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View Diary: States lagging in implementing health care regulations (41 comments)

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  •  A comment on the current system (6+ / 0-)

    I lost my insurance for almost two years when I was laid off from my former employer. I finally landed a job and got my coverage back. On my first visit to the doctor my claim was denied as a preexisting condition.

    So now I essentially still don't have coverage unless I am fortunate enough to develop a new medical problem.

    Is this a great system or what?

    •  Wait...there's supposed to not be pre-existing (1+ / 0-)
      Recommended by:
      musiccitymollie

      conditions anymore due to ACA, right? Might want to double check that claim with your insurer.

      When life gives you wingnuts, make wingnut butter!

      by antirove on Fri Feb 01, 2013 at 05:08:50 PM PST

      [ Parent ]

      •  Blue Cross told a friend of mine not to count on (2+ / 0-)
        Recommended by:
        antirove, musiccitymollie

        the pre existing exclusion going away.  I was shocked but some insurance companies are telling their customers that they are not sure that is going to be enforced. Then I have friends who tell them their insurance companies are telling them that their rates will go up if they cannot refuse people due to pre existing conditions. Ie some insurance companies are lying to patients, misleading them , and so on. Be on the lookout for that. I was stunned because my insurance company tends to like and promote ACA but some do not and some insist they are not sure when they will decide to make changes.

        Follow PA Keystone Liberals on Twitter: @KeystoneLibs

        by wishingwell on Fri Feb 01, 2013 at 05:29:41 PM PST

        [ Parent ]

      •  It did go away but they can charge you so much (1+ / 0-)
        Recommended by:
        WillR

        that you can't afford it.

        •  Although you will... (0+ / 0-)

          ...get a rebate if they don't spend enough of the premiums on medical care.

          It's unknown how many chronically ill people who are now living w/o insurance due to pre-existing conditions will choose to get insurance once they are no longer excluded and can't be charged extraordinary high rates reflecting their higher risk status. Estimates on such things are likely to be quite wrong for a variety of reasons.

          These patients may be very expensive to provide care for. One of the nightmare scenarios for an insurance company may be someone who requires 7/24 skilled nursing care for a condition and who is currently relying on government provided care but is unhappy with the choices and level of care. If such a person has middle class parents, they could now pay for an insurance policy for their offspring (since such a person is unlikely to be making a living). It could take the profit from thousands of "moderate risk" insureds to just to provide health care for this one person - i.e., just to break even. Although there are probably not many such people, they are extraordinary risks.

          Once the insurance company has written a policy w/a specific rate, I think they are generally required to honor that rate for the term. If they underestimate the rate, they don't have the luxury of going back to the rate payers to get a rebate if they spent 110% of premiums on health care (unlike the rate payers who do get a rebate if the insurance company guesses too high on the premiums). I expect insurance companies to be conservative and jack rates up quite high and adjust them down slowly as needed once they have data to know where to set rates.

          I also expect some, perhaps most, insurers to just suspend writing new individual policies entirely while this all sorts out. Once a few large insurers do this, there could be a domino effect as those insurers who are writing new policies end up with more high risk patients so they can't be cost competitive and attract any of those already insured with companies no longer writing new policies.

          It should be interesting to watch. I'm very glad I have access to a self-insured employer plan which won't be impacted much by the PPACA.

          •  Are you sure that . . . (0+ / 0-)

            ". . . a self-insured employer plan which won't be impacted much by the PPACA."

            I'm not contesting your statement, but it does contradict what Mr. Mollie's "self-insured employer" is telling us.

            We were told during last year's "Open Enrollment" for  their group plan, that they would not likely offer group insurance if the (PP)ACA was not repealed.  They cite the adverse impact of the bill.

            Final word has not come down.  We just hope that it does before the traditional Open Enrollment period, which is the month of November.

            Are they lying?  (BTW, we wouldn't be surprised if they are, LOL!)

            Mollie

            "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

            "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

            by musiccitymollie on Sat Feb 02, 2013 at 10:35:38 AM PST

            [ Parent ]

    •  hnichols--You might want to check this American (0+ / 0-)

      Cancer Society brochure, or brief on "How the ACA affects pre-exisiting conditions and HIPAA."

      Good luck!

      Mollie

      "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

      "If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

      by musiccitymollie on Sat Feb 02, 2013 at 10:28:41 AM PST

      [ Parent ]

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