Tracym

I was curious, looking at Obama's health care proposal. Sounds reasonably nice, acceptable to folks.

But one thing I haven't figured out yet - re. pre-existing conditions. That is one of the biggest problems with our system, I think. If you're healthy, insurance doesn't generally cost that much.

Here's what I can't tell yet - can you?

He says people can't be turned down because of pre-existing conditions.

But, does the insurance have to COVER that condition?
And, can they charge more for it?

If they can deny coverage for a condition, or charge through the nose for it, that would pretty much invalidate the usefulness of accepting the people.

Anyone know?

Tracym

His plan seems to say a few conflicting things to me:

"Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status."

and

"For small businesses, having a single employee with catastrophic expenditures can make insurance unaffordable to all of the workers in the
firm. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers' premiums."

paddingtongreen

The original insurance companies were "mutual" companies, they accepted all comers and the risks, and ownership, were shared. He wants to go back to the shared risk principle.

Since companies became profit centers they have tried to eliminate the high risks, and that destroys the original principle. Start by assuming that everyone is healthy, with the same risk factors and then set uniform rates for coverage, based on experience, change all of the rates when experience cost go up.

The "Existing condition" problem is manufactured by the companies and is completely unfair in its application. You could work for a company for, say, 20 years, covered by Blue Cross, and get sick in the last year, just before you get downsized. If the new job is with a company that uses United health, you lose coverage of the condition because it is now a pre-existing condition. If you strayed with the original company, Blue Cross would continue coverage.

If you made people pay premiums that cover their own costs, there would be no point to being insured.

Tracym

I agree, kill all the actuaries

Actually, that highlighted bit isn't always true anymore. HIPAA would make the next company cover your pre-existing condition, as long as it's a group plan, hasn't been too long since your last health care, etc...

But the thing is - Obama's plan says they have to ACCEPT people with the conditions. It doesn't specifically say they have to cover that condition, that they can't exclude it. Probably they do, but I can't really find that stated.

He also does NOT say they can't charge more for those people- exactly. The two statements I quoted from his website seem in opposition to each other - why would there be more costs that the govt. would have to defray, if the same price was charged for all employees?

I'm still confused.

paddingtongreen

He isn't going single payer, so the different groups will have different cost experiences. My wife had leukemia, and had a bone marrow transplant that cost about a quarter of a million, even at the reduced rates that BC negotiates. If that had been with a small group, it would have been disastrous to their premium structure.

Tracym

So you think he IS allowing for different premiums? Although his first statement seems to contradict that...

I hope your wife is ok btw, what a terrible thing to go through.

paddingtongreen

I think he means uniform within the group.

My wife recovered from the leukemia but six years later, got terminal endometrial cancer, she died in 2002.

Tracym

Oh I am so sorry. Life sometimes is so unfair.

As far as prices just being uniform within a group, I'm not impressed. I believe it's that way now - big deal.

paddingtongreen

Except for the pre-existing conditions and the must offer part. If you are not covered by a "group", they can refuse you.

Bob

The problem with pre-existing conditions, to get around having to pay a huge whack of cash, some companies say you've got to be there for x period of time before your eligible for certain benefits, with that kind of gap in coverage, HIPAA won't be any use....and lets face it, who honestly can afford cobra long term unless they're single and not home owners?

Tracym

Right, I meant group plans - I am well aware that HIPAA didn't help with individual.