guest]

17 minutes ago, Celery Man said:

Yeah, I would assume that I would run into problems if I had to shop for insurance, despite having a clean bill of health and several years sober.

Maybe if you have psychiatric records or a paper trail which nails you down. I've expunged everything and a while ago got the highest rating (least risk bucket) on some life insurance I was shopping for, which obviously took into account blood work/labs, but also background check/records.