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Old 02-26-2016, 04:17 PM   #21
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As someone who worked in the actuarial field for 23 years (specializing in personal auto insurance), someone who lives in New York who has seen pre-ACA rates rise since I joined the individual market in 2009, and someone who has developed some health issues in the last 12 months, I can offer several perspectives in this good thread.


(1) Gone4Good's first post (#6) is right on target. The individual mandate is the price to be able to cover everyone if they are sick or not. A single payer system also has the healthy people paying into a system via taxes.


(2) Pb4uski's post (#9) is also on target. You can't have free riders gaming the system. That is, people waiting until they get sick to buy insurance. In my old personal lines field (I worked in personal homeowners for a little while, too), people couldn't buy HO insurance just as a hurricane was nearing their shoreline home because that was gaming the system. They had to buy it a certain amount of time (I forget what it was) before they could make a storm-related claim.


(3) The discussion about cross-state insurance reminds me of problems Vermont insurers had with people there buying cheap auto insurance using their second homes (usually used for skiing) as their domiciles even though their cars were actually registered in NY City where they lived most of the year. The added claim activity from living in a high-claim area resulted in higher insurance rates for those Vermonters who actually lived in VT year-round and resulted in a crackdown on these fraudsters. I also share the concerns about the "race to the bottom" about cross-state planes and varying state regulations.


(4) I had been very healthy until last year when I developed some health issues. One was solved with some minor surgery but the other resulted in my being diagnosed with Diabetes. Without the ACA, I would still be in the situation described by Senator's first post (#2). But now, I can shop around and find a more suitable and affordable plan (still a Silver one) than I had before.
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Old 02-26-2016, 04:54 PM   #22
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I'd hate to see the requirement to cover pre-existing conditions eliminated. I'm 63 and by all accounts insanely healthy, but I've had a couple of benign colon polyps, had a benign breast lump removed when I was 18, and have borderline high cholesterol which I prefer to control with diet and exercise. In the Bad Old Days, an insurance company might offer me coverage but exclude any problems related to breast or colon cancer or, worse, take my premium for years and then when I developed something expensive, go back through my medical records with a fine-tooth comb and deny my claim because I never told them I had 3 kidneys. (No, I'm not making that up. ) In one notorious case a photogenic 3-year old was denied coverage for cancer because his mother hadn't noted on the application that she'd taken antidepressants years ago.

The whole principle of insurance is that the many cover the expensive losses of the unfortunate few.



I would, however, STRONGLY support wellness programs such as those used in some employer plans, which give you financial and other incentives for keeping your weight at normal levels, lowering your blood pressure, controlling your diabetes, etc. (I'm typing this on a computer purchased with $400 worth of Amazon.com credits from my last employer's wellness program.) One Harvard study concluded that obesity added about $1.5 billion a year to health care costs. Let's focus on controlling the controllable, but covering everyone for the "there but for the grace of God go I" stuff that can happen to any of us.
While having virtually no claims over the last thirty years I certainly can understand the concern. I have heard enough examples of preexisting conditions to include rather normal aging conditions. You really need to drill down beyond the current situation of those posting here and elsewhere. Fit and Forty, Fifty five with lifetime healthcare and everthing in between.

Personally I have corporate retiree medical but I surely wouldn't want to exclude those with pre existing conditions
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Old 02-27-2016, 02:07 AM   #23
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Originally Posted by scrabbler1 View Post
As someone who worked in the actuarial field for 23 years (specializing in personal auto insurance), someone who lives in New York who has seen pre-ACA rates rise since I joined the individual market in 2009, and someone who has developed some health issues in the last 12 months, I can offer several perspectives in this good thread.


(1) Gone4Good's first post (#6) is right on target. The individual mandate is the price to be able to cover everyone if they are sick or not. A single payer system also has the healthy people paying into a system via taxes.


(2) Pb4uski's post (#9) is also on target. You can't have free riders gaming the system. That is, people waiting until they get sick to buy insurance. In my old personal lines field (I worked in personal homeowners for a little while, too), people couldn't buy HO insurance just as a hurricane was nearing their shoreline home because that was gaming the system. They had to buy it a certain amount of time (I forget what it was) before they could make a storm-related claim.


(3) The discussion about cross-state insurance reminds me of problems Vermont insurers had with people there buying cheap auto insurance using their second homes (usually used for skiing) as their domiciles even though their cars were actually registered in NY City where they lived most of the year. The added claim activity from living in a high-claim area resulted in higher insurance rates for those Vermonters who actually lived in VT year-round and resulted in a crackdown on these fraudsters. I also share the concerns about the "race to the bottom" about cross-state planes and varying state regulations.


(4) I had been very healthy until last year when I developed some health issues. One was solved with some minor surgery but the other resulted in my being diagnosed with Diabetes. Without the ACA, I would still be in the situation described by Senator's first post (#2). But now, I can shop around and find a more suitable and affordable plan (still a Silver one) than I had before.
great post!

so I guess I can't wait until my house is actually on fire to buy my fire insurance ?

what a rip-off.
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Old 02-27-2016, 10:43 AM   #24
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Gotta Cover Those Pre-Existing Conditions

I wonder why they can't say if you have existing health insurance in the last year or 5 year or even 10 years, then you can't be denied for pre existing condition. Lots of people who have health insurance until they get laid off. I admit I only skimmed the whole thread.


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Old 02-27-2016, 11:37 AM   #25
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Well, I have to say I am encouraged. If candidates are promising pre-existing conditions coverage on whatever new plan they envision, then they must know they'd get too much push-back to deny such coverage. They must recognize that denying medical insurance coverage for pre-existing conditions today is not longer politically palatable.

But then they've pretty much boxed themselves in. Because covering pre-existing conditions pretty much forces the other things that people like to complain about.
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Old 02-27-2016, 11:48 AM   #26
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I wonder why they can't say if you have existing health insurance in the last year or 5 year or even 10 years, then you can't be denied for pre existing condition. Lots of people who have health insurance until the get laid off. I admit I only skimmed the whole thread. ....
I don't see that as workable. If someone has not had insurance for the last 1, 5 or 10 years and has a pre-existing condition does that then mean that they can never buy health insurance? Is that what we want? That a close cousin to where things were before.
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Old 02-27-2016, 11:59 AM   #27
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How can they keep pre-existing conditions coverage and get rid of the individual mandate, which ACA opponents hate more than anything else?

I've heard conservatives say pre-existing conditions requirement is not fair to insurers so they should not be forced to provide coverage.
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Old 02-27-2016, 12:21 PM   #28
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How can they keep pre-existing conditions coverage and get rid of the individual mandate, which ACA opponents hate more than anything else?

I've heard conservatives say pre-existing conditions requirement is not fair to insurers so they should not be forced to provide coverage.

Well, we could limit the types of treatment made available for pre-existing conditions so that the sickies wouldn't be a drag on the system.

For example:
http://youtu.be/9m2FxgyADpQ

It's been done before. Sound fair to everyone?


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Old 02-27-2016, 12:23 PM   #29
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How can they keep pre-existing conditions coverage and get rid of the individual mandate, which ACA opponents hate more than anything else?

I've heard conservatives say pre-existing conditions requirement is not fair to insurers so they should not be forced to provide coverage.
That's why I thought it was encouraging to see candidates embrace the concept of covering pre-existing conditions. They apparently feel they can't run on a platform that removes coverage for pre-existing conditions.

And yes, even though the individual mandate is hated by ACA opponents, I don't see how you can remove it without dropping pre-existing conditions.

The insurer fairness thing is a big can of worms. We have so few large medical insurance companies now. Congress has given them a pass on anti-monopoly rules. Plus they helped write the ACA.
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Old 02-27-2016, 12:45 PM   #30
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And yes, even though the individual mandate is hated by ACA opponents, I don't see how you can remove it without dropping pre-existing conditions.
I agree. One reason employer medical coverage has worked so well for decades is that nearly everyone was enrolled; I suppose there were exceptions for people who were on a spouse's or parent's plan, but since there was little incentive to opt out when the employer provided it at little or no cost to the employee, the insurer got the healthy employees, too. (And, of course, even being healthy enough to work FT meant lower costs on average.) You couldn't game the system by waiting to enroll till you got sick because typically you could enroll only when you started, as of January 1, or if certain qualifying events happened (e.g., married, spouse lost job, etc.)

Medicare has similar requirements. If you hit Medicare age and don't immediately start Part B and prescription coverage and try to enroll a few years later when you get sick and/or get an expensive prescriptions, you'll get hit with a permanent surcharge on your premiums. The only way around it is if you had "equivalent coverage"- in DH's case he signed up when I retired and I was 61, he was 76. He'd been on my employers' plans so there was no surcharge.
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Old 02-27-2016, 01:29 PM   #31
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I don't see that as workable. If someone has not had insurance for the last 1, 5 or 10 years and has a pre-existing condition does that then mean that they can never buy health insurance? Is that what we want? That a close cousin to where things were before.

Why not? This encourages people to buy insurance. No mandate necessary. What we have now doesn't work for most people anyway. Some people has huge deductible and the premium is also expensive. They get to spend zero health care.


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Old 02-27-2016, 01:31 PM   #32
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I agree. One reason employer medical coverage has worked so well for decades is that nearly everyone was enrolled; I suppose there were exceptions for people who were on a spouse's or parent's plan, but since there was little incentive to opt out when the employer provided it at little or no cost to the employee, the insurer got the healthy employees, too. (And, of course, even being healthy enough to work FT meant lower costs on average.) You couldn't game the system by waiting to enroll till you got sick because typically you could enroll only when you started, as of January 1, or if certain qualifying events happened (e.g., married, spouse lost job, etc.)

Medicare has similar requirements. If you hit Medicare age and don't immediately start Part B and prescription coverage and try to enroll a few years later when you get sick and/or get an expensive prescriptions, you'll get hit with a permanent surcharge on your premiums. The only way around it is if you had "equivalent coverage"- in DH's case he signed up when I retired and I was 61, he was 76. He'd been on my employers' plans so there was no surcharge.

I like the surge charge too or give people with health insurance like car insurance more discount the longer they have the insurance. The penalty is too small compare to the insurance premium.


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Old 02-27-2016, 01:34 PM   #33
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Well, we could limit the types of treatment made available for pre-existing conditions so that the sickies wouldn't be a drag on the system.

For example:
http://youtu.be/9m2FxgyADpQ

It's been done before. Sound fair to everyone?


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With the existing plan, most people avoid to have the small income because they don't really want the Medicaid plan. I know my sister does. But she barely exercises, if she can, she would watch Korean soap for 24 hours. Yes she is the sickest person in my family and also poorest.


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Old 02-27-2016, 01:51 PM   #34
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Well, we could limit the types of treatment made available for pre-existing conditions so that the sickies wouldn't be a drag on the system.

For example:
http://youtu.be/9m2FxgyADpQ

It's been done before. Sound fair to everyone?
Sounds to me like you are trying to get this thread closed!

Isn't this the kind of post that would earn a warning for most of us?
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Old 02-27-2016, 02:03 PM   #35
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And yes, even though the individual mandate is hated by ACA opponents, I don't see how you can remove it without dropping pre-existing conditions.
It's easy if you don't care about detonating the entire law . . . "see, we told you it wouldn't work."
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Old 02-27-2016, 02:07 PM   #36
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....Some people has huge deductible and the premium is also expensive. They get to spend zero health care. ....
Why do you think they call it insurance?

For car insurance you pay premiums and most years don't have any claims but every once in a while you do. Ditto with home insurance. In fact, home insurance is probably a better analogy in that some years you have no claims, some years perhaps a small claim and every so often someone has a big claim.
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Old 02-27-2016, 02:17 PM   #37
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For years or rather decades, we had no health insurance claims. Then suddenly, between my son and myself the insurance had to pay in the 6 figure over 3 years, and that's after we paid our $30K deductible ($10K/year). It could be a lot worse. So, I am not complaining anymore.

By the way, our care level was good. Not much to complain about. We got the best treatments that medicine had to offer. In my shoes, Bill Gates would have a nurse stationed by his hospital bed 24 hours at his beck and call, but he would not get different medicine or surgeries.
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Old 02-27-2016, 02:29 PM   #38
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For years or rather decades, we had no health insurance claims. Then suddenly, between my son and myself the insurance had to pay in the 6 figure over 3 years, and that's after we paid our $30K deductible ($10K/year). It could be a lot worse. So, I am not complaining anymore.

Years ago, a solo-practice consulting actuary I knew tried to get coverage for his family with a $10k deductible and couldn't find it. My, how times have changed! I can't complain about my high deductible; like you, I want to be protected against the really expensive nightmares. I would, however, like more transparency about what tests and other procedures will cost me when weighing options!
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Old 02-27-2016, 02:33 PM   #39
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Years ago, a solo-practice consulting actuary I knew tried to get coverage for his family with a $10k deductible and couldn't find it. My, how times have changed! I can't complain about my high deductible; like you, I want to be protected against the really expensive nightmares. I would, however, like more transparency about what tests and other procedures will cost me when weighing options!
Our serious illnesses were covered by a pre-ACA policy. I think post-ACA, the care should still be the same.

And yes, I still want to know what each procedure or medicine costs, even if it is covered by the insurance. I do not know beforehand, but do get the invoices afterward for everything. The problem is all the items are coded with no description, as if they do not want you to know. I guess I could look the codes up somewhere, but have not done that.
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Old 02-27-2016, 02:52 PM   #40
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Why do you think they call it insurance?
Except it really isn't. A better name would be called health care intermediation, with a rider for insurance. The "insurer" is not simply insuring risk, as is the case with life and homeowners. They are imposing themselves between providers and consumers and extracting money from each. If we, as consumers, had the option of health care at the same price as the insurer, the market might structure itself more like auto insurance. Now, however, we are forced into the insurance product by law and also coerced by pricing.
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