ACA as a whole is not all that popular, although some of the opposition is from those who want a more socialized system (e.g. Medicare for all). However, provisions of ACA are mostly popular, with the main exception being the individual requirement to have insurance (which exists to enable the issuing of policies to those with pre-existing conditions).
“I’m curious to know how other first world countries deal with pre-existing conditions”
Universal healthcare is pretty much a given in countries we consider to be our peers and even those we don’t. It’s accepted practice of any country considered advanced or aspiring to be considered advanced.
https://en.wikipedia.org/wiki/Universal_health_coverage_by_country
“One other thought. The common advice is to get a job full benifits so you can be in a large pool with heathy people.”
So, forget starting a business or working for a small company. I thought that was part of the American way?
There is no such thing as pre-existing conditions in other industrialized nations (for the vast majority of them at least) because you’re covered from birth until death.
Many, perhaps most, of us with chronic conditions can’t work full time jobs that are high enough on the ladder to get full benefits.
With my conditions, I also have chronic fatigue which leaves me able to work for a few hours a day at a time. Not something an employer really wants.
Generally, a universal coverage requirement for all individuals with government subsidies (like what ACA attempted to do, but not very well), or government issued coverage (like Medicare in the US if you are age 65+). Requiring coverage of pre-existing conditions without either of these things results in the market failing due to adverse selection, as some or many individuals defer buying coverage until they are diagnosed with something expensive.
Many politicians have said they’ll get rid of the insurance mandate and keep the pre-existing conditions language. That can’t be done, since then healthy people would refuse to buy insurance, have no financial penalty if they don’t, but would buy insurance only after getting sick.
Likewise selling insurance state lines is problematic. There’a a real reason it’s not done now. The states reserve the right to look at the financial stability of insurers who sell insurance to their residents in order to protect us. What they’re avoiding is this: an insurance company is based in one state. It starts selling under a new, separate subsidiary in another state where it low-balls all the other insurance companies and gets a lot of business. Then when it declares bankruptcy it just continues operations in its home state. If a federal law says the second state has to let them do it, the second state has no way to make sure its citizens are covered. So long as the home state is treated well, everything is hunkey dorey for the insurance company.
@MotherOfDragons - the supposed preexisting condition coverage that was in effect before the ACA was window-dressing. It required that your condition come into existence while you were covered by a certain type of policy (like an employer policy). When you lost that job, there were very limited conditions under which you could stay covered.
If you were self employed and had individual insurance when you initially became ill, companies could (and did) drop you pretty much at will. I lived it.
That’s what I’m worried about. Congress will go back to the sham pre-existing condition laws to placate their constituents. I lived for five years unable to get insurance for myself at any price. I’m desolate now knowing that we’ll be going back to that. I’ve built a decent little business for myself but if I can find a big employer to hire me, I’ll have to shut it down and go back to the corporate world. The flip side of that of course is that at my age, nobody is likely to hire me so I’ll just go back to living on the edge.
DH is a colon cancer survivor. He is now 9 years distant from his diagnosis. We received a solicitation from an insurance company offering him a cancer rider if he is at least five years “clean.” Do you think he will be insurable if the pre-existing condition protection falls by the wayside?
Often, they only find that out after leaving their jobs and see the prices of the COBRA plan. (Note that the more deluxe plan you choose as an employee, the higher the cost it will be as a COBRA plan.)
S1 turns 26 in Sept of 2017. Our Cobra quote to cover him for 3 months next year is $800 month. Pre ObamaCare we paid $700 (BC?BS) for family of 4 with a $1500 deductible. Now we are up to $2200 with an $8000 deductible.
S1 goes off next year and hopefully S2 will find a job with benefits after he finishes grad school next year. Then we will drop to around $800 month.
I should go and get a job just to pay the premiums.
And yet about half of US just voted for someone who will repeal the ACA in 100 days
DH and I are OK – I have a good employer plan, and he’s less than a year from Medicare. But D has a policy off the ACA exchange and she’s panicking, since we’ve been promised many many times that that will poof disappear on January 20. I can’t tell her that it won’t. I’m literally shaking with fear as I type this.
MODERATOR’S NOTE
2 threads dealing with ACA have been merged.
I wonder, is the lack of universal health care one of the reasons we are able to keep our taxes relatively low? Other countries’ governments choose to control that market; we allow our people to pay relatively lower taxes so they can do their own shopping. (that is one way to look at it)
I tried to get my kiddo insurance online (he has well controlled asthma since he was a young child but only takes Rx for it a few times per year and rarely ever needs to see an MD and has never been hospitalized). We couldn’t find him any insurance in 2010, when he aged off our plan by turning 22 until we turned to cobra and the BCBS plan that has covered him all of his life. Both of them offered to cover him for up to xx months, since there had been no gaps in his coverage. He has since bought insurance thru his full time employer.
D is not healthy enough to hold any full time position. Fortunately we got her covered as a disabled dependent under H’s policy–otherwise, I gave no idea how we would get her covered with her asthma and other pre-existing medical issues (except the ACA requires policies cover even with pre-existing medical conditions).
http://www.bcbstx.com/producer/pdf/tx_uw_guide.pdf is what appears to be a pre-2014 medical underwriting guide from an insurance company listing what pre-existing conditions may be accepted, declined, or accepted with a rider or premium surcharge. Different insurance companies may have had different lists.
One issue that came up in legislative hearings before ACA was passed was that, when previously healthy policy holders got an expensive condition, insurance companies would go over medical history with a fine tooth comb and rescind policies (refunding paid premiums and refusing to continue coverage or pay for current treatment) if there was any difference between the medical history the policy holder described as an applicant and what the recorded medical history found by the insurance company was, even in the absence of error or deception by the policy holder. One example was of a policy holder whose policy was rescinded due to an error (by a past medical provider prior to obtaining the policy) of coding a minor condition as something that would have resulted in initial denial. The insurance company’s refusal to reinstate the policy when the provider acknowledged the error did not make the insurance company look good.
Not really. http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS indicates that public spending on health care in the US is 8.3% of GDP in 2014. This is similar to the 7.7% of GDP that high income countries overall spend (see the bottom of the chart). I.e. our government spending on health care is as much (as a percentage of GDP) as or more than that of universal health care rich countries overall.
Of course, http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS shows the total spending on health care as a percentage of GDP in 2014. This was 17.1% for the US, versus 12.3% for high income countries overall, implying private spending of 8.8% for the US and 4.6% for high income countries overall.
The ever growing cost monster in US health care is a huge problem, one which was not caused by the ACA but which the ACA did little to stop. Note that the higher private spending (mainly by employers) is a competitive disadvantage for employers hiring in the US and providing medical insurance benefits, compared to hiring in other places like Canada.
I’m thinking the smartest thing for my two kids is for them to buy individual plans NOT on the exchange.
If your kids are healthy and can find policies in their budget, that could be a good option. I’m just glad H’s and S’s employers provide excellent insurance plans, which was a very attractive benefit of working for that employer.
Actually, not so simple. Medicare rates, which is a strong form of price control, for all would discourage future Docs from the biz.
Well, medicare rates can be adjusted as needed to keep providers in the business.