Speaking of ACA

[ShokWaveRider]

So even if Congress were to pass legislation mandating coverage for pre-existing conditions, few would be able to afford such insurance without the generous subsidies currently offered under the ACA.

I think that if the question could not be asked in the first place by law, this would not be the case. Insurance companies would not know (Initially). It is possible that after a couple of years of insuring people they could track the claims and make an assumption. But initially it would be an equal playing field.

 

[Rianne]

I just finished two yearly Dr appts, blood tests and have two more Dr appts. in the near future. HI discounted (quite a bit, I was surprised) the charges. Obviously mammogram, no charge. IMO the ridiculous rates the hospitals charge is the problem. Healthcare for all does not solve our problem. Prescription prices (god forbid anyone get a brand name) are insane. My DN has gestational diabetes with an insulin pump. He is 22 yrs. old. He's dependent on insulin for the rest of his life.

One of our posters moved to Hungary. I recall him saying he pays cash for healthcare. It's affordable that way. Sorry, don't mean to speak for him, but I remember this post and can't find it. It's buried in travel somewhere.
Unless a dire emergency, I'll get on a plane and go to Hungary or Italy or Czech Republic and pay cash. I guarantee that's a lot less than our $12,000 deductible. Key is to know someone in one of those countries to guide through the process.

 

[razztazz]

Seems to me it would be political suicide to go back to allowing no coverage or extreme cost coverage for pre-existing conditions. Removing subsidies would also be career suicide. Unless we go to some kind of universal coverage, ACA should be here to stay in close to the same form as now.

It wouldn't be suicide for the people who want to end it. They didn't want it in the first place. They still haven't come close to iterating a replacement. They want the "olde system." The people who would be harmed are A)In "Blue States" and they will lose those states anyway. And B) Those in Red States are apparently more interested in.... shall we say, "Other Things".
They will win those states anyway. If they thought it was political suicide they wouldn't even be talking about it, except for maybe "One-Upping" the other party over it.

It was said for many decades that you could never end deductibility of State income taxes on federal returns because it would be political suicide. But they dared that "iron protocol" (because it was never a rule or law. It was always just sort of a Gentleman's Agreement.) and nothing bad happened. The Rich people in Blue States aren't going anywhere. The party in question will lose those States anyway. Nothing changes but they got their political "slap" in and I don't see anybody running from it.

Begging pardon up-front for tickling the frontier of "getting political" but I didn't see any other way to address the "political suicide" POV

 

[aaronc879]

What exactly qualifies as a "pre-exisiting condition"? I would thingk pretty much everyone over 40 has something that could be considered a pre-existing condition.

 

[Aerides]

The first article linked shows a 27+% increase in average per person cost between signing and 2017. But inflation was only 12% during that time..so, HC increased >2X inflation by 2017..would it without the ACA? Hard to say..

Remember though, pre-ACA on the free market (non-employer healthcare, truly individuals going and buying policies), there were many other limits, not just "pre-existing". A lot of policies denied many things that are now guaranteed under the aca law. Essentially the policy market was flush with low cost low risk plans (low risk for the insurers), granted to low consumers of healthcare. Everyone else had to wing it or stay employed.

A lot of folks that thought they had decent, affordable coverage, really had swiss-cheese plans that fell apart after a major claim. So comparing costs of the prior environment is still kinda apples and oranges.

 

[marko]

I think that if the question could not be asked in the first place by law, this would not be the case. Insurance companies would not know (Initially). It is possible that after a couple of years of insuring people they could track the claims and make an assumption. But initially it would be an equal playing field.

This is a good point.

With all the privacy laws, HIPPA etc, how does a corporation (insurance company) get to ask what conditions (pre-existing or otherwise) you have.

I do know that when on our corporate HC plan we had a guy who's wife was in extremely poor health (>$500K in hospital bills) but they covered him and her anyway when we changed providers. This was 30 years ago.

AFAIK, legally, I'm not even allowed to ask my own mother what her health history is.

 

[ShokWaveRider]

This is a good point.

With all the privacy laws, HIPPA etc, how does a corporation (insurance company) get to ask what conditions (pre-existing or otherwise) you have.

Seems insurance companies are exempt from this under certain conditions. I.E. switching from a Medicare Advantage plan to a Medicare Supplement.

They WILL get round it.

 

[ncbill]

I think that if the question could not be asked in the first place by law, this would not be the case. Insurance companies would not know (Initially). It is possible that after a couple of years of insuring people they could track the claims and make an assumption. But initially it would be an equal playing field.

They don't need to discriminate individually from person to person, they would simply set their rates (likely based on age cohorts) to cover the worst case scenarios.

20 years ago I had mom enrolled after her dementia diagnosis in a (high-risk pool) BCBS plan here, ~$1,000/month with a $10,000 deductible, IIRC...imagine what such would cost nowadays.

 

[MRG]

Seems insurance companies are exempt from this under certain conditions. I.E. switching from a Medicare Advantage plan to a Medicare Supplement.

They WILL get round it.

Or just refuse to pay when they discover a preexisting condition. They, life insurance companies, refuse to pay death claims when someone didn't disclose health issues.

 

[Draggon]

I don't have as much of an issue paying $15K'ish for 2 mid 50/early 60 people, but the deductibles make the insurance all but worthless - unless you get hit by a bus..

I get your point, but it's not entirely worthless - you still get the negotiated insurance prices for out-of-pocket services. This can be significant depending on the service.

 

[candrew]

Remember though, pre-ACA on the free market (non-employer healthcare, truly individuals going and buying policies), there were many other limits, not just "pre-existing". A lot of policies denied many things that are now guaranteed under the aca law.

Not the least of which is that pre-ACA, insurers were charging women higher rates than men.

 

[Spock]

I get your point, but it's not entirely worthless - you still get the negotiated insurance prices for out-of-pocket services. This can be significant depending on the service.

That is the first thing that needs to be fixed in true health insurance reform: 1 published price per procedure regardless of who pays. The provider can charge whatever they want, they just have to publish that price. The consumer can then choose who they want to provide the service.

 

[orchid55]

We are in our early 60s and have a non-subsidized ACA policy. The premium is 17k and the deductible is $6,700 per person. We have found that the negotiated discount for prescriptions is higher than the GoodRX rate. We are still using our long term PCP even though he is out of network. He gives us a 70% discount for being "uninsured" which is higher than the 60% discount we received from BCBS when he was in- network. My point is that we have not found the negotiated discounts to be very valuable.

 

[BeachOrCity]

I may be wrong, but I thought HIPAA only guaranteed coverage when moving from existing group coverage to individual. Guaranteed issue only covered business issued group, not self-employed or sole proprietor. There were no mandates or guarantees for individual coverage.

You might be right but I got that from a full time health care policy specialist I happen to know because it was part of my retirement decision matrix (availability of insurance if aca goes away)
Regardless of whether you are right or my contact was right, if aca goes away and one does not have state level protections the insurance company will individually underwrite the preexisting condition making coverage unaffordable.
I am lucky to live in a place where they have put a back stop in place just in case.

 

[zinger1457]

I'd like to see it repealed and replaced with something better - lower premiums, lower deductibles - as long as coverage for pre-existing conditions was mandated.

And I would like to win the lottery, not much chance of either happening.

 

[AnonEMouse]

What exactly qualifies as a "pre-exisiting condition"? I would thingk pretty much everyone over 40 has something that could be considered a pre-existing condition.

Birth. bada-bing (Thursday is joke day, right?)

No one really knows what's going to happen to ACA. The best you can do is call your representatives and give them your opinion. Worrying about it isn't going to change anything.

Seems like threads like these are just to commiserate. That's well and good, but stokes unnecessary anxiety I think.

An "alternatives to health insurance" thread might be more interesting. Something like the "baguette" plan for retirement.

 

[MRG]

That is the first thing that needs to be fixed in true health insurance reform: 1 published price per procedure regardless of who pays. The provider can charge whatever they want, they just have to publish that price. The consumer can then choose who they want to provide the service.

We have a provider in our area who is posting their prices for common procedures and tests. I'd seen a price of ~$350 for an MRI on their website. My insurance paid a couple grand for my last one.

It's absolutely insane how badly our system is broken and yet no one is saying to fix it. While ACA is a great start, the problem is greed and ignorance.

 

[ShokWaveRider]

I honestly do not blame folk who do not get a subsidy for complaining about the ridiculous costs of healthcare. ~$20k a year plus high deductibles is daylight robbery. This is just another example of Insurance companies pushing the limits of what they can get away with to maximize their profits at the expense of those who in theory have the money to pay them.

This is why we need a system that does not allow them to do so. I look at it as their way of funneling money to lobbyists at the expense of those who have no choice but to pay them for healthcare insurance that is poor at best. Not the Healthcare itself being poor, such as the coverage restrictions, absorbent premiums, copays, co-insurance and deductibles.

 

[FreeBear]

.

The insurance market place is still a competitive market from private insurance companies. Overtime, subsidies will trash the market just like they have education loans and everything else that is made artificially cheap. Since insurance company profits are essentially capped under ACA it will take longer for subsidies to skew the market because "creative accounting" would have to be created in parallel to hide the profits from rate increases.

I think this is true, but let's not forget that "subsidies" have been around much longer than ACA, but in the form of employer subsidized HI. One poster child for this is Cadillac PPO HI through megacorp. Maybe big-gov. has the same, but I don't have any experience with it.

My friends from megacorp have absolutely no idea of the full price (let alone true cost) of health insurance because their employer pays most of the burden. Furthermore, none of these friends fully realize that their Cadillac PPO in NOT available at any price, at any deductible level (metal level), on the individual market, at least in this area. The health provider networks are no where near as extensive, even if can even find an individual PPO plan.

A buddy of mine complains about dropping $8K/yr for 3 people for his Cadillac retiree PPO through megacorp. I just laugh and say that my ACA rack rate is over $12K/yr for only 2 people and $15K/yr deductibles on HMO with 2-3 tier hospitals. He's got not idea how good he has it.

To be fair, I'm not complaining. ACA is a retirement enabler and saver for us, at least until something better comes along or we both stumble into Medicare. Now, back to living my life in retirement. I'm not going to wring my hands waiting for the next tragedy.

 

[CRLLS]

We are in our early 60s and have a non-subsidized ACA policy. The premium is 17k and the deductible is $6,700 per person. We have found that the negotiated discount for prescriptions is higher than the GoodRX rate. We are still using our long term PCP even though he is out of network. He gives us a 70% discount for being "uninsured" which is higher than the 60% discount we received from BCBS when he was in- network. My point is that we have not found the negotiated discounts to be very valuable.

There is a down side to working with your out of network Dr, and Rx plans like GoodRX outside your insurance. That is that what you do pay out of pocket is not applied toward your deductible. It should be IMO.

ACA has its good points and its bad points in my experience. I would welcome some sort of compromise. I have very low expectations that this will occur.

 

[FreeBear]

Remember though, pre-ACA on the free market (non-employer healthcare, truly individuals going and buying policies), there were many other limits, not just "pre-existing". A lot of policies denied many things that are now guaranteed under the aca law. Essentially the policy market was flush with low cost low risk plans (low risk for the insurers), granted to low consumers of healthcare. Everyone else had to wing it or stay employed.

A lot of folks that thought they had decent, affordable coverage, really had swiss-cheese plans that fell apart after a major claim. So comparing costs of the prior environment is still kinda apples and oranges.

For anyone forgetting about HI in the "good old days", take a long look at even current short term health insurance plans, which are all NOT ACA compliant. The only good news is that they can be cheap.

The bad new? Everything else, including our favorite friends preexisting condition restrictions and underwriting. Need drugs of ANY kind?? Nothing covered, nada... Get sick during a coverage term (limited to 6 months in my state), well, the insurance company can deny coverage renewal at the end of the term.

 

[ShokWaveRider]

So, in other words, survive just long enough for you to benefit from it, until you're 65, then go away as soon as you no longer need it since you don't want to pay for it any more?

Do I have that right?

With the sheer lack of action from those who can actually do something about HC in the USA, do you honestly blame this attitude?

At the end of the day it boils down to everyone for themselves, the current systems encourages it. Medicare is not cheap, but at least it is predictable.

 

[Mtmingus]

Do we need congress on this or the Supreme Court would rule?

 

[NW-Bound]

... Medicare is not cheap, but at least it is predictable.

Actually, Medicare is VERY cheap, compared to unsubsidized ACA and what employers pay for their employees.

And if you consider that Medicare covers people who are a lot older and sicker than people on ACA and younger workers, Medicare is a heck of a steal.

See following post by FreeBear, which I fully agree with.

I think this is true, but let's not forget that "subsidies" have been around much longer than ACA, but in the form of employer subsidized HI. One poster child for this is Cadillac PPO HI through megacorp. Maybe big-gov. has the same, but I don't have any experience with it.

My friends from megacorp have absolutely no idea of the full price (let alone true cost) of health insurance because their employer pays most of the burden. Furthermore, none of these friends fully realize that their Cadillac PPO in NOT available at any price, at any deductible level (metal level), on the individual market, at least in this area. The health provider networks are no where near as extensive, even if can even find an individual PPO plan.

A buddy of mine complains about dropping $8K/yr for 3 people for his Cadillac retiree PPO through megacorp. I just laugh and say that my ACA rack rate is over $12K/yr for only 2 people and $15K/yr deductibles on HMO with 2-3 tier hospitals. He's got not idea how good he has it.

To be fair, I'm not complaining. ACA is a retirement enabler and saver for us, at least until something better comes along or we both stumble into Medicare. Now, back to living my life in retirement. I'm not going to wring my hands waiting for the next tragedy.

 

[jimbee]

I honestly do not blame folk who do not get a subsidy for complaining about the ridiculous costs of healthcare. ~$20k a year plus high deductibles is daylight robbery. This is just another example of Insurance companies pushing the limits of what they can get away with to maximize their profits at the expense of those who in theory have the money to pay them.

This is why we need a system that does not allow them to do so. I look at it as their way of funneling money to lobbyists at the expense of those who have no choice but to pay them for healthcare insurance that is poor at best. Not the Healthcare itself being poor, such as the coverage restrictions, absorbent premiums, copays, co-insurance and deductibles.

Health insurance company profits are not the reason health insurance is expensive. Check the 80/20 rule explanation on this page. https://www.healthcare.gov/health-care-law-protections/rate-review/