<p>They were few in number compared to the total pool of subscribers. But they were the people who needed their insurance the most. And of course, between having a major illness and being rescinded, those people could never get insurance again. That’s not a small problem if you’re very ill and suddenly find yourself uninsured.</p>
<p>As for omitting preexisting conditions – First, the rescission cases were subjected to the kind of careful underwriting which should have taken place before the policy was issued, if it was going to be done at all. Second, the pre-existing conditions which were used as an excuse to boot a subscribers were often a) distant in time, and/or b) completely unrelated to the current illness. For example, your breast cancer case might get you kicked out because you forgot to report an ear infection which happened 9 years before the policy was issued.</p>
<p>And even if you faithfully reported every single medication, every single doctor, every single illness, procedure, or surgery, you could STILL be booted for minor clerical errors. Let’s say you reported taking a medication in 2003. If they found you actually took it in 2004, they could and DID cry “fraud” and use it to kick you out.</p>
<p>Recission was not a minor problem. It was one of the most despicable things that insurance companies did. And as Fang said upthread, they unequivocally told Congress that they would not stop.</p>
<p>Wellpoint, and other insurers, had a computer program that scanned the records of people who had gotten diagnosed with serious illnesses, trying to find excuses to rescind those people. If they had been genuinely concerned about underwriting, they would have used these programs with everyone. But no. They just wanted to save money, so they looked for excuses. </p>
<p>And in most cases, these alleged omissions were not fraud, nor were they related to the new diagnosis that was going to cost the insurer money. One woman with breast cancer was booted for not having reported acne. Another woman with breast cancer was rescinded for not reporting some condition that was on her chart, but that she didn’t know about. </p>
<p>As LasMa said, this was despicable. And the insurers told Congress in plain terms, right in the open, that they would not stop it.</p>
But the problem hasn’t been with the large employer market. The big problem has been with small group market and individual market – where the customer had no real bargaining power with the insurer and no where to go after they were kicked off.</p>
<p>Employer-provided insurance is usually open enrollment, without requiring submission of medical history forms. On the individual market, to buy health insurance, a consumer would typically have to fill out a long medical history form, give consent for release of all their medical records, and often also have a medical exam by an in insurance company doctor. That’s why the insurance companies could get away with rescinding the policies - they’d go back to that original medical history form and start combing the medical records to see if they could find anything that the applicant had left off. It didn’t matter if it was significant or related to the condition being treated at the time of rescission – the point was that the insurance company could come up with a plausible reason and cut the person off. There person with the rescinded policy was in no position to litigate against the insurance company, and had no where else to go.</p>
<p>RE: #820
It is a state by state thing, CF, you are in CA, right? So CoveredCA should be working, though I have not checked it today. I am learning that in one state with a federally run exchange there is not really a format to allow us, the agency, to view all the exchange plans at once. There is supposed to be a link we click through the insurance company website, but no one is sure yet, if that will only show plans on the exchange company by company.</p>
<p>Theoretically, there is allowed to be a link on an agency website to run the plans, but only once they get that up & running & available.</p>
<p>So, you, the client, could click on the federally run marketplace and login as yourself and see all the plans, but if you agent was not sitting next to you, they could not yet see the plans in those states. You can still designate your servicing agent by adding their NPN when asked.</p>
<p>“But the problem hasn’t been with the large employer market. The big problem has been with small group market and individual market – where the customer had no real bargaining power with the insurer and no where to go after they were kicked off.”</p>
<p>I am addressing very specific statement with quotes in my post 810 which was addressing post 789. I want to make sure it was not universal for all insurances that insurance companies could throw out people from any insurance.</p>
<p>The big issue, IMHO, with the large employer market pre-ACA is that employers can fire people who get expensive illnesses. So the insurance company doesn’t need to kick them out; they lose coverage via the job loss. It is a rare person who can go through chemo without it affecting their job performance at all. So employers almost always had some kind of cover if they wanted to get rid of Cancer Man.</p>
<p>Trust but Verify and I am not sure about trusting health insurance companies. :)</p>
<p>It wasnt that long ago when Anthem tried to push thru rates increases in the high 30’s percent and the numbers used to justify these rate increases was bs. Many of us received increases in the mid 20 percent instead after the phony numbers were discovered. I think voters should support the proposition. Many states already do what Calif could accomplish.</p>
<p>Calmom, I do have to be careful to extrapolate my situation generally because most people are going to get subsidized health care insurance and I am not. The silver plan is going to cost me about 3500 a year more than a bronze plan and I cant see a situation where a silver plan works for me. </p>
<p>The silver plan may work for others with large subsidies. Having said this, I am pretty confident the bronze plan will be the plan chozen most. Blue Shield has cut their network and Kaiser’s rates are not competitive in many cases. Kaiser thinks Anthem’s rates are too low. </p>
<p>There were at least some protections for people with Cancer - FMLA, but only if those people could afford to take time off for free.</p>
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<p>The problem with small employers used to be small risk pool. Your previous employer would probably have to stop offering health insurance if you got sick while working for that employer. It would have become unaffordable for everyone. Or the health insurance could have dropped your employer too.</p>
Well they don’t even have to be fired-- as you’ve noted, when people get seriously ill, they often are unable to continue working. Even someone with an understanding and supportive employer may have to resign. </p>
<p>That’s why I don’t think that insurance should be tied to employment at all. The new system might solve the problem of getting insurance, but it will also force people to be shopping around and researching different plans at a time when they need to be focusing on continuity in treatment. With the differences in provider networks, that could lead to a lot of confusion.</p>
I’ve done the math an the Bronze is almost always a better deal for full pay – the bottom line is that the difference in the plans cost is built into the premiums. I wrote a blog post detailing the math (Google “Why the Bronze plan may be better than you think” if you want to read it). </p>
<p>In the example I wrote about, the full-payer is charged 80% of the difference in deductible costs up front in premiums. So when you factor in the Silver plan’s deductible as well, you aren’t even beginning to see any sort of savings until you’ve spent 88% of the Bronze deductible. Under ACA even the cheapest plan gives you free preventive care, so it won’t make a difference for the annual physical.</p>
<p>On the top end, all plans have a maximum out-of-pocket that is the same. (Somewhat reduced in California on the platinum, but again, that’s being paid up front with the premiums). </p>
<p>So on the high end of costs the Bronze will be cheaper too – the consumer will hit the maximum and the insurance will pay out 100%.</p>
<p>It’s only a narrow band of costs roughly between the Bronze deductible and maximum payout levels where there is a potential for a small amount of savings on the Silver - in the range of a few hundred dollars, not thousands. So it’s like playing the slots at a casino – you just aren’t going to win that way. </p>
<p>The best deal for a full-payer is the Bronze with an HSA, so you get the tax benefits of the HSA. The only exception would be a person with a chronic illness with fixed costs that are within the window where the Silver plan is beneficial. If the costs are due to medications, then the person might even do better with a higher premium, low or no deductible plan if that will result in a lower copay for the prescription drugs. </p>
<p>But the healthy person who wants insurance primarily for the catastrophic benefits, Bronze is definitely the way to go for full payers.</p>
<p>Yes, the best plan for a full-payer is the Bronze with an HSA, which is going to cost me over $13,000 a year. However, the subsidized subscriber is going to pay a fraction of that for the silver plan. The middle class is getting screwed. Hopefully, I am allowed to use that word. :)</p>
<p>Goldenpooch, you never answered my question about how much over the 400% mark your family is – or, to put it another way, what percentage of your family income that $13K represents. </p>
<p>Or how about this question: what’s your current marginal federal tax rate? </p>
<p>If you don’t want to answer those questions, that’s fine – but then you might want to quit whining.</p>
<p>I am self-employed so it varies considerably. In the last few years the amount is considerably less than it use to be. I am not sure why you need to know my marginal tax rate, but I can tell you it will be higher if you include the additional premiums. </p>
<p>Your definition of whining is different from mine. Regardless of my income, the 60 year old couple who earns around $65,000 a year will pay premiums equal to 24% of their income. Is that whining if they’re unhappy?</p>
<p>Or the couple earning $65,000 can get real jobs that have health care benefits which are subsidized by other taxpayers. </p>
<p>Goldenpooch was not really insured before ACA. One major illness and the insurance was worth toilet paper. Actually the insurance was worth less than toilet paper because toilet paper serves a purpose. </p>
<p>I find it interesting that people who have health insurance through their employers dislike ACA. </p>
<p>Those that receive health insurance through their employers dont like the health insurance costs of the self employed? Lol… We aren’t thrilled either. :)</p>
<p>dstark, I am having trouble understanding your posts. Why is my insurance no better than toilet paper? In Ca. they can’t drop your coverage if you get sick. Although I wasn’t thrilled with the agents and the bureaucracy at Blue Shield, they always paid every claim. I know quite a few people who got very sick and their individual insurance did what it was suppose to.</p>
I think voters should support the proposition. Many states already do what Calif could accomplish.</p>