So this bill makes pre-existing conditions a thing of the past, right? Well....
‘SEC. 2701. FAIR HEALTH INSURANCE PREMIUMS.
‘(a) Prohibiting Discriminatory Premium Rates-
‘(1) IN GENERAL- With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--
‘(A) such rate shall vary with respect to the particular plan or coverage involved only by--
‘(i) whether such plan or coverage covers an individual or family;
‘(ii) rating area, as established in accordance with paragraph (2);
‘(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 2707(c)); and
‘(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and
‘(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).
So what that means is that if you can be charged more than three times as much, for exactly the same plan, as someone younger than you. So being older is a pre-existing condition. So is being a smoker. Which makes sense from a profit-making point of view--these people could cost insurance companies more. But it also means that you can be charged more for being older or a smoker.
It's not just those issues, either. There's those employer-based wellness programs which are a little more subtle, but are a route to you being charged more if you, say, have high blood pressure. Or high cholestrol. Here's Wendell Potter talking about it:
How does that work in this reformed system, you ask?
By more than doubling the maximum penalties that companies can apply to employees who flunk medical evaluations, the legislation could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol....
In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems such as diabetes, heart disease and stroke.
"Everybody said that we're going to be ending discrimination based on preexisting conditions. But this is, in effect, discrimination again based on preexisting conditions," said Ann Kempski of the Service Employees International Union.
The legislation would make exceptions for people who have medical reasons for not meeting targets.
Incentives for helping people stay healthy are a key part of making longterm reform work. A healthier population will save the entire system money down the road. But is this designed more to get people healthy, or as a way to get more money into insurance company coffers? Let's just say that AHIP likes this provision a lot.
Just so you know, when you hear the pre-existing conditions argument, well, it's conditioned.