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Gotta Cover Those Pre-Existing Conditions
Old 02-25-2016, 09:23 PM   #1
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Gotta Cover Those Pre-Existing Conditions

So, watching the debate tonight, all the candidates mentioned they'd not exclude based on pre-existing conditions no matter what form a future health care system would have. IMO, the pre-existing coverage is a good given as a starting point .
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Old 02-26-2016, 05:45 AM   #2
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Pre-existing conditions are one of the main ways for health insurers to exclude people. It also keeps rates high.

Once a group of people are in a plan, the insurer raises rates. The healthy one leave to find a better policy, so the plan has more claims. Rates raise again, and more healthy people leave.

Soon, only the pre-existing condition people are in the plan. they have to pay more, as they cannot leave.

If the ACA would have just gotten rid of that piece, along with any waiting periods, and let insurers compete across state lines, I think health insurance would be much cheaper today. An insurance mandate is also a good idea.
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Old 02-26-2016, 06:14 AM   #3
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If the ACA would have just gotten rid of that piece, along with any waiting periods, and let insurers compete across state lines, I think health insurance would be much cheaper today. An insurance mandate is also a good idea.
The ACA gets hammered over the mandate but that was what enabled no pre-existing conditions. As to insuring across state lines, that was stopped dead by ACA opponents as was the public option, another good idea. Of course, either of those things could be instituted with a statutory tweak if Congress ever returns to governing.
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Old 02-26-2016, 06:26 AM   #4
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As to insuring across state lines, that was stopped dead by ACA opponents as was the public option, another good idea. Of course, either of those things could be instituted with a statutory tweak if Congress ever returns to governing.
Almost correct. The not insuring across state lines was a part of the original bill. It was never stopped, as it was never in. Maybe it was in when they were drafting it? Maybe it was the insurers themselves that stopped it?

More competition would be a great tweak. Even international insurers, who had a presence here in the USA, might be a great option.

There may even be an international insurance company that can team up with overseas medical professionals to work here in the USA. They could even create a medical center, like the Mayo.
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Old 02-26-2016, 06:32 AM   #5
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Almost correct. The not insuring across state lines was a part of the original bill. It was never stopped, as it was never in. Maybe it was in when they were drafting it? Maybe it was the insurers themselves that stopped it?
I can't really remember precisely what was in the first bill debated. I think both cross state plans and the public option were pushed early on but drafters backed arguing that those provisions would never get through. I vaguely remember some discussion very early about modeling the pools on the Federal plan which has both nationwide plans and local plans but who knows. that might even go back to 1993.

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More competition would be a great tweak. Even international insurers, who had a presence here in the USA, might be a great option.

There may even be an international insurance company that can team up with overseas medical professionals to work here in the USA. They could even create a medical center, like the Mayo.
+1
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Old 02-26-2016, 07:05 AM   #6
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1) If you want to mandate that insurance must cover pre-existing conditions then . . .

2) You must also require everyone to have insurance so that they don't wait until they get sick to get insured a.k.a. an "Individual Mandate."

3) And if the government mandates that everyone must buy insurance, then the government really should help poor people afford that mandated coverage.

Welcome to the logic and basic framework of the ACA.

As of yet no one has figured out how to provide the first thing without also doing the second and third things too.
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Old 02-26-2016, 07:17 AM   #7
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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.
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Old 02-26-2016, 07:54 AM   #8
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Gotta Cover Those Pre-Existing Conditions

How does the cross state insurance idea differ from the multi state options available under ACA?

And is cross state insurance expected to make a big difference in premiums? I'm asking because ACA caps MLR at 80% and from California's experience it seems more important to have competition at the provider level. Would it make a bigger impact (cross state ins) for small states?


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Old 02-26-2016, 07:55 AM   #9
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Originally Posted by Gone4Good View Post
1) If you want to mandate that insurance must cover pre-existing conditions then . . .

2) You must also require everyone to have insurance so that they don't wait until they get sick to get insured a.k.a. an "Individual Mandate."

3) And if the government mandates that everyone must buy insurance, then the government really should help poor people afford that mandated coverage.

Welcome to the logic and basic framework of the ACA.

As of yet no one has figured out how to provide the first thing without also doing the second and third things too.
Good points. The only way to avoid make a system without a mandate or preexisting conditions work would be if as a society we were willing to let people who decide not to buy health insurance, get sick and can't afford their medical care to go without medical care and live with the natural consequences of their decision not to buy health insurance.... and I don't see that happening. If you eliminate preexisting conditions and don't mandate then it makes it too easy for people to game the system and absorb the cost of a serious illness only until the next enrollment period and then push the cost of their care onto the rest of us by purchasing insurance. We already have a smaller version of this in that people can keep HDHP while they were healthy and then buy a better plan once they are sick.
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Old 02-26-2016, 08:03 AM   #10
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Originally Posted by photoguy View Post
How does the cross state insurance idea differ from the multi state options available under ACA?

And is cross state insurance expected to make a big difference in premiums? I'm asking because ACA caps MLR at 80% and from California's experience it seems more important to have competition at the provider level. Would it make a bigger impact (cross state ins) for small states?


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I was having similar thoughts. Today, insurers can cross state lines by just registering and selling insurance in another state... it is just that consumers cannot. I don't see allowing buyers to cross state lines as working because rates are ostensibly based on the cost of health care in the area the insurance is being sold (expected claims) divided by the 80% MLR and then adjusted based on competition.

If insureds in a HCOL area bought insurance priced for a LCOL area it would just push up premiums in the LCOL area as the claims cost for that cohort increase and the policy in the HCOL area would collapse due to no customers. Besides, networks are the way insurers manage claims costs and there are no national networks.

If medical costs were uniform across the country then perhaps it would work, but they are not.
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Old 02-26-2016, 08:20 AM   #11
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I don't know that I've seen an estimate of cost savings from selling across state lines, but I imagine that it would be modest savings at most and more likely just a red herring. Credit cards, for example, are not less expensive since they were all allowed to "move" to South Dakota (or wherever.) Allowing health insurance to be sold across state lines could only be done effectively, if the Feds were able to strongly regulate the practice, otherwise there would be a race to the bottom in regulation of an industry with a few, very large players. Is more federal control, less local control a desired outcome?

A few years ago, one of the large insurance companies purchased a California based HMO (thus reducing competition) and promptly decided that since they were based out of another state, they would pay claims in 180 days as required by their state rather than California's 30 days. California had both the power and the will to stop them, but how would you guarantee that the people of consumer oriented states would continue to choose their own governance, rather than be governed by the preference of people living in business oriented states? California stomps its really big foot and the insurers fall in line, but Rhode Island and Wyoming don't have that power. Do you want to take that power away from Californians?

You also have the sticky topic of women's health. Would coastal women have to abide by the health care restrictions placed on women in other states?

I'm not going to tell you some of the sad stories that I lnow about pre-existing conditions, so I'll drop out of this conversation rather than get myself angry making trouble....
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Old 02-26-2016, 08:22 AM   #12
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How does the cross state insurance idea differ from the multi state options available under ACA?
Each state still has it's own insurance rules and regs under ACA. So a TX provider wanting to offer insurance in NY still has to jump through all the hoops and conform their product to the specific requirements of NY.

Mostly when people talk about "selling insurance across state lines" what they're talking about is offering the exact same product that's available in TX to people living in NY.

Back in the "olden days" before ACA there were huge differences in the price of insurance at the state level because of huge differences in regulatory requirements.

New York, for example, required insurance companies to sell policies regardless of pre-existing conditions whereas Texas did not. That made NY a hugely expensive place for individuals to buy health insurance because only sick people bought policies. In Texas, individual policies were much cheaper because insurance companies could and did refuse to insure sick people.

Now some folks looked at the price discrepancies between NY and TX and concluded there was a simple solution. Because TX policies were cheaper than NY policies, we could reduce the cost of all policies by letting TX providers "sell insurance across state lines" to people in NY.

Other people looked at the same situation and noticed that the reason TX polices were cheaper is because they could screen out sick customers. NY deliberately forbid that practice. So allowing TX companies to sell TX products governed by TX rules to people in NY did nothing more than dismantle New York's rule requiring insurers to accept people with pre-existing conditions.

People feared that if this were allowed, all insurance companies would set up shop in whatever state had the least regulation and fewest consumer protections. Eventually we'd end up with a largely de-regulated health insurance market.

Some people saw that as a virtue. Not surprisingly, other people saw it as a huge problem.

Since the passage of ACA this all seems like a much smaller issue. The price differences and regulatory schemes between states aren't as large. There's no longer a big concern that competition between states would result in a "race to the regulatory bottom" because everyone still has to abide by the ACA.

Ironically, with ACA there's probably a better case for allowing cross-state competition than before. Today cross-state competition would be less about regulatory arbitrage and more about creating a larger risk pool. And a larger risk pool should be cheaper to insure.

But mostly whenever I read that someone wants to "allow insurance across state lines" they're usually talking about going back to the pre-ACA days of regulatory arbitrage.
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Old 02-26-2016, 08:36 AM   #13
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Solving our health care problems by permitting insurers to sell across state lines brings to mind the quote of Menkin "There is always a well-known solution to every human problem--neat, plausible, and wrong." It's right up there with balancing the budget by eliminated waste, fraud and abuse.
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Old 02-26-2016, 08:42 AM   #14
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Here's a really good summary of the problems with the claim about cost sqvings from selling across state lines:
http://www.nytimes.com/2015/09/01/up...ines.html?_r=1
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Old 02-26-2016, 09:03 AM   #15
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Thanks everyone for the input and thoughts on cross state plans.
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Old 02-26-2016, 09:13 AM   #16
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If the ACA would have just gotten rid of that piece, along with any waiting periods, and let insurers compete across state lines, I think health insurance would be much cheaper today. An insurance mandate is also a good idea.
This would not benefit the insurance industry, and they're the ones who wrote the ACA to begin with...

Obamacare Architect Leaves White House

Lots of door revolving going on as well, not just her:

Obamacare's Revolving Door
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Old 02-26-2016, 09:14 AM   #17
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I did read on CNBC? that several insurers were complaining that some people were loading up on platinum plans, getting expensive treatments in the beginning of the year and then dropping the insurance after their was treatment. Not sure how widespread that is but obviously it's a way to potentially "game" the system.
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Old 02-26-2016, 10:38 AM   #18
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Good points. The only way to avoid make a system without a mandate or preexisting conditions work would be if as a society we were willing to let people who decide not to buy health insurance, get sick and can't afford their medical care to go without medical care and live with the natural consequences of their decision not to buy health insurance.... and I don't see that happening. If you eliminate preexisting conditions and don't mandate then it makes it too easy for people to game the system and absorb the cost of a serious illness only until the next enrollment period and then push the cost of their care onto the rest of us by purchasing insurance. We already have a smaller version of this in that people can keep HDHP while they were healthy and then buy a better plan once they are sick.
+1

IMHO, the real issue in American health care costs is not providing insurance for those who have a known health problem. It's why Americans pay so much more for the same medicines, treatments, prosthetics, etc. than our equals in Europe, Japan, Canada, etc.
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Old 02-26-2016, 02:30 PM   #19
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I do not see how allowing insurance companies to sell across state lines will actually do much....

There are 3 to 5 big players in health insurance and some minor players... the big players probably are in all 50 states right now... the minor players probably do not want to ramp up in other states.... of if they do, at a slow pace....

So, no change...
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Old 02-26-2016, 03:38 PM   #20
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I do not see how allowing insurance companies to sell across state lines will actually do much....

There are 3 to 5 big players in health insurance and some minor players... the big players probably are in all 50 states right now... the minor players probably do not want to ramp up in other states.... of if they do, at a slow pace....

So, no change...
I don't doubt you but I wonder why nobody ever brings this up and slaps them in the face with it? Bernie hasn't. Robert Reich hasn't. Even people on The Right side of the spectrum. If they know "The marketplace" mechanics they'd have noticed this too instead of repeating it. This has to have hit more people than just you and me.
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