Unintended consequences of no pre-existing conditions?

[gorfle]

Over on slashdot (www.slashdot.org) there is a discussion about the health care reform bill.

Some folks pointed out what I think is a pretty realistic flaw in banning discrimination based on pre-existing conditions, which I supported.

What is to stop people from not buying insurance, taking the $750/year fine, and then just buying the insurance when they get sick, since insurance companies can't deny people for pre-existing conditions?

[kestrel91316]

1. Have you tried to buy insurance recently? The process is very long and drawn

out as they have to round up all your ancient medical records to make sure you aren't committing fraud when filling out the application. And if, as in my case, your physicians fail to forward records though they may be a decade old because you rarely need a doctor, the insurance company simply says they cannot process your application. That's a legal stunt here in CA. They suspected I had a PEC, I think (I didn't - I'm healthy as a horse), but in CA they have not been able to deny for PEC's for years. So they find all sorts of clever ways to deny.

[Donnachaidh]

2. I wouldn't wait like that, and here is why

While they cannot deny you coverage, they also have NO caps on what they can charge people with pre-existing conditions. That's the little hole that will have the insurance companies slobbering in their cereal.

Would you like to be in the predicament of seeking insurance, and getting a price that is so outrageous you cannot possibly pay it, because YOU make too much money for a subsidy? The insurance companies don't care -- THEY avoid fines because they *did* -offer- insurance, but at a rate you cannot possibly afford.

AND - because you cannot afford it, and YOU make too much money for a subsidy - YOU get fined for your efforts. With the IRS collecting the fines. You STILL need medical care - but you've slipped into the zone of *you're fucked*.

You see, the real working class and middle class are going to get jammed all around on this mess. When you really sit down and map out the bullshit, it's going to be a nightmare.

[Gman2]

5. Flawed analysis.

You ommit the exchanges. Take your subsidy, and go to the exchange, and get good ins, for a fair price.

[Donnachaidh]

7. and what is the DATE the exchanges go into effect?

And what are the income limits on subsidies?

Knee jerk reaction to an analysis that doesn't toss confetti and sing wondrous hymns to an insurance company give away.

So answer the questions -- what are the dates and the limitations -- and wHO are running the exchanges? Let me guess -- the INSURANCE companies.

bwahahahahahahahahahahahahaha!!!! Little red riding hood buying from the big bad wolf :eyes:

[Gman2]

8. Yesterday? What planet can setup Hc in minutes?

[Donnachaidh]

34. translation -- you.don't.know YET

you use exchanges to marginalize my opinion in a previous post.

Real smart game of chess you got going there :rofl: :rofl: :rofl: Want some salt for that foot? :rofl: :rofl:

remember you need to have a few FACTS on hand if you want to argue about something :rofl: :rofl:

[muriel_volestrangler]

9. No, they cannot charge more for pre-existing conditions

Section 1201 "Allows premium rates to vary only by individual or family coverage, rating area, age, or tobacco use". Official summary here: http://www.opencongress.org/bill/111-h3590/show

[Donnachaidh]

35. sure they can -- up to 300 % for AGE after a certain age

And I can guarantee that if you have a pre-existing condition that is proven in their actuarial tables to be EXPENSIVE they will find a way to stick you with higher charges.

All of these WEAK rules in this bill probably already have been gamed by the companies. They are just waiting to implement the changes.

[pnwmom]

15. Are you sure there are no caps? That's not what I'd heard. n/t

[Statistical]

17. You sure about that.

I thought they could only vary price of insurance based on age & sex.

If they can charge whatever they want for pre-existing conditions then it is a defacto ban. Sure you can have insurance. It is $4389402389034834902849304 per day. Oh you don't want it? Well we offered.

I have to think Congress wasn't that stupid to leave a backdoor the size of Interstate 64 open.

[Fire1]

3. That's going out the world backwards for a poor person

making less than 88k a year. If a poor person can afford to pay a 750.00 fine, that same money could go toward a premium payment for affordable health insurance in the exchange!

[Lance_Boyle]

6. The $750 fine is annual.

Prices in the exchange will be that amount or more monthly. It would be a rational choice for the young and healthy to opt-out, pay the $750 "fee" and only seek to buy insurance when they fall ill. BUT, there is no restriction on how much insurers could charge when this theoretical person does fall ill and applies for coverage. I would hope to see their calculated "savings" from previous years taken as premiums at that point. Maybe not from that point onward (assuming they recover), but the freeloader problem is very real in this reform.

[Fire1]

10. ALOT of circumstances can change in four years when these

fines go into effect. The exchange is supposed to have a 'range' of affordable coverages available. I'd like to see a link indicating that ALL coverage will be the same amount (750.00)when the fines are incremental starting at $94.00.

[cbayer]

4. The fines are scheduled to increase over time so that eventually this will not be a good

option. But you make an excellent point. If the healthy "opt out" and choose to pay the fine, the risk pool issue is not resolved. This is the basic argument in support of the mandate.

[ecstatic]

11. That is what the fine addresses...

[gorfle]

14. The point is, the fine is CHEAP.

If you could pay $750 A YEAR for your fine, as opposed to paying, say, $500 A MONTH for health insurance, it's cheaper just to skip the insurance and only buy it when you get sick or injured.

If they can't deny pre-existing conditions, that's what a lot of people will do.

[ecstatic]

21. It wouldn't be very wise

but then again, there are people who drive the streets with no car insurance. Yet I find that that approach of trying to squeeze a few pennies by avoiding necessary insurance ends up costing way more in the end.

If someone is sick and waits til the last possible moment to sign up (or worse, is unconscious as a group of strangers decide where to take him/her), they may wake up to find out they had a treatable illness but now only have six months left to live. Or they may wake up having just had surgery performed by a bunch of students at a less than stellar hospital.

I guess everyone is free to make a determination of how much their life is worth and go from there. Is emergency room care by unknown doctors good enough? If so, roll the dice.

Also, from my understanding, there will be subsidies for people who need them. I have the feeling that it won't be so much about who can afford what, but about whether someone wants to pay for it.

[harun]

12. I don't think many people will think that is wise. You'll get a few

whacko's taking exemptions to not pay but I doubt this will be more than 1% of the people.

[EFerrari]

13. What is to stop the insurance cos from just taking the fine for discriminating?

:shrug:

[bridgit]

16. I understand the concern, but "to stop people from not buying insurance, taking the $750/year fine

"and then just buying the insurance when they get sick" is a Limbaugh talking point

[Statistical]

18. Well it really depends on how expensive the insurance ends up being.

Get a couple years of 39% premium increases and I may decide to "opt out" knowing I can get back in for catastrophic coverage if/when needed.

[gorfle]

23. How so?

It seems to me a legitimate concern. Why would I pay $500 a month for health insurance if I could skip it and pay only $750 A YEAR in fines? I'd save $5200 a year by not buying insurance.

And if I need insurance, I can wait until I need it and then buy it, since I can't be denied coverage.

About the only thing against going this route is it seems that while you can't be denied coverage, there is no cap on how much the insurance companies can charge you for insurance.

Which means that pre-existing coverage insurance is simply going to be hugely expensive. Rather than denying pre-existing conditions, they'll say, "Sure, we'll sell you insurance for your pre-existing condition...only it's going to cost you $5000 a month!"

[bridgit]

24. How so? How so what? Its Limbaugh's talking point, I'm confident he'll defend it for you

It is the case, however, that people are able to set themselves up for rude awakenings merely as a result of their attempts to be penny wise and pound foolish - that will come into play the day they walk not up to the receptionist of a doctor's office expecting to be seen and treated - but the counter at which you'd be picking up these insurance services; and yes I know :eyes: but nevertheless after the fact with a broken limb in hand. How will that work, explain that to me

Cause you can no sooner collect on an insurance policy you do not have *after* your car crashes (even into another uninsured motorist who is also 'saving money'), your airline tumbles into the Bermuda Triangle, a Super Bowl or Red21 if you have no money on the table

If people think themselves extra-prescient one particular day, like that guy in the Twilight Zone with the quarter that landed on its side; and see a medical calamity in their very near future then yeah - crash the car, tumble the plane, bet on the Super Bowl and spin the wheel going by but you're talking about a form a gambling, and as regards health issues that may end up involving prayers and tears so I gotta tell'ya that sure...

Plinko has 10,000 bucks right down the middle, but there are 0's on either side. And that is able to generate a 2/3's chance to save nothing



edit: to

[gorfle]

31. But if you can't deny pre-existing conditions...

that will come into play the day they walk not up to the receptionist of a doctor's office expecting to be seen and treated - but the counter at which you'd be picking up these insurance services; and yes I know :eyes: but nevertheless after the fact with a broken limb in hand. How will that work, explain that to me


If you cannot be denied insurance for a pre-existing condition, what is to stop someone from breaking their arm and then going to buy insurance after-the-fact to cover that pre-existing condition?

Are hospitals going to now turn away people who don't have insurance?

It suppose it is possible that insurance companies will charge exorbitant sums for such pre-existing condition insurance polices, but if they are allowed to do that, won't they just do that for anyone with a pre-existing condition? And if so, isn't that the same thing as just denying coverage for pre-existing conditions?

[bridgit]

33. Very well. How bout you walk in with "a broken limb in hand" every three weeks?

It is to be a continued belief that there are no limits to anything? Doesn't that fall into the generalized 'my dog ate my homework' bin?

[gorfle]

37. I have no idea what you are talking about.

Very well. How bout you walk in with "a broken limb in hand" every three weeks? Doesn't that fall into the generalized 'my dog ate my homework' bin?

Why would someone do that? I've only had one broken bone my entire life. What's to stop someone from not carrying insurance for years, paying only the annual $750 fine, and then buying insurance just ONCE after being diagnosed with an illness or injury?

What this has to do with homework or dogs is beyond me.

[bridgit]

38. Gaming the system will in the future be discouraged

[Motown_Johnny]

19. that is why the mandate is trying to force people to get insured

the fine will be contributed to the system to help pay for the people who take this route.

[gorfle]

22. But it can't possibly make up for it.

A measly $750 A YEAR fine is cannot possibly make up not buying insurance.

Even a simply c-section delivery is $10,000. You're talking about over 10 years of fines just to make up one delivery.

[Lex]

27. Yeah, but not everyone who is fined will need a procedure.

nt

[gorfle]

30. Just about everyone does eventually. n/t.

.

[kctim]

20. Hopefully nothing stops them

since I plan on doing the same thing now.

[optimator]

25. I hope everyone refuses to buy insurance

.

[kiranon]

26. There are always those who take advantage of the system. IMHO

it is not a reason to deny health insurance to everyone else because of it. Better to have insurance and services available at reasonable, negotiated rates than multiple visits to ER. What do you suggest be done? Let a cancer patient die on the front lawn because he/she did not buy insurance earlier? Give them a bigger fine? Take their house or car away from them? Put a lien on their estate? Not care for a TB patient or make him/her wait for medication and endanger everyone he/she comes in contact with? Just asking.

[gorfle]

32. I favor single-payer.

What do you suggest be done? Let a cancer patient die on the front lawn because he/she did not buy insurance earlier? Give them a bigger fine? Take their house or car away from them? Put a lien on their estate? Not care for a TB patient or make him/her wait for medication and endanger everyone he/she comes in contact with? Just asking.

I favor a single-payer, government-run insurance plan that covers everyone.

[Lex]

28. This is why eventually it will have to logically be single-payer.

nt

[Eric J in MN]

29. fines: "$695 for an individual or 2.5 percent of household income in 2016, whichever is greater."

http://www.philly.com/inquirer/world_us/88797017.html

[shimmergal]

36. It works for AAA.

To the best of my knowledge, a non-member CAN phone in when they're stranded on the highway, pay a year's membership fee with their credit card, and then AAA will send a wrecker under the free towing service.

Some big differences here, of course. Joining AAA costs less than $100, and most people who join do it routinely, rather than take the above route. Still, in principal it's not so different from what Hillary explained about a mandate: if you end up in the hospital, they'll sign you up on the spot (though she did -- wisely -- have a public option you could join then.)