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Pre existing condition coverage and similar expenses will kill ACA.

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  • Strongly Liberal Democrat
    Democrat
    Pensacola, FL
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    The flag waving hallmark of pre-existing condition coverage and similar conditions will kill ACA. I must admit my naivety and ignorance because I had thought ACA was subsidized in some extent by the government. Otherwise what would be the purpose of Obamacare? As it turns out Obamacare is simply a reorganization of billing procedures. No government money. Well, you can't use wonderful words like no denial for pre-existing condition coverage without paying for it. That is why insurance companies denied it in the first place. Why sell insurance to somebody who will be a significant long term liability. Insurance companies denied it to keep the costs down. So what is going to happen now that the law requires health insurance and requires insurance companies to offer pre existing condition coverage. This is what happens: Insurance rates will sky rocket up and deductibles and co-pays will skyrocket up. Resulting in higher health insurance premiums with less coverage. jaredsxtn, you have always presented pre-existing coverage as a Hallmark of Obamacare. Am I right or wrong ? This has not been posed by anybody else or has it?
  • Center Left
    Independent
    Central, FL
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    Chet wrote: Insurance companies denied it to keep the costs down. So what is going to happen now that the law requires health insurance.....

    They didn't do that to keep costs down - they did it to keep profits up. I'd feel differently if the Ins companies were struggling financially but they are not. It (in my mind) is the way of discounting the lives of those not financially comfortable. If you can't make political contributions, you have almost no worth...... was the slop served to the poor the last 40 years.

    I think it will be a crazy juggling act over the next decade or two. Insurance companies, medical professionals and pharma companies are huge players but some standards need to be in place to keep everything balanced. I don't have the answers but I have been damned proud to have a good man as our president the last 7+ years. Lobbyist are serious trouble and I'd love it if somehow their agendas could be lessened or diluted.

  • Strongly Liberal Democrat
    Democrat
    Pensacola, FL
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    Chet Ruminski Wrote: The flag waving hallmark of pre-existing condition coverage and similar conditions will kill ACA. I must admit my naivety and ignorance because I had thought ACA was subsidized in some extent by the government. Otherwise what would be the purpose of Obamacare? As it turns out Obamacare is simply a reorganization of billing procedures. No government money. Well, you can't use wonderful words like no denial for pre-existing condition coverage without paying for it. That is why insurance companies denied it in the first place. Why sell insurance to somebody who will be a significant long term liability. Insurance companies denied it to keep the costs down. So what is going to happen now that the law requires health insurance and requires insurance companies to offer pre existing condition coverage. This is what happens: Insurance rates will sky rocket up and deductibles and co-pays will skyrocket up. Resulting in higher health insurance premiums with less coverage. jaredsxtn, you have always presented pre-existing coverage as a Hallmark of Obamacare. Am I right or wrong ? This has not been posed by anybody else or has it?
    They are apparently counting on the mandate requiring everybody to have insurance to provide extra revenue to make up for the pre-existing condition extra cost. I can't see ant way that a monthly premium can offset the monthly cost of a pre existing condition expense. AVA says that pre existing conditions exist with every one out of three enrollees. Without high deductibles and co-pays I can't see three premiums paying for one pre existing expense.
  • Strongly Liberal Democrat
    Democrat
    Portland, OR
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    Chet Ruminski Wrote: The flag waving hallmark of pre-existing condition coverage and similar conditions will kill ACA. I must admit my naivety and ignorance because I had thought ACA was subsidized in some extent by the government. Otherwise what would be the purpose of Obamacare? As it turns out Obamacare is simply a reorganization of billing procedures. No government money.

    You are grossly misinformed about Obamacare. Of course the ACA is subsidized in some extent by the government. What would you call the tax credits and expansion of Medicaid? Many Republican states chose to screw their citizens over by not expanding Medicaid, but the tax credits are still there for every individual who qualifies for them.

    Chet Ruminski Wrote: Well, you can't use wonderful words like no denial for pre-existing condition coverage without paying for it. That is why insurance companies denied it in the first place. Why sell insurance to somebody who will be a significant long term liability. Insurance companies denied it to keep the costs down. So what is going to happen now that the law requires health insurance and requires insurance companies to offer pre existing condition coverage. This is what happens: Insurance rates will sky rocket up and deductibles and co-pays will skyrocket up. Resulting in higher health insurance premiums with less coverage.

    Yes you can because there is no denial for pre-existing conditions anymore. It is illegal to even have it on an application form.

    And as TJ said--insurance companies denied it to keep their profits up and to pass all the risk to the Federal government. People who didn't have health coverage and got sick still went to the hospital and those costs were then passed on to the government, aka the American taxpayer. Now when they get sick the vast majority of the costs go to the health insurer instead of the Federal government.

    Chet Ruminski Wrote: jaredsxtn, you have always presented pre-existing coverage as a Hallmark of Obamacare. Am I right or wrong ? This has not been posed by anybody else or has it?

    I've never once suggested that mandating preexisting coverage is the hallmark of Obamacare.

    What I have said is that it's one of the many things that are good about Obamacare. It forces insurance companies to pay for things instead of the American taxpayer. I'd say my favorite thing about Obamacare is that insurance companies are now legally required to spend a minimum of 80% of premiums on claims and other activities that improve health care quality. It's 85% for insurance companies in large group markets.

    That, in the long run, will help bring down costs because companies aren't able to pocket all of their money. It will also force insurers to think of new ways to provide benefits to consumers that keep them from unneeded trips to the hospital.

    One of my favorite new things about my BCBS plan in Oregon is the 24/7 nurse hotline. Many other companies are rolling out video chats with medical doctors that are included with their premiums. Those are the kind of things that will eventually bring down costs as insurance companies continue to adapt to the new world of Obamacare.

  • Strongly Liberal Democrat
    Democrat
    Pensacola, FL
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    I know about qualifying for premium subsidies. I don't see anyplace where they account for the expense of preexisting condition coverage. The insurance companies excluded it because pre existing conditions start day one with high costs. TThe insurance companies have actuaries that tell them how much that kind of coverage costs.That includes aids, cancer and a mmultitude of incredibly expensive conditions. I don't see how the insurance companies can absorb these extraordinary expenses. I could cars less about the financial status of the insuranve companies and I know they have all the data to project the extra costs. I wonder how they can not only cover these costs and at the same time potentially offer assistance to means qualified enrollees. Is there a mechsnism that kicks in with aid if the pre-existing condition expenses exceed an established threshold. I was deeply involved with insurance when HMO's were trying to sell the UMWA. They proposed special measures dealing with chronically ill members. That's why I am concerned now.

  • Strongly Liberal Democrat
    Democrat
    Portland, OR
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    Chet Ruminski Wrote: I know about qualifying for premium subsidies. I don't see anyplace where they account for the expense of preexisting condition coverage. The insurance companies excluded it because pre existing conditions start day one with high costs.

    Qualifying for premium subsidies and mandating that preexisting conditions be covered are two entirely different things.

    Many individuals who don't qualify for any subsidies still had preexisting conditions and many people who do qualify for subsidies don't have any preexisting conditions. Someone who could easily afford coverage but had depression used to have their coverage denied by an insurance company. That is not a preexisting condition that would cost the health insurance company much money at all, but they still refused coverage to that person.

    Chet Ruminski Wrote: TThe insurance companies have actuaries that tell them how much that kind of coverage costs.That includes aids, cancer and a mmultitude of incredibly expensive conditions. I don't see how the insurance companies can absorb these extraordinary expenses. I could cars less about the financial status of the insuranve companies and I know they have all the data to project the extra costs. I wonder how they can not only cover these costs and at the same time potentially offer assistance to means qualified enrollees. Is there a mechsnism that kicks in with aid if the pre-existing condition expenses exceed an established threshold. I was deeply involved with insurance when HMO's were trying to sell the UMWA. They proposed special measures dealing with chronically ill members. That's why I am concerned now.

    How can you worry about these incredibly expensive conditions in one sentence and then insist you aren't concered about the financial status of the companies in the next?

    Different conditions cost health insurers different amounts of money. Treating heart disease with medication is far cheaper than paying for a heart transplant. Mandating insurance companies provide rehabilitation services for alcoholics and drug addicts is far cheaper than paying for a liver transplant. The list goes on and on.

    Health insurance companies can no longer look at people on a case by case basis. They have to take a more holistic approach. That is why they are rolling out new services that are intended to keep individuals from having to go to the hospital in the first place.

    It's true that many older individuals who never had health insurance are creating a strain on them in the short term, but younger individuals like myself who pay into the system are helping alleviate that burden. The more people utilize things like a 24/7 nurse hotline and video chats with doctors the more the costs to the overall system will decrease.

  • Independent
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    We must remember that insurance companies do not exist to provide coverage of medical expenses. They exist to make profit and therefore it is in their interest to NOT pay for medical treatments.
  • Strongly Liberal Democrat
    Democrat
    Portland, OR
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    lonely bird Wrote: We must remember that insurance companies do not exist to provide coverage of medical expenses. They exist to make profit and therefore it is in their interest to NOT pay for medical treatments.

    No, they don't.

    If they only existed to make a profit then this country would be bankrupt because they would have run our budget dry.

    Facts matter. Facts matter a lot. I encourage you to study facts and not conjecture.

  • Strongly Liberal Democrat
    Democrat
    Pensacola, FL
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    "How can you worry about these incredibly expensive conditions in one sentence and then insist you aren't concered about the financial status of the companies in the next?"

    Because I am concerned about the people. Pre-emptive care as opposed to dealing with developed conditions makes sense logically but it does nothing to explain or offset the high expense of offering no denial for pre-existing conditions. It doesn't make sense and I can see a possible big adjustment in rates once the insurance companies have compiled data on accrued billing. It is a big deal to offer pre-existing coverage and it doesn't make sense that the companies would do it without a safeguard.

  • Independent
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    jaredsxtn Wrote:
    lonely bird Wrote: We must remember that insurance companies do not exist to provide coverage of medical expenses. They exist to make profit and therefore it is in their interest to NOT pay for medical treatments.

    No, they don't.

    If they only existed to make a profit then this country would be bankrupt because they would have run our budget dry.

    Facts matter. Facts matter a lot. I encourage you to study facts and not conjecture.

    in a word, jared, bullshit. they do not exist to provide payment. like every single business that is for profit that is their existence: profit. every single for profit business exists to make a profit, nothing more, nothing less. that the owners of said business decide the manner in which they do it is to manufacture a product or engage in a service is irrelevant. once they decide what product or service they are going to attempt to derive profit from their next goal is to seek profit in the most efficient and effective way possible. thus control of expenses, costs etc most certainly is closely examined. if they did not do so they would end up out of business. as an anecdote mrs. bird and i had the same home owners insurance company "provider" for 20+ years. when we lived in bolingbrook, illinois we had a situation occur when the electric cable to the house (buried utilities in the sub-division where we lived) broke off of the block in the meter box due to settlement of soil and made contact with the side of the meter box. this occurred on a sunday and resulted in the fire department coming out and checking it and calling commonwealth edison. commonwealth edison said it was our responsibility after they examined the situation and so we had to hire a contractor to come out that day and make repairs. cost was $1,900. we had a $500 deductible which we paid and we were reimbursed for the other $1,400 by the insurance company. we then moved to ne ohio in 2009. we bought a house and kept the same company. a few months after moving in we received a bill from the insurance company which required us to pay an additional $300 at that time and raised our premium. when asked why we were told it was for excessive claims. we had ONE phucquing claim in 23 years.

    as for running the budget dry that is nonsense. the budget they run dry is that of their customers. why did they engage in pre-existing conditions? to assemble risk pools that were the lowest to MAXIMIZE THEIR PROFITS.

    i took accounting from a an adjunct professor who worked in the navy at the great lakes finance center. he discussed defense contracts one time and talked about how they were written to allow for the cost overruns that occur constantly when it comes to the defense department. this is stupid on the part of the department of defense but on the contractor side it is simply companies MAXIMIZING THEIR PROFIT.

    i have no problem with profit. i have no problem with the private sector. but it is simplistic nonsense to thing companies do not engage in practices to maximize their profits. and insurance companies due so by actively trying to avoid paying money to their customers in any legal manner possible. sometimes illegally.

  • Independent
    Ft.myers, FL
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    lonely bird Wrote:
    jaredsxtn Wrote:
    lonely bird Wrote: We must remember that insurance companies do not exist to provide coverage of medical expenses. They exist to make profit and therefore it is in their interest to NOT pay for medical treatments.

    No, they don't.

    If they only existed to make a profit then this country would be bankrupt because they would have run our budget dry.

    Facts matter. Facts matter a lot. I encourage you to study facts and not conjecture.

    in a word, jared, bullshit. they do not exist to provide payment. like every single business that is for profit that is their existence: profit. every single for profit business exists to make a profit, nothing more, nothing less. that the owners of said business decide the manner in which they do it is to manufacture a product or engage in a service is irrelevant. once they decide what product or service they are going to attempt to derive profit from their next goal is to seek profit in the most efficient and effective way possible. thus control of expenses, costs etc most certainly is closely examined. if they did not do so they would end up out of business. as an anecdote mrs. bird and i had the same home owners insurance company "provider" for 20+ years. when we lived in bolingbrook, illinois we had a situation occur when the electric cable to the house (buried utilities in the sub-division where we lived) broke off of the block in the meter box due to settlement of soil and made contact with the side of the meter box. this occurred on a sunday and resulted in the fire department coming out and checking it and calling commonwealth edison. commonwealth edison said it was our responsibility after they examined the situation and so we had to hire a contractor to come out that day and make repairs. cost was $1,900. we had a $500 deductible which we paid and we were reimbursed for the other $1,400 by the insurance company. we then moved to ne ohio in 2009. we bought a house and kept the same company. a few months after moving in we received a bill from the insurance company which required us to pay an additional $300 at that time and raised our premium. when asked why we were told it was for excessive claims. we had ONE phucquing claim in 23 years.

    as for running the budget dry that is nonsense. the budget they run dry is that of their customers. why did they engage in pre-existing conditions? to assemble risk pools that were the lowest to MAXIMIZE THEIR PROFITS.

    i took accounting from a an adjunct professor who worked in the navy at the great lakes finance center. he discussed defense contracts one time and talked about how they were written to allow for the cost overruns that occur constantly when it comes to the defense department. this is stupid on the part of the department of defense but on the contractor side it is simply companies MAXIMIZING THEIR PROFIT.

    i have no problem with profit. i have no problem with the private sector. but it is simplistic nonsense to thing companies do not engage in practices to maximize their profits. and insurance companies due so by actively trying to avoid paying money to their customers in any legal manner possible. sometimes illegally.

    Yes lonely; due to the fact that this country bows to the lobbyists because it remains corrupt (ask Bernie) then our "drug" prices and "doctors" visits remain overpriced. An example as I see it: My co-pay at the doctor $50.- however he recharges Medicare (United Health) $400 for a 10 minute consult, then prescribes some "pills" costing ten times the price as in Spain.

    As I said many times as long as our government does not apply the European system of strict price control ; like having an agreed listing of all drugs what they cost, as well an per hour fixed rate for doctors, hospitals and specialist, then "wild growth" which takes place here continues. No lobbyists are allowed in Europe; this is solely an US sickness.

    So I'm afraid if they refuse to copy the European model, it will stay an "profitable" business; I've never seen here a "poor" doctor. But plenty of poor patients.

    I fully agree that our government is one huge waste basket; trillions mean nothing.

  • Strongly Liberal Democrat
    Democrat
    Portland, OR
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    lonely bird Wrote: in a word, jared, bullshit. they do not exist to provide payment. like every single business that is for profit that is their existence: profit. every single for profit business exists to make a profit, nothing more, nothing less.

    There are more nonprofit health insurance companies than for profit ones and they have a very strict set of rules in order to keep that status.

  • Strongly Liberal Democrat
    Democrat
    Portland, OR
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    Dutch Wrote: So I'm afraid if they refuse to copy the European model, it will stay an "profitable" business; I've never seen here a "poor" doctor. But plenty of poor patients.
    I take it you've never been to a community health center then. There are thousands upon thousands of doctors in this country who aren't rich by any measure and work their ass off to help the poorest among us.
  • Strongly Liberal Democrat
    Democrat
    Pensacola, FL
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    jaredsxtn Wrote:
    lonely bird Wrote: in a word, jared, bullshit. they do not exist to provide payment. like every single business that is for profit that is their existence: profit. every single for profit business exists to make a profit, nothing more, nothing less.

    There are more nonprofit health insurance companies than for profit ones and they have a very strict set of rules in order to keep that status.

    Not for profit has absolutely nothing to do with salaries of administrators. Their salary is their profit and I assure you they do everything to maximise their profit while maintaining their not for profit status.
  • Strongly Liberal Democrat
    Democrat
    Pensacola, FL
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    "The top paid, actively employed executive on the list was George Halvorson, the outgoing chairman and CEO of Oakland, Calif.-based Kaiser Permanente, who received total compensation of $7.9 million in 2011 with $1.2 million in base salary and $5 million in incentive pay. "

    Average compensation same period for profit CEO's was 14 million.