House "Affordable Health Care for America Act"

[dgoldenz]

IMO, your trade group, AHIP, is the most duplicitous, dishonorable group of incompetent jackals in existence. If your company is still a member, they should be ashamed.

AHIP is largely responsible for the mess we are now in--in so many ways.

Not that I have a strong opinion on this.

AHIP is a bunch of crooks that would sell agents down the river in a second if they could...

 

[M Paquette]

I sell health insurance.... their great healthcare reform is going to cost them $1500 per month instead.

So, my rates will go down, eh? Yaaaay for me.


Nothing personal, but I've never had particularly good luck relying on salespeople for unbiased product information and projections on future pricing.

 

[dgoldenz]

So, my rates will go down, eh? Yaaaay for me.


Nothing personal, but I've never had particularly good luck relying on salespeople for unbiased product information and projections on future pricing.

You probably haven't found a good salesperson then. That is why I am an independent agent - I don't have to sell anything for a particular company, I sell for all of the major ones in my state based on the client's needs and medical history. You can't jam a square peg in a round hole, but a lot of people love to take that approach....not me.

It is impossible for a salesperson to perfectly project future prices since there are so many variables in health insurance and things change rapidly. However, it has been proven time and time again that guaranteed-issue health insurance is incredibly expensive and rightly so based on the amount of claims for COBRA and HIPAA policies versus traditional underwritten coverage. All you have to do is go to https://www.mahealthconnector.org/portal/site/connector/ and run some numbers for yourself to see what you can expect. That is the Massachusetts "health exchange" - Mass. has guaranteed-issue policies with no pre-existing conditions. A family of 4 with two 55-year-old parents can expect $1200/month for a junk policy or $1500-3000 per month for a very good policy. A 60 year old husband/wife can expect $1000/month for a junk policy and $1500-2500/month for a good policy. If a husband/wife make over $46k per year, they get no subsidies. What kind of person making $50k (let's call it $40k after taxes) is going to shell out $15k of after-tax money on health insurance premiums? That's before you pay anything for deductible/copayments.

Take a look at the cost of health insurance in New York where they have community rating (everyone pays the same price regardless of age, sex, or health) - great deal for old people, horrible deal for young people. A 20 year old in perfect health in NY would pay $450/month for a junk policy, $1000/month for a good one. How many 20 year olds have $450, let alone $1000/month to spend on health insurance?

 

[FinanceDude]

Also I'd like to give a shout out to all those nice folks making a $1 million+ who are helping to fund my Hawaii retirement, keep working hard we need you to pay the extra 5.4% on the income...

SO, we're going to punish the folks who create all the jobs in this country, and believe they won't find ways to reduce their income and such? Boy, I guess Joe Biden was right when he said: "It's patriotic to pay taxes".......

 

[DeborahB]

You probably haven't found a good salesperson then. That is why I am an independent agent - I don't have to sell anything for a particular company, I sell for all of the major ones in my state based on the client's needs and medical history. You can't jam a square peg in a round hole, but a lot of people love to take that approach....not me.

I'm curious - since you are an agent (and not in my state), how hard is it for someone like me to get insurance and what type is the most likely to be underwritten? Is it easier for me to be accepted for a high deductible plan?

I'm female, looking for individual coverage, 61, with a recent history of recurrent asthmatic bronchitis. I haven't been hospitalized for it - just on prednisone and antibiotics. I also had low grade ("borderline") ovarian cancer almost 14 years ago with no chemo, no recurrence. No hospitalizations in 40+ years except the cancer surgery in 1996.

Right now I'm covered at work but hoping to stop in June at 62. I can afford COBRA but it's the 18 months after it runs out that I'm worried about. I can also afford to cover the expenses a high deductible policy wouldn't cover.

I've had no luck getting a hint of whether I'm likely to be denied coverage! I won't hold you to it, just would like an opinion. Thanks.

 

[antmary]

This conversation is interesting...Which is why we need a public option. I fault the cartels such as Anthem Blue Cross. The insurance sales people are just trying to make a living. Our insurance guy could not afford his and his wife's own health insurance, so he decided to skip a few months until he could get Medicare. Well, he had a major stroke. He is in a wheel chair, and cannot eat or talk. He will be disabled for the rest of his life. Advanced rehabilitation is not available for him. He is a prisoner in his own body. He and his wife need to file for bankruptcy. Nice retirement, huh.

I am a nice person. I am trustworthy, honest and loyal. I am not Democratic or Republican - I'm independent, and I love this country. But, I am angry to see health insurance premiums being the biggest expense we have. As I have said before, I would be glad to pay higher taxes if there would be a community clinic to go to. At least I could see my tax dollars at work. I know that my current doctor would drop me like a hot potato if we were unable to afford (in two years) Medicare supplement insurance. Yea, as a matter of fact, how about my tax dollars going to fund the kind of health insurance our illustrious elected officials now receive?

Maybe I am so grumpy because I have not had a vacation for a long time; we are saving for retirement, and private health insurance premiums are astronomical. Where is free enterprise and a sense of fairness? If the health insurance companies are so altruistic and caring about my well-being, and they are doing such a good job, then why not a public option?

 

[DeborahB]

AntMary - I too would be glad to pay some more taxes and see everyone have health care, just as most other industrialized nations have. Your stroke/bankruptcy story is all too common. Even if he had health insurance it could have happened.

 

[dgoldenz]

This conversation is interesting...Which is why we need a public option. I fault the cartels such as Anthem Blue Cross. The insurance sales people are just trying to make a living. Our insurance guy could not afford his and his wife's own health insurance, so he decided to skip a few months until he could get Medicare. Well, he had a major stroke. He is in a wheel chair, and cannot eat or talk. He will be disabled for the rest of his life. Advanced rehabilitation is not available for him. He is a prisoner in his own body. He and his wife need to file for bankruptcy. Nice retirement, huh.

I am a nice person. I am trustworthy, honest and loyal. I am not Democratic or Republican - I'm independent, and I love this country. But, I am angry to see health insurance premiums being the biggest expense we have. As I have said before, I would be glad to pay higher taxes if there would be a community clinic to go to. At least I could see my tax dollars at work. I know that my current doctor would drop me like a hot potato if we were unable to afford (in two years) Medicare supplement insurance. Yea, as a matter of fact, how about my tax dollars going to fund the kind of health insurance our illustrious elected officials now receive?

Maybe I am so grumpy because I have not had a vacation for a long time; we are saving for retirement, and private health insurance premiums are astronomical. Where is free enterprise and a sense of fairness? If the health insurance companies are so altruistic and caring about my well-being, and they are doing such a good job, then why not a public option?

What makes you think he would be able to afford the premiums on a guaranteed-issue basis if he couldn't afford them as it was? A public option would not change that. People seem to think a public option will wave its magic fairy dust and lower premiums by 50%, except they have it completely backwards.

I'm curious - since you are an agent (and not in my state), how hard is it for someone like me to get insurance and what type is the most likely to be underwritten? Is it easier for me to be accepted for a high deductible plan?

I'm female, looking for individual coverage, 61, with a recent history of recurrent asthmatic bronchitis. I haven't been hospitalized for it - just on prednisone and antibiotics. I also had low grade ("borderline") ovarian cancer almost 14 years ago with no chemo, no recurrence. No hospitalizations in 40+ years except the cancer surgery in 1996.

Right now I'm covered at work but hoping to stop in June at 62. I can afford COBRA but it's the 18 months after it runs out that I'm worried about. I can also afford to cover the expenses a high deductible policy wouldn't cover.

I've had no luck getting a hint of whether I'm likely to be denied coverage! I won't hold you to it, just would like an opinion. Thanks.

Actually, a high deductible policy covers just as much as any other higher-priced policy. You just pay more out of your own pocket in expenses before the insurance company pays anything. I'm not sure about the laws in your state or whether you have a state risk pool, but after COBRA runs out you would still be able to get guaranteed-issue coverage with no pre-existing conditions under the HIPAA law. The premiums would be very expensive but everything would be covered in full. If I was in your position and you work for a company that offers severance packages or retiree benefits, I would strongly consider exploring the option of continuing your health coverage through the company instead of going on COBRA and HIPAA. Maybe they can work something out with you to provide coverage until you are eligible for Medicare.

If the recurrent bronchitis is still effecting you, you would either be declined or may be able to get an exclusion rider for the condition (probably your best option). The prior cancer surgery would be subject to underwriting from each carrier - it is really difficult to know whether you would be accepted based on the information provided. An underwriter would want to review the medical records to see exactly what is in the doctor's notes and get follow-up testing/exam information to see how the condition has improved over the last 13 years.

 

[antmary]

The insurance companies are very busy - creating a moat around their own self-interests. Regarding our insurance agent, I am convinced that they (at Anthem Blue Cross) would search around for a pre-existing condition - so they would have to pay as little as possible.

The only good thing about this situation is that I really focus on taking care of myself - eating well, exercising, social contacts, etc.

I don't think I'm alone. People are getting so fed up...I have never, in my life, seen so much financial distress in our community. And, our community is considered to be pretty affluent. I'm distressed - and, we are considered to be better off than 99% of our neighbors!

 

[samclem]

AntMary - I too would be glad to pay some more taxes and see everyone have health care, just as most other industrialized nations have.

If all the people who want to pay more taxes would just donate that money to a charity which would pay for health care, I guess there'd be enough money to do it, right?

Talking about guaranteed issue without talking about an individual mandate at the same time doesn't make much sense. The only other way to do it without an individual mandate is to put huge govt cost sharing into place (i.e. the other taxpayers match your premium payment up to XX dollars) to help offset the higher cost that most people pay due to the government's policy of guaranteed issue. I guess that sidesteps the issue of the constitutionality of an individual mandate. Apparently it may be unconstitutional to force a person to buy insurance, but no one blinks if we take that same amount of money from a person in order to buy insurance for others. Kinda funny.

 

[antmary]

"What makes you think he would be able to afford the premiums on a guaranteed-issue basis if he couldn't afford them as it was? A public option would not change that. People seem to think a public option will wave its magic fairy dust and lower premiums by 50%, except they have it completely backwards."

I agree with you re: being unable to afford the premiums. All these years, he was promoting products that were in essence: breathtakingly unethical, well organized in their ability to bilk citizens out of millions of dollars, and manipulating the primal fear that we all have of losing everything we have worked so hard to enjoy.

My advocacy for a public option arises because I am fed up with business as usual. I see no argument that favors the insurance companies. I think many who work for those companies are self-serving people who have lived a lifetime dedicated to the feathering of their own nests - at the expense of others.

 

[huusom]

Why do we have to make it so complicate?

Can we get civilized and provide insurance for everyone just like other industrialized countries in the world? They pay only 10 percent of their GDP and everyone is covered while we paid 16.5 of our GDP and 46 millions are uninsured?

 

[ziggy29]

Can we get civilized and provide insurance for everyone just like other industrialized countries in the world? They pay only 10 percent of their GDP and everyone is covered while we paid 16.5 of our GDP and 46 millions are uninsured?

If we can find a way to wring 6.5% of GDP out of the cost of care while insuring everyone and not hurting quality or availability, sure.

And here's a hint: insurance company profits are a LOT less than 6.5% of GDP, so putting all (or even most of) the blame there doesn't hunt.

 

[antmary]

Husuum,
I totally agree with you. We simply need to agree upon a system wherein our neighbors are covered. The other issue that I mentioned on another thread:

I don't want to go to the grocery store and be exposed to who knows what (flu, or drug-resistant TB) just because the person in front of me can't get health insurance.

I believe that a healthy population is an asset to us all. I'm also not interested in living in a metaphorical mega-gated community of just the "insured."

 

[antmary]

Ziggy,
Yes, the problem is multi-faceted; for me, though, the negative experiences have been with the insurance companies. It is hard to feel sorry for Blue Cross. I agree with you in that I think there is plenty of blame to go around - e.g. hospitals, clinics, etc.

 

[dgoldenz]

"What makes you think he would be able to afford the premiums on a guaranteed-issue basis if he couldn't afford them as it was? A public option would not change that. People seem to think a public option will wave its magic fairy dust and lower premiums by 50%, except they have it completely backwards."

I agree with you re: being unable to afford the premiums. All these years, he was promoting products that were in essence: breathtakingly unethical, well organized in their ability to bilk citizens out of millions of dollars, and manipulating the primal fear that we all have of losing everything we have worked so hard to enjoy.

My advocacy for a public option arises because I am fed up with business as usual. I see no argument that favors the insurance companies. I think many who work for those companies are self-serving people who have lived a lifetime dedicated to the feathering of their own nests - at the expense of others.

I would hope your agent isn't selling "breathtakingly unethical" products, unless you are simply referring to what is available from the insurance company and have a very jaded view of them. Blue Cross/Blue Shield is a non-profit organization in many states, and yet, the premiums are still expensive!

Here is the crux of the issue - if everything is guaranteed-issue with no pre-existing waiting period, younger, healthier individuals will almost certainly balk at the insanely high premiums they would be forced to pay. As more young people decide not to participate in the pool, what is left is a bunch of unhealthy older people. In comes the domino effect - premiums rise to cover the cost of claims from the pool of sick people, more healthy people find the premiums ridiculous and cancel their policies, leaving yet an even sicker pool of insureds, and so on.

Sometimes the disease is better than the cure. I am just curious, how much do you think your average family of 4 would pay for their health insurance premiums under Obamacare, whether getting a policy from the public option (if it existed) or from a private insurer?

 

[ERD50]

Can we get civilized and provide insurance for everyone just like other industrialized countries in the world? They pay only 10 percent of their GDP and everyone is covered while we paid 16.5 of our GDP and 46 millions are uninsured?

Probably for the same reasons that we can't provide public education that is as good as the other industrialized countries in the world, even though we spend more. Why should we expect US governement provided Health Care to be different?

We simply need to agree upon a system wherein our neighbors are covered.

There may be a "simple" solution, but Congress does not seem very interested in that. They have all sorts of complex "solutions" that do not address the real problems. I think they are more interested in control (of various sorts) than they are in fixing any problems. The problems are a side-show in all this, just something to point to while they try to "sell" whatever it is they want us to buy.

-ERD50

 

[DeborahB]

Actually, a high deductible policy covers just as much as any other higher-priced policy. You just pay more out of your own pocket in expenses before the insurance company pays anything. I'm not sure about the laws in your state or whether you have a state risk pool, but after COBRA runs out you would still be able to get guaranteed-issue coverage with no pre-existing conditions under the HIPAA law. The premiums would be very expensive but everything would be covered in full. If I was in your position and you work for a company that offers severance packages or retiree benefits, I would strongly consider exploring the option of continuing your health coverage through the company instead of going on COBRA and HIPAA. Maybe they can work something out with you to provide coverage until you are eligible for Medicare.

Thanks, I appreciate the info. We do have a state risk pool. Unless something changes, I won't have any medical retiree benefits - just 18 months of COBRA as an option. Ironically, I work for a large health system . I would like to have pre-existing conditions covered if possible.

My current game plan (unless some legislation that affects this is passed) is to wait until close to my birthday, apply for insurance and see whether I can get coverage. Then I still will probably take COBRA but I'll know if I'm likely to get declined and have to be looking at the high-risk pool.

 

[Texas Proud]

So... I will sound like a broken record, but having everyone insured does not do anything for the 'costs'.... we need cost controls... those are hard to do...

I will give a a couple of real life examples of why are costs are high. Both have happened in the last few months.

My mother had a seizure. Not good at the time, but it seemed that it might have been a reaction to the flu shot. She goes to the emergency room. They admit her and do a scan (not sure which kind). Then give her some medicines etc. Nothing more that I know of... she is admitted into the hospital where she stays for 4 days of testing and monitoring. The first benefit info showed up and the hospital bill was $30K... but the insurance amont was just under $5K. Either it cost $5K to have here there and they were charging a lot more... or they are losing money for everyone that has insurance. Not sure which. But, I am not sure why she needed to be in there 4 or 5 days.


This one is a sad one for me. I had this lady who worked for me who was diagnosed with pancreatic cancer. She was only 45, but died about a week ago. There was no hope of recovery as it had spread to her liver. Now, in another country, they would have not done anything. But she was having problems with an ulcer, so she could not eat well. So they did an operation to resection her stomach (not sure if I am getting this correct or not... but she did have a major operation). She was in the hospital for over a week. She was not able to eat well for a full month. She died less than two months after the operation. Now, compare the cost of my mother, who did not have much done to her to this lady. I bet that the 'bill' will be $60K... If you want to get the costs down, then these are the costs that have to be removed from the system.

I am not saying that she should not be able to get this procedure done, but that the cost of doing it should fall mostly on her and her family.



Back to my original premise.... we need competition on the cost side (or cost controls), not the insurance side...

 

[antmary]

Dgoldenz,

Yes, after paying, since say, 1990 about $259,200 (I low-balled it) to Blue Cross; yea, I do have a jaded attitude.

Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised. I won't even get into the wall-street tar-baby.

 

[ziggy29]

I would like to see those making over $250,000 per year (couple) have their taxes raised.

Democracy is two wolves and a sheep voting on what to have for lunch.

 

[dgoldenz]

Dgoldenz,

Yes, after paying, since say, 1990 about $259,200 (I low-balled it) to Blue Cross; yea, I do have a jaded attitude.

Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised. I won't even get into the wall-street tar-baby.

You must either have a very, very good plan or some sort of condition if you've been paying an average of $1000/month for the past 19 years. Have you ever explored the possibility of lowering your benefit level to keep your cost down, or changing carriers if you don't have any major conditions? Would you have felt better if you had paid your $259,000 and then had cancer, but were able to receive your $1 million/year cancer treatments for $13,000?

Medicare is nearly insolvent because the money that has been put into it by taxpayers has not been enough to offset the claims. Medicare is also a system that people pay into for years before they ever get to use it (usually). When talking about health insurance, most people are covered cradle to grave, so there is no 20, 30, 40 years of taxes to be paid before entering the system.

Why should those making over $250k be forced to pay for everyone else's health insurance premiums on top of paying for their own? Does everyone making over $250k get to have their health insurance for free if they have their taxes raised, or do they have to pay the same ridiculous premiums as everybody else on top of a tax increase?

 

[ERD50]

Where is free enterprise and a sense of fairness? If the health insurance companies are so altruistic and caring about my well-being, ...

antmary - I'm going to suggest that if this is your take on life, you are going to find frustration at every turn.

Free enterprise will produce "fairness" only because most businesses realize that if they want repeat business, they need to treat their customers well. If an industry is in a closed market, don't expect any "fairness", but that is not the fault of "free enterprise", it is the fault of closed markets.

Companies have no inherent interest in being altruistic or caring, but in a free market they usually will go out of business if they are always screwing their customers. That makes them "care". It's not perfect, but I'd rather take my chances that some company will do right by me because they are afraid of losing my business, than to count on the owner of the business being a "good guy/gal".

There have been proposals to increase competition across the insurance cos, but Congress won't go there ( ins cos are actually exempt from some anti-trust regulations - gee, who passes the laws?).

These are old ideas:

Why Adam Smith is important

Adam Smith (1723-1790) was a Scottish philosopher and economist who is best known as the author of An Inquiry into the Nature and Causes of the Wealth Of Nations (1776), one of the most influential books ever written.


Adam Smith Quotes

The Wealth Of Nations, Book IV, Chapter II, p. 456, para. 9.

It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our necessities but of their advantages.

-ERD50

 

[ziggy29]

Companies have no inherent interest in being altruistic or caring, but in a free market they usually will go out of business if they are always screwing their customers. That makes them "care". It's not perfect, but I'd rather take my chances that some company will do right by me because they are afraid of losing my business, than to count on the owner of the business being a "good guy/gal".

Which is why I think a significant part of the problem is lack of real and transparent competition among insurers. Many consumers, depending on their employer and/or the state where they live, have an artificially limited number of options.

Even if there was a universal mandate with no underwriting or exclusions allowed, if there was real and transparent competition you'd have a lot more efficient health insurance market than we have now, and you'd see much more incentive for better customer service and cost containment. Maybe we'd start seeing statistics for the percentage of claims that are denied, too, as part of the transparency.

That's not a magic bullet by itself -- but then, nothing in this debate is, and what we need to do is look at things which might not make all the difference by itself but might help a lot in the aggregate. And that might paradoxically mean increasing government control in some areas and adding free market reforms in other areas.

 

[ERD50]

Re: your question: I would like to see national health care available to all - like Medicare. Being an American citizen would give you entry. I would like to see those making over $250,000 per year (couple) have their taxes raised.

OK, you are certainly entitled to your viewpoint. But could you flesh that out for us? How much would we need to raise the taxes on couples over $250,000 in order to pay for universal HC (and I mean pay for it each year, not push the bill onto future generations)?

-ERD50