Ban on dropping people based on pre-existing conditions is effective 6 months after bill is enacted

[ProSense]

There is a restriction period followed by the tactic being outlawed.

Sec. 2301. Insurance Reforms. Extends the prohibition of lifetime limits, prohibition on rescissions, and a requirement to provide coverage for non‐dependent children up to age 26 to all existing health insurance plans starting six months after enactment. Starting in 2014, extends the prohibition on excessive waiting periods to existing health plans. For group health plans, prohibits pre‐existing condition exclusions in 2014 (for children, they are prohibited starting six months after enactment), restricts annual limits beginning six months after enactment, and prohibits them starting in 2014. For coverage of non‐dependent children prior to 2014, the requirement on group health plans is limited to those adult children without an employer offer of coverage.

PDF

5. ENDS RESCISSIONS—Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.

<...>

12. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH‐RISK POOL)—Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition ‐ through a temporary high‐risk pool. Effective 90 days after enactment.

PDF

fixed link

[Tansy_Gold]

1. second pdf link doesn't work n/t

[ProSense]

2. Thanks, fixed. n/t

[Tansy_Gold]

7. I still get a "page not found"

I'm interested in examining this issue because while it appears to address those who are uninsured BECAUSE OF a pre-existing condition, the question remains about cost, eligibility, etc.

One opinion piece from Hamsher says something like less than 1% of those who have PECs would actually be eligible; I don't know what she bases her claim on.

What about people who are uninsured due to inability to pay premiums, but have no PECs? People who are not covered by an employer's group policy may not have a PEC but simply can't afford an individual policy. Are they just SOL for the next four years? Same with self-employed, or unemployed. For example, I have a relative, divorced, with a special needs child. Her ex-husband is required to carry insurance on the child, but she herself has no insurance. She works two part-time jobs, neither of which offers any kind of insurance.

I saw something yesterday or the day before that says premiums for those over 55 (or was it over 60???) could legally be as much as 400% of the premiums for younger people. Would this also apply to the high risk pool for those with PECs? If the standard HRP premium is $1500/mo for an individual, will the HRP premium for an older-but-not-yet-eligible-for-Medicare person be $6,000/mo?

Of course, now that Stupak is back in the mix, I have even less desire to see this piece of shit pass, so it probably is all moot anyway.


Tansy Gold

[Tansy_Gold]

10. Got it this time. n/t

[Ozymanithrax]

3. I've seen this before but thanks for posting it again.

But we will continue to see the right wing Limbaugh talking point that adults with pre-existing conditions are just left to die.

[Ozymanithrax]

4. Why do people unrec the truth? N/A

[ProSense]

5. Interferes with the distortion n/t

[EFerrari]

9. And we can't have that.

[kestrel91316]

6. Because they are assholes? Seriously. There's no other explanation.And it's one of only about 6

people that's likely to be doing it. I could name names, but I'd get in trouble.

[mzmolly]

12. Good question! I've wondered that all day.

It's bizarre. :crazy:

[KittyWampus]

13. because there's a good amount of ratfuckery going on here.

[EFerrari]

60. Because ProSense is wrong. n/t

[harkadog]

8. The annual limits are six months

The ban on pre-existing situations is 2014. They are two different things.

[Name removed]

14. Deleted message

Message removed by moderator. Click here to review the message board rules.

[NYC_SKP]

15. I've just had a word with the Mods, they are not going to remove this post from the board.

Thanks for playing.

NYC_SKP

:loveya:

[joycean]

16. I agree. Someone got excited and read waaay too fast.

They completely misunderstood the wording of the House summary, so this post is completely factually inaccurate, with no room for interpretation.

[tkmorris]

18. Never mind

On edit: The OP has been edited to be more factually accurate, so credit to the OP for that anyway.

[joycean]

11. You are miss reading this

The annual limits on benefits (i.e. limiting people to X number of dollars paid by their insurance per year) are restricted after six months, and prohibited completely in 2014.

You need to reread the language.

[ProSense]

20. No, I'm not

Protection from Rescissions of Existing Coverage

•The President's proposal will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact. This provision takes effect six months after enactment and applies to all plans.

link

[joycean]

23. You misread your own evidence, again

The link you provided from media matters is telling you that when you file a claim, your insurance can not then drop your coverage. This is not the same as denying coverage because of a pre-existing condition. It is similar, but not the same.

The denial of coverage in the first place because of a pre-existing condition is what is at issue here. And the bill currently states that insurance providers will not be allowed to ban coverage for children after 6 months of enactment, and in 2014 for adults. In the meantime, adults with pre-existing conditions without coverage right now will be put into high-risk pools.

You really need to slow down, read the language, and if you don't understand the language, look it up. I work in the medical field, I know what I am talking about. Do you?

[ProSense]

25. It's rescission, and the bill restricts the practice within six months. It

provides a high-risk pool in the interim and outlaws the practice in 2014.

Facts.

[Fire_Medic_Dave]

27. It is plain from your OP you are wrong.

For group health plans, prohibits pre‐existing condition exclusions in 2014 (for children, they are prohibited starting six months after enactment),

[ProSense]

30. Here,

read it again:

5. ENDS RESCISSIONS—Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.

[Fire_Medic_Dave]

34. Rescissions are not pre-existing condition exclusions.

An exclusion is when someone is denied insurance because of a pre-existing condition. Rescission is when an insured person is dropped.

[Fire_Medic_Dave]

29. Rescission is not Pre-Existing Condition Exclusion.

[laughingliberal]

36. Yeah, that was confusing. Seems the OP has the 2 things mixed up. nt

[joycean]

37. Wrong again, sorry

Yes, the practice of arbitrarily dropping coverage is called rescission, but the bill will prohibit that practice for everyone in 6 months. This part does not have the 2014 date attached to it.

There are at least four other people on this board trying valiantly to get you to understand that you are misreading the language of the House summary. You are not interpreting most of this correctly. I don't know if it is a lack of experience with health insurance on your part, or that you are reading too fast, but I implore you: listen to what we are trying to tell you. The prohibition on pre-existing condition denials for adults DOES NOT take effect until 2014.

[ProSense]

38. Question:

Will those with pre-existing insurance be provided coverage?

12. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH‐RISK POOL)—Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition ‐ through a temporary high‐risk pool. Effective 90 days after enactment.]

[joycean]

39. No, because

If you already have insurance with a pre-existing condition, then no, you would not get into the high-risk pool until you no longer have coverage. However, after 6 months your insurance company would not be allowed to drop you just because you are filing claims (i.e. rescission). The language you posted says: "Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition"

[ProSense]

41. What's so hard to understand:

"If you already have insurance with a pre-existing condition, then no, you would not get into the high-risk pool until you no longer have coverage. "

5. ENDS RESCISSIONS—Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.

"However, after 6 months your insurance company would not be allowed to drop you just because you are filing claims (i.e. rescission). The language you posted says: 'Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition'"

12. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH‐RISK POOL)—Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition ‐ through a temporary high‐risk pool. Effective 90 days after enactment.

[joycean]

45. Obviously something, because you are not getting it

I am going to write this big and slow, just for your pre-frontal cortex.

Rescission and Pre-Existing Conditions

ARE NOT THE SAME THING

They are similar. SIMILAR.

But there is a CONCRETE difference.

It begins with the terms INSURANCE and COVERAGE. For the purposes of the bill language:

INSURANCE is when you are applying to get on an insurance policy.

COVERAGE is when you are already on an insurance plan.

RESCISSIONS are when you are dropped from COVERAGE because you file a claim, usually when you are diagnosed with an expensive disease.

PRE-EXISTING CONDITION: It applies when you are trying to get INSURANCE and are denied because you were PREviously diagnosed with an expensive medical condition. (and probably dropped via RESCISSION)


IS ANY OF THIS GETTING THROUGH?

So, the current legislation says:

AFTER 6 MONTHS: Rescission will be prohibited for EVERYONE. Pre-existing condition discrimination will be prohibited for CHILDREN. A high-risk pool will be created for those ADULTS uninsured because of a pre-existing condition until...

2014! When ALL pre-existing condition discrimination will be prohibited.

I don't know what else I can say. Many of us have tried to get through to you. If I may suggest a book about the health insurance industry at your obvious reading level: Rainman by John Grisham

[ProSense]

53. Don't "write this big"

Read. The claims that people will be left out in the cold until 2014, whether because of a pre-existing condition or being dropped by insurers is complete BS.

[joycean]

57. Wrong today, too.

First, your first statement in your OP was flat wrong.

The title of your OP was "Ban on dropping people based on pre-existing conditions is effective 6 months after bill is enacted."

WRONG.

Then you highlighted a portion of the House summary that 'proved' your OP.

"restricts annual limits beginning six months after enactment, and prohibits them starting in 2014"

Wrong again. That's the part about annual limits, not pre-existing conditions.

Try to rewrite this all you want, but you were wrong from the beginning, and you know it.

Now, will every single person with a pre-existing condition and no insurance qualify to join the high risk pool until 2014?

No. It will only be available if your coverage was dropped at least 6 months before the enactment of the law. Also, the language of the bill makes it unclear (but likely) that the only persons eligible for this from now until 2014 will be those with a pre-existing condition right now. The senate may alter the language to close this gap, but we will see. Also, this high-risk pool could carry costs to patients as much as 37%. Most of us with insurance pay 20% (in-network).

So the outrage over the fact that the pre-existing conditions clause for adults does not go into effect until 2014, comes from the fact that there is no rationale for this delay that we can think of except giving the insurance companies more time to profit before they take on these expensive customers.

So no, you are wrong that pre-existing conditions for adults are banned in six months, wrong that this high-risk pool is somehow equivalent to an earlier passage of the pre-existing condition law. No, it is not the same. Repeating your flawed opinion over and over does not change the language of the bill.

"I have said it thrice. What I say thrice is true." -Lewis Carrol

[Fire_Medic_Dave]

58. So now you have changed your statement. I'm glad you finally understand that you were wrong.

[Fire_Medic_Dave]

43. Those with pre-existing insurance are covered!!!!!! It's not complicated.

[depakid]

17. So what's the remedy when the abuses in the above provisions continue unabated?

[joycean]

47. Torts (nt)

[depakid]

48. Doesn't look that way

For one thing ERISA preemption is still in place- cutting off a huge segment of potential plaintiff's from any remedy other than paying upfront for a lawyer to recover the amount of benefits that would have been paid out.

No tort cause of action or damages allowed.

[1776Forever]

19. Media Matters article says this is for children only - 2014 would apply to everyone......

http://mediamatters.org/research/201003110002

No Pre-existing Coverage Exclusions for Children

•The President's proposal eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the plan prohibits health insurers from excluding coverage of pre-existing conditions for children, effective six months after enactment and applying to all new plans.

[ProSense]

21. Read down further.

Protection from Rescissions of Existing Coverage

•The President's proposal will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact. This provision takes effect six months after enactment and applies to all plans.

link

[Fire_Medic_Dave]

35. You see that phrase existing coverage. That means they weren't excluded.

[NYC_SKP]

22. And, read further up.

Access to Affordable Coverage for the Uninsured with Pre-existing Conditions

* The President's proposal will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective 90 days after enactment, and coverage under this program will continue until new Exchanges are operational in 2014.


As I read this, the full on ban on refusal based on pre-existing conditions becomes effective in 2014, but this group WILL have access to affordable coverage regardless of age, effective after 90 days after enactment.

[1776Forever]

28. Wow they don't make it easy do they?

Your quote seems to say there will be help for those people and I hope that is true!

[ScreamingMeemie]

31. It's not true...only that they will offer a very (extremely) high priced high risk

pool for those of us who have been denied (x34) due to preexisting conditions. Texas has a High risk pool. Benefits for me (very little is covered with extreme deductibles) would cost anywhere from $900 and up. No, it's not an option. And no subsidy on earth will help...unless I was willing to house myself and my son in a box on the corner.

[Imajika]

24. So when they can't dump or refuse to offer insurance..

...to people with pre-existing conditions, won't that mean everyone else's policies will go up in price?

I mean, they aren't going to just absorb the loss.

My concern is, the polls are making it very clear that most people have insurance, tolerate it well enough, and don't seem to want to give up much of anything to help other people get at least some level of care.

Oh sure, people want to do something about Health Care, but not if they have to pay for it in taxes or higher premiums themselves.

So, if insurance companies are required to do a whole bunch of things right away, before the individual mandate kicks in, that cost them much more money, aren't the rest of us just going to pay more. And wouldn't this mean average rates go up and people end up blaming the entire HCR bill the Democrats just passed?

I mean, I am for HCR. We have to do something. It is very clear the current system simply doesn't work. I am just concerned that the result of this fight and final passage is that we will OWN health care in the minds of a majority of Americans, and even if things are better overall, they will blame every single thing that goes wrong with their dealings with insurance, doctors, specialists, etc on "ObamaCare".

It's the right thing to do, it's just there are a lot of pitfalls I've been mulling over.

[NYC_SKP]

33. A couple things.

Whether it's a private insurer or a government insurer, covering those with pre-existing conditions will mean higher costs distributed among existing members.

That's just math.

Government or Private, math is math. Covering people with more health problems is going to cost us all a little more.

The differences are that government health care removes the profit component.

The other point is that there are costs that we bear when we DON'T cover these people.

Preventive medicine and early intervention, even with pre-existing conditions, can SAVE money in the long term.

People without insurance still receive services, often too late and usually too costly, at emergency centers.

So, there are just a few reasons to include us all, every one, in a holistic health care system.

It will be mostly private at first, but over time we'll move closer and closer to a universal single payer system.

Hope this helps.

:P

[joycean]

40. If I may be allowed to assuage

I cannot promise that taxes will never increase. I can assure you, however, that this bill does save as much money as the Congressional Budget Office says it saves, and that means that taxes will not go up because of this bill.

A limitation on rate hikes was going to be included in this bill, but it had to be removed. Why? Because this bill is being passed under the procedural rules of reconciliation. Part of those rules (known as Byrd rules) state that nothing can be passed under reconciliation if it is not budgetary, and if it does not decrease the deficit. Unfortunately a law restricting insurance companies from raising rates does not affect the federal budget in any way.

BUT do not lose heart. We still plan to pass that piece of legislation, just not through reconciliation. It would have to survive the filibuster, but it is not beyond the realm of possibility that such language could pass both the House and the Senate, especially considering its popularity among voters, red and blue alike.

Hope that helps.

[Scurrilous]

26. K & R

:thumbsup:

[nonconformist]

32. I thought you hated mandates.

At least, that's what you said during the primary. Over and over and over again.

[ddeclue]

42. NO - it implements it FOUR YEARS from now in 2014.

it says so in your own quote.

[Juche]

44. How do they ban rescissions?

An effective way to do it IMO is to say if you do not rescind a policy within 12 months of someone joining, you are not allowed to rescind it at any time after that.

But I don't know what their mechanism is. I am wary as to the concept that the legislation has meaningful teeth to stop rescissions.

[joycean]

46. Torts, and

that is not the definition of rescission. Rescission is when you arbitrarily drop coverage because a claim is filed, and a previously healthy policy holder now has a medical condition that is expensive.

Enforcement will probably come in the form of torts, and fear of torts. Someone will be dropped, illegally under this new law, and they will sue. They will (most likely) win, receive a payment, the insurer will come to realize that it is more expensive to ignore this law than to follow it. Ideally.

[grahamhgreen]

49. Big insurance and their team of lawyers will crush these law suits handily. nt

[Juche]

52. That is what I meant with rescission

If you make it illegal to drop someone for any reason after 12 months of them joining, you can't rescind. As it stands now you can pay claims for 8 years, then get sick and have your coverage dropped. So make it illegal to drop someone after 12 months of joining for any reason. However I believe they still allow 'fraud' to be used as a justification to rescind policies, and HI companies will likely find ways to abuse that fact.

I am under the impression we already have suits and torts, but the loss of revenue from them is less than the loss of revenue from paying out claims for sick people. Not only that, but HI companies can capture the regulators (the same way they captured financial regulators) and prevent them from implementing those measures.

[WVRICK13]

50. Another Gift To Insurance Companies

They will rid themselves of these policy holders within the 6 month period and be free of them for at least 3 1/2 years until they have to issue insurance. Bet those new rates will be favorable for them.

[Change Happens]

51. Thank God! This effects both my wife and me......nt

[harkadog]

54. Don't thank god yet.

The OP post is flat out wrong.

[Fire_Medic_Dave]

59. Unfortunately the OP is wrong. Read the thread it's very clear.

[Iggo]

55. Why not six minutes?

[branders seine]

56. 'ban' effective in 2014

'restrictions' (unspecifed in your excerpts) effective in 6 mos.

[Lex]

61. "prohibits pre existing condition exclusions in 2014

(for children, they are prohibited starting six months after enactment)"

That's pretty clear.