Got a Pre-Existing Condition? Your Premium Could Rise Sharply Under New GOP Plan

[smilesammich 10,727]

  Quote

President Donald Trump insists that the GOP’s American Health Care Act makes good on that pledge, and House Speaker Paul Ryan says on his websitethat “under no circumstance can people be denied coverage because of a pre-existing condition.”

But a recent amendment to the AHCA, authored by House Republican Tom MacArthur (shown above), from New Jersey, provides a loophole. It allows states to let insurers charge higher premiums to sicker people if their coverage has lapsed, and if the state has set up a so-called "high-risk pool," or special health insurance programs for sicker patients.

In a bid to garner more votes from moderate Republicans concerned about going back on their pledge to cover sick people, House Republicans said Wednesday they are discussing adding more funding for those high-risk pools.

But critics say that even with that extra cash those risk pools will be underfunded. And they point out that people with pre-existing conditions are especially likely to have gaps in insurance, because if they become too sick to work they may lose coverage through their employer, says Sara Collins, vice president of health care coverage and access at the Commonwealth Fund, a nonpartisan foundation that supports independent research on health and social issues.

And while those people may technically still have access to insurance, in practice it may be out of their reach. "If you can charge sick people whatever you want, that’s effectively denying people coverage,” says Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute, a nonpartisan health policy research group.

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http://www.consumerreports.org/health-insurance/got-a-pre-existing-condition-your-premium-could-rise-sharply-under-new-gop-plan/

[bcking 3,157]

The concept of a "high risk pool" for health insurance is completely contradictory to how insurance is supposed to work. Furthermore the obsession with "preexisting conditions" is crazy, since everything is "preexisting" other than trauma, you just don't necessarily know about them. You want people with preexisting conditions to be covered and cared for, because good care will reduce their use of the healthcare system in the future. A person with undiagnosed diabetes technically doesn't have a "preexisting condition" but is going to cost a lot more than the person who was diagnosed early, has regular care, and is well managed. 

 

If you put all the sick people into one pile, they won't be able to pay for their care. You need to spread them around with healthy people. Getting upset about "paying for someone else's healthcare" is basically contrary to the entire concept of insurance. No one pays for their own healthcare when they have insurance. You are paying a relatively small amount that is going to cover you for potentially for more costly events. Do people really think their few hundred dollars a month covers them when they incur a million dollar + bill in the hospital after an accident or unsuspecting illness? 

 

1 thousand dollars per month for 20 years would be 240,000 dollars. That wouldn't cover much in the way of serious illness whether it is "preexisting" or not. 

[yuna628 9,811]

  On 5/4/2017 at 3:58 PM, bcking said:

The concept of a "high risk pool" for health insurance is completely contradictory to how insurance is supposed to work. Furthermore the obsession with "preexisting conditions" is crazy, since everything is "preexisting" other than trauma, you just don't necessarily know about them. You want people with preexisting conditions to be covered and cared for, because good care will reduce their use of the healthcare system in the future. A person with undiagnosed diabetes technically doesn't have a "preexisting condition" but is going to cost a lot more than the person who was diagnosed early, has regular care, and is well managed. 

 

If you put all the sick people into one pile, they won't be able to pay for their care. You need to spread them around with healthy people. Getting upset about "paying for someone else's healthcare" is basically contrary to the entire concept of insurance. No one pays for their own healthcare when they have insurance. You are paying a relatively small amount that is going to cover you for potentially for more costly events. Do people really think their few hundred dollars a month covers them when they incur a million dollar + bill in the hospital after an accident or unsuspecting illness? 

 

1 thousand dollars per month for 20 years would be 240,000 dollars. That wouldn't cover much in the way of serious illness whether it is "preexisting" or not. 

Expand  

Few hundred dollars? At over $700 per month, I know whatever I pay doesn't cover squat. That's because the insurance company barely pays out to the doctors for anything. Last time I went to the clinic for illness I think the doctor maybe saw about $60 of it. Was appalling. Where does my money go to? It's a joke. And I still go to the clinic only when I get sick.. not to a regular primary for basic care or followups or any of the things I suspect I might have, because opening pandoras box is something I cannot afford with this crappy coverage. Mom's a cancer survivor so she's obviously in the 'pre existing pool', can still barely afford the insurance though medicare has been great in seeing her through, and now she's going to need to have a big surgery in the month and lengthy rehab.. no idea how that's all getting paid.

 

Elected repubs need to get their heads out of their bums and start realizing that if they continue down this path and don't start actually thinking of real solutions they are going to be on the losing side of history. Ocare doesn't work properly, but this bill makes it even worse. People that are behind the lines fighting insurance companies every day to get authorizations and coverage for their very sick patients know this.

Edited May 4, 2017 by yuna628

[smilesammich 10,727]

  On 5/4/2017 at 3:58 PM, bcking said:

The concept of a "high risk pool" for health insurance is completely contradictory to how insurance is supposed to work. Furthermore the obsession with "preexisting conditions" is crazy, since everything is "preexisting" other than trauma, you just don't necessarily know about them. You want people with preexisting conditions to be covered and cared for, because good care will reduce their use of the healthcare system in the future. A person with undiagnosed diabetes technically doesn't have a "preexisting condition" but is going to cost a lot more than the person who was diagnosed early, has regular care, and is well managed. 

 

If you put all the sick people into one pile, they won't be able to pay for their care. You need to spread them around with healthy people. Getting upset about "paying for someone else's healthcare" is basically contrary to the entire concept of insurance. No one pays for their own healthcare when they have insurance. You are paying a relatively small amount that is going to cover you for potentially for more costly events. Do people really think their few hundred dollars a month covers them when they incur a million dollar + bill in the hospital after an accident or unsuspecting illness? 

 

1 thousand dollars per month for 20 years would be 240,000 dollars. That wouldn't cover much in the way of serious illness whether it is "preexisting" or not. 

Expand  

exactly.  my dad had cancer when he was in his early twenties and our entire family was faulted for his 'preexisting condition' when we moved and he changed employers. and currently, this is why my sister has had to argue with insurance companies attempting to justify the cost of her insulin pump.

i listened to some republican thugs this morning talk a bunch about governors signing waivers and trump 'giving' millions of dollars to cover sick people. it's all such a racket. i wonder what in the world republicans were so scared of when they cried about obama care and death panels.

[Amica Nostra 4,803]

  On 5/4/2017 at 3:58 PM, bcking said:

The concept of a "high risk pool" for health insurance is completely contradictory to how insurance is supposed to work. Furthermore the obsession with "preexisting conditions" is crazy, since everything is "preexisting" other than trauma, you just don't necessarily know about them. You want people with preexisting conditions to be covered and cared for, because good care will reduce their use of the healthcare system in the future. A person with undiagnosed diabetes technically doesn't have a "preexisting condition" but is going to cost a lot more than the person who was diagnosed early, has regular care, and is well managed. 

 

If you put all the sick people into one pile, they won't be able to pay for their care. You need to spread them around with healthy people. Getting upset about "paying for someone else's healthcare" is basically contrary to the entire concept of insurance. No one pays for their own healthcare when they have insurance. You are paying a relatively small amount that is going to cover you for potentially for more costly events. Do people really think their few hundred dollars a month covers them when they incur a million dollar + bill in the hospital after an accident or unsuspecting illness? 

 

1 thousand dollars per month for 20 years would be 240,000 dollars. That wouldn't cover much in the way of serious illness whether it is "preexisting" or not. 

Expand  

How much is that in terms of iPhones?

[bcking 3,157]

  On 5/4/2017 at 4:08 PM, yuna628 said:

Few hundred dollars? At over $700 per month, I know whatever I pay doesn't cover squat. That's because the insurance company barely pays out to the doctors for anything. Last time I went to the clinic for illness I think the doctor maybe saw about $60 of it. Was appalling. Where does my money go to? It's a joke. And I still go to the clinic only when I get sick.. not to a regular primary for basic care or followups or any of the things I suspect I might have, because opening pandoras box is something I cannot afford with this crappy coverage. Mom's a cancer survivor so she's obviously in the 'pre existing pool', can still barely afford the insurance though medicare has been great in seeing her through, and now she's going to need to have a big surgery in the month and lengthy rehab.. no idea how that's all getting paid.

 

Elected repubs need to get their heads out of their bums and start realizing that if they continue down this path and don't start actually thinking of real solutions they are going to be on the losing side of history. Ocare doesn't work properly, but this bill makes it even worse. People that are behind the lines fighting insurance companies every day to get authorizations and coverage for their very sick patients know this.

Expand  

Yes for many it's not just a few hundred, which is why my last example was 1,000 dollars per month.

 

If you have employee based insurance, it's not unrealistic for it to be "a few hundred" for just a single person or a couple, since the employer pays a larger share.

[bcking 3,157]

  On 5/4/2017 at 4:09 PM, smilesammich said:

exactly.  my dad had cancer when he was in his early twenties and our entire family was faulted for his 'preexisting condition' when we moved and he changed employers. and currently, this is why my sister has had to argue with insurance companies attempting to justify the cost of her insulin pump.

i listened to some republican thugs this morning talk a bunch about governors signing waivers and trump 'giving' millions of dollars to cover sick people. it's all such a racket. i wonder what in the world republicans were so scared of when they cried about obama care and death panels.

Expand  

The other line I really liked was

 

"The states will know better how to manage the sick that live there" or something like that (I'm paraphrasing)

 

While I agree a lot of things should be left to the states, and in certain situations they may "know better", I don't see how a state government knows any more about healthcare than the federal government. They are all clueless politicians.

 

Even insurance companies don't really know how to take care of patients. I hate having to call for a "peer to peer", it's like pulling out my own teeth.

[Dashinka 25,311]

  On 5/4/2017 at 4:08 PM, yuna628 said:

Few hundred dollars? At over $700 per month, I know whatever I pay doesn't cover squat. That's because the insurance company barely pays out to the doctors for anything. Last time I went to the clinic for illness I think the doctor maybe saw about $60 of it. Was appalling. Where does my money go to? It's a joke. And I still go to the clinic only when I get sick.. not to a regular primary for basic care or followups or any of the things I suspect I might have, because opening pandoras box is something I cannot afford with this crappy coverage. Mom's a cancer survivor so she's obviously in the 'pre existing pool', can still barely afford the insurance though medicare has been great in seeing her through, and now she's going to need to have a big surgery in the month and lengthy rehab.. no idea how that's all getting paid.

 

Elected repubs need to get their heads out of their bums and start realizing that if they continue down this path and don't start actually thinking of real solutions they are going to be on the losing side of history. Ocare doesn't work properly, but this bill makes it even worse. People that are behind the lines fighting insurance companies every day to get authorizations and coverage for their very sick patients know this.

Expand  

I often wonder what will be done in the end.  Obamacare is ready to implode, this new bill is not much better, and what we had wasn't the greatest either.  Single payer may be an answer, but that doesn't really change much except moving the insurance provider, and if we believe the insurance bureaucracy is bad, we can only imagine how it will be under the Feds along with the much longer wait times.

 

The last few times I have been to the doctor, I started asking for a cash price.  Unfortunately my doctor wasn't in to that, but I did learn that if things changed to a cash system, it would be cheaper for the most part which makes sense relative to needing to pay for the current insurance infrastructure.

 

Time will tell.

[yuna628 9,811]

  On 5/4/2017 at 4:09 PM, smilesammich said:

exactly.  my dad had cancer when he was in his early twenties and our entire family was faulted for his 'preexisting condition' when we moved and he changed employers. and currently, this is why my sister has had to argue with insurance companies attempting to justify the cost of her insulin pump.

i listened to some republican thugs this morning talk a bunch about governors signing waivers and trump 'giving' millions of dollars to cover sick people. it's all such a racket. i wonder what in the world republicans were so scared of when they cried about obama care and death panels.

Expand  

Dad had a brain tumour way back when before I was born. He survived somehow, mainly through some very excellent doctors who worked with Carson (yes him... if I could only chew him out now...) and continued on with some minor disabilities but required multiple drugs to function. With insurance these days it's been rough trying to get the prior authorizations for the now very expensive drugs required (it was an injection and a few other things). Now with medicare + supplement it's completely off the table. He can't afford it out of pocket, so he's gone without. The alternatives were too expensive as well. This has had some really serious negative effects on his health...

 

Yeah insurance is the real death panel.

 

  On 5/4/2017 at 4:12 PM, bcking said:

Yes for many it's not just a few hundred, which is why my last example was 1,000 dollars per month.

 

If you have employee based insurance, it's not unrealistic for it to be "a few hundred" for just a single person or a couple, since the employer pays a larger share.

Expand  

I know. The insurance his work offers is like the best insurance you could get, but until they offer more hours it's off limits for him. But even with employer based insurance, as my dad used to have.. the constant fighting to get coverage and prior authorizations for medication that's needed was ridiculous.

[bcking 3,157]

  On 5/4/2017 at 4:17 PM, Bill & Katya said:

I often wonder what will be done in the end.  Obamacare is ready to implode, this new bill is not much better, and what we had wasn't the greatest either.  Single payer may be an answer, but that doesn't really change much except moving the insurance provider, and if we believe the insurance bureaucracy is bad, we can only imagine how it will be under the Feds along with the much longer wait times.

 

The last few times I have been to the doctor, I started asking for a cash price.  Unfortunately my doctor wasn't in to that, but I did learn that if things changed to a cash system, it would be cheaper for the most part which makes sense relative to needing to pay for the current insurance infrastructure.

 

Time will tell.

Expand  

In general I agree with you. Obamacare isn't working as intended, and there are many reasons for that. I do believe strongly it is better than what we had before, but I also have specific definitions for what I consider to be "better" that others may not agree with.

 

The new plan isn't going to fix any problems. We will have less people with insurance, either because they are healthy and think they don't "need it", or they are sick and can't afford it.

 

While a "cash system" may make certain things cheaper overall (doctor's visits perhaps), obviously that isn't tenable for the entire healthcare system. A hospital stay or ED visit, paid in cash, wouldn't be cheap enough for people to afford.

[smilesammich 10,727]

  On 5/4/2017 at 4:15 PM, bcking said:

The other line I really liked was

 

"The states will know better how to manage the sick that live there" or something like that (I'm paraphrasing)

 

While I agree a lot of things should be left to the states, and in certain situations they may "know better", I don't see how a state government knows any more about healthcare than the federal government. They are all clueless politicians.

 

Even insurance companies don't really know how to take care of patients. I hate having to call for a "peer to peer", it's like pulling out my own teeth.

Expand  

yeah right?! 'the sick that live there' like there's a leper dwelling, probably under a bridge somewhere close to the local watering/bathing hole.

 

insurance companies do not care about patients. they care about $. which is why the actually argue that the cost of an insulin pump (which is far far less when considering the cost of multiple daily injections and probability of other health issues from this antiquated approach) is not justifyable even when considering the increase in quality of life/health with pump use.

[smilesammich 10,727]

  Quote

In addition to rape, postpartum depression, Cesarean sections, and surviving domestic violence are all considered preexisting conditions. Companies can also deny coverage for gynecological services and mammograms.

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just..wow

 

http://nymag.com/thecut/2017/05/under-new-healthcare-bill-rape-is-a-pre-existing-condition.html

[Amica Nostra 4,803]

  On 5/4/2017 at 4:17 PM, Bill & Katya said:

I often wonder what will be done in the end.  Obamacare is ready to implode, this new bill is not much better, and what we had wasn't the greatest either.  Single payer may be an answer, but that doesn't really change much except moving the insurance provider, and if we believe the insurance bureaucracy is bad, we can only imagine how it will be under the Feds along with the much longer wait times.

 

The last few times I have been to the doctor, I started asking for a cash price.  Unfortunately my doctor wasn't in to that, but I did learn that if things changed to a cash system, it would be cheaper for the most part which makes sense relative to needing to pay for the current insurance infrastructure.

 

Time will tell.

Expand  

Really? cash talks and BS walks in healthcare?  I doubt that is a serious solution to the gaps in coverage, access  and affordability.

 

Real life story:

 

I prepaid for my  daughters birth at a "birthing center" run by what I know now to be a greedy Dr > 15K in todays terms.  Night of delivery comes...baby in distress..Dr Greed redirects us to the hospital where another (Dr Good) did the delivery ( the pregnancy was a preexisting condition and now are out another 30K) for the hospital.  Dr Good says it was essential that the delivery was done at the hospital because the baby was breach.  Dr Greed claims that the baby was good to go the day before but "flipped" in the womb that night.  

 

In that scenario, paying cash was a liability and led to actually riskier outcomes with more cost. Never got the 15 g back for the unused birthing center.   In the fog of illness and healthcare...caveat emptor is a bad individual policy, get insurance.

[Teddy B 17,252]

  On 5/4/2017 at 4:21 PM, bcking said:

In general I agree with you. Obamacare isn't working as intended, and there are many reasons for that. I do believe strongly it is better than what we had before, but I also have specific definitions for what I consider to be "better" that others may not agree with.

 

The new plan isn't going to fix any problems. We will have less people with insurance, either because they are healthy and think they don't "need it", or they are sick and can't afford it.

 

While a "cash system" may make certain things cheaper overall (doctor's visits perhaps), obviously that isn't tenable for the entire healthcare system. A hospital stay or ED visit, paid in cash, wouldn't be cheap enough for people to afford.

Expand  

I know this is your area of expertise so I'd like to hear your opinions on the following.

 

Do you think it would be a big help to the financial side of the ACA if the penalties for not having coverage were made more expensive than if you did have it?

 

Do you think adults over the age of 21 should be required to carry their own health coverage and not allowed to ride on their parents health care coverage to the age of 26 (I believe it's 26 could be wrong)?

 

I personally think that changing both of these things would make the ACA much more solvent and stable.

Edited May 4, 2017 by Teddy B

[bcking 3,157]

  On 5/4/2017 at 4:31 PM, ccneat said:

Really? cash talks and BS walks in healthcare?  I doubt that is a serious solution to the gaps in coverage, access  and affordability.

 

Real life story:

 

I prepaid for my  daughters birth at a "birthing center" run by what I know now to be a greedy Dr > 15K in todays terms.  Night of delivery comes...baby in distress..Dr Greed redirects us to the hospital where another (Dr Good) did the delivery ( the pregnancy was a preexisting condition and now are out another 30K) for the hospital.  Dr Good says it was essential that the delivery was done at the hospital because the baby was breach.  Dr Greed claims that the baby was good to go the day before but "flipped" in the womb that night.  

 

In that scenario, paying cash was a liability and led to actually riskier outcomes with more cost. Never got the 15 g back for the unused birthing center.   In the fog of illness and healthcare...caveat emptor is a bad individual policy, get insurance.

Expand  

That happens all the time.

 

Near where I work there are hospitals that actually advertise abroad in certain countries for women to come and deliver. They charge a flat fee. Any complex case, even when known prenatally, ends up being transferred but they still take their fee. They don't explain to the parents that their fee doesn't cover the care if they need to be transferred. So they come to a hospital that is actually able to manage their case and have a huge bill that they can't pay.