Yes, it’s true. See Grassley Amendment - a Republicsn admendment added to ACA before it was passed. They have to purchase off the D.C. SHOP marketplace - which is being discontinued under TrumpCare. I’m sure there will be no Grassley Amendment to the TrumpCare bill.
Members of congress do purchase through “an exchange”…but they only pay 25% of the cost. The rest is paid by taxpayers. Their subsidy is quite a bit higher than what others at their income level get…which is NOTHING. In addition, they have 57 plans from which to,choose.
They aren’t harming themselves at all,
Sounds like Congress has what we have in name only. They’re costs and choices are decidedly different.
“they have 57 plans from which to choose.”
57 GOLD plans! Yes, different from their constituents for sure.
Does anyone know whether the removal of parity for mental health will affect veterans? We all know many vets suffer from PTSD and face a high suicide rate. I though the new administration made a pledge to care for our veterans?
I couldn’t find anything online about it but I did see this:
“There is a tendency to think that all veterans get health coverage through the VA, which is far from the case,” said Kathy Hempstead of the Robert Wood Johnson Foundation, which helped pay for the study.
“While the coverage situation for vets has improved a great deal, hundreds of thousands of veterans remain uninsured, many of whom would be eligible if their states expanded Medicaid.”
Not only was mental health not treated with equity before ACA, it was a preexisting condition, and a really really bad one. D saw a counselor when she was a junior in HS, for stress issues. Not a psychiatrist, an MFT. No diagnosis, no medication, no insurance claim. Just sitting in the therapists’s office and talking. But those visits made her uninsurable; “automatic decline,” the broker said. That was before ACA. As I read the new law, there’s nothing to prevent insurance companies from going back to that if the state allows it.
^ @LasMa - did you pay out of pocket (ie you were private pay) for your daughter’s therapy? No insurance claim submitted by anyone? Were you too honest and acknowledged to the insu broker that she had seen a therapist for what may have been considered “health/growth” issues? Likely if that info was disclosed the potential insurer would want a copy of the therapy notes, and if you/they refused, citing confidentiality, they would decline coverage. So unfair.
We were private pay. Honestly it never occurred to me to even try to run it through insurance. I found out about this a year later when we were trying to reduce DH’s insurance bill. The broker suggested breaking D out onto her own policy. He ran a quote and I said “Heck yeah!” “How’s her health?” “Good. A couple of ear infections but that’s about it.” “Any mental health issues?” “Well, she saw a therapist last year.” “Oh. No, that’s an automatic decline. She’ll have to stay on your husband’s policy.”
I protested as noted above – no MD, no diagnosis, no medical treatment, no insurance. He said it didn’t matter. It wasn’t a matter of being overly honest with the broker; it was right there on the application, something like “psychiatrist, psychologist, therapist, counselor, or any other mental health professional.” There was no way around reporting her visits unless I wanted to commit perjury. And I hate to say it but I would have been seriously tempted, except that I knew Anthem was zealous about rescission, and I didn’t want the lie to come back and bite her years down the road. Gee, wasn’t free-market-based insurance wonderful?
Hmm, speaking of rescission, that’s yet another curse which was eliminated by ACA. I expect we’ll see it reappear under the new law. Great.
Back in college, I saw a therapist a few times when trying to decide whether to break up or get married when approaching being separated great distances. I guess that would have disqualified me from getting an individual policy, even though it was at the student health center and the therapists were friends of mine and we just had me talk. In any case, I think our childhood asthma would have disqualified all of 4 of us in my nuclear family from any individual policies.
We did try to get S a policy on esurance, but after spending a lot of time completing pages and pages of info, he was rejected because he has mild, intermittent asthma since early childhood which is very-well controlled, for which he is not taking any medication and has never been hospitalized! It was their loss, since he just made premium payments in the months between the end of his university policy and being able to rejoin our family policy in January and received NO services at all. The only policy we could find him for that gap was BCBS and only because he had never had a gap in coverage from BCBS, so that was what we purchased him for 4.5 months. My mom thought we were silly to insist that he had no gaps in coverage, but being uninsured (even just for a few months) was not something that I was ready to do, even to save a few thousand dollars.
Military/retiree/dependent coverage is confusing, between Champus/Champva and Tricare (tricare standard, tricare prime, tricare reserve select, etc). And to make it more confusing, like Medicare, Tricare is managed by diffferent companies in different regions. Currently (and this can change whe it is up for bid again) the west is managed by UHC, the North ny Health Net and the South by Humana. Does each manage the plans consistently? Hopefully…
As for coverage, if a veteran has a diagnosed service connected disability lik PTSD, they are supposed to get coverage through the VA or satellite clinics, and if the facilities aren’t able to meet the demand, they are supposed to contract out for services. But, from what I have heard, that system is fraught with problems too…
I can’t believe we’re actually heading back into that jungle, HImom. I literally can’t believe we’re choosing to do it. There is nothing about insurance which is made better by AHCA. Nothing. In fact, everything is made worse. What is wrong with people?
It’s really, really sad and depressing. I do know that but for my H’s job and S’s, our entire family would have extreme difficulty getting insurance, other than if we COULD get a job that offered some sort of decent group plan with premiums we could afford. Individual policies are not written for asthmatics or anyone that is deemed to have some pre-existing condition, no matter how healthy they are and how little they have cost in medical care.
I thought one of the promises was that pre-existing conditions would be covered. I guess what one hears and what is promised is not worth much.
Well there is something being made better for the insurance companies, right? $$$$$$$$$$ This is all about money. Not about people seeing doctors or getting treated for or preventing diseases. Money, pure and simple.
Re: pre-existing conditions
https://govtrackinsider.com/key-facts-on-the-repeal-and-replace-bill-7f9ca20ce578 and http://www.usatoday.com/story/news/politics/2017/03/08/republican-health-care-bill-facts/98917660/ indicate that coverage of pre-existing conditions remains in the AHCA as currently proposed. (Coverage of pre-existing conditions was the most popular part of the ACA.)
The ACA individual mandate in the form of an extra tax if one does not have insurance is removed. It is to be replaced by a requirement to have continuous coverage; if one has a gap of more than 63 days over the past year, insurance companies may charge an extra 30% for the next year. (The individual mandate was the least popular part of the ACA, but it or something along those lines is necessary to enable coverage of pre-existing conditions without having adverse selection destroying the individual market.)
That continuous-coverage-or-30%-higher-premiums provision may not be enough incentive to get all of the healthy-but-financially-stretched people in the individual market into the system. As with ACA, under AHCA, such people may choose to risk going without insurance until they get expensively sick and then buy insurance (of course, this means that they are vulnerable to sudden health issues, like accidents that take them to the emergency room).
Also, if the AHCA allows for significantly lesser coverage plans (at presumably lower cost), some adverse selection could occur if some people chose the most minimal plans when healthy, but then switch to higher coverage plans when sick. This probably occurs under the ACA individual market and in employer plans that offer a choice of varying levels of coverage, but probably to a lesser extent when the differences in plans is narrower than they could be under AHCA individual market.
Note that coverage pre-existing conditions may only mean that pre-existing conditions will not result in denial of writing the insurance plan. For example, mental health history may not result in denial of coverage, but the coverage itself may not include mental health (for anyone on the plan).
Yep, sylvan, there is a clear purpose to the bill. It’s just that the purpose isn’t insurance. Paul Ryan admitted as much today. He said that the free-market approach is “never going to win a coverage beauty contest” against a government-mandated approach, but that’s OK because Freedom. Coverage is not the goal.
ucb, California is firmly committed to keeping whatever we can about ACA, but of course the reduction in federal Medicaid dollars is going to hurt badly. Another thing that will undermine us is the selling-across-state lines feature which hasn’t been discussed much. Here’s what will almost certainly happen: CA decides to keep the ACA 10 essential benefits – comprehensive coverage. Mississippi decides to eviscerate the 10 essential benefits, maybe excluding maternity, mental health, preventive care, which of course makes their insurance a lot cheaper. Then an insurer in MS looks at, say, the Bay area in CA, and decides that it’s a tempting enough market that they go to the trouble and expense to put together a credible network there, and then heavily market their cheap low-coverage insurance to Bay area residents. Young/healthies jump into that risk pool instead of the better-coverage CA risk pool, driving premiums up for the sicker/olders who remain because they need the benefits. So the state which tries to protect its residents gets punished, and the state which screws its residents gets rewarded. That’s just one of the many perverse incentives in this bill.
Right now…there are precious few doctors in some areas who are accepting ACA exchange policies. Phoenix is one of those areas. @ucbalumnus found a bunch of PCP whomwehre listed on the ONE individual plan marketed in Phoenix…but I can tell you…it took my kid well over a year to find a PCP who would SEE him with that plan.
I don’t see doctors signing up quickly for low reimbursement plans from lower cost of living areas in other states.
This is what TrumpCare is for. It’s not intended to provide health insurance for all or to be affordable.
Then there is another bill that will penalize a person if the don’t participate in their company’s wellness program.
I’m a bit confused by this as they put up such a fuss about ACA penalties for not having insurance because “freedom”, but they are fine with this penalty for non participation.
Opening up more choices for cheaper insurance plans is a good thing. If the plans were cheaper, more people could afford coverage.
The whole purpose of ACA was to get more people covered. People were going bankrupt from catastrophic illnesses that without insurance they couldn’t pay for. No one goes bankrupt over office visit charges, flu shots, or the like. So a catastrophic plan is what most people would like and could afford. No one has a homeowner’s policy that covers broken windows. It would be prohibitively expensive and unnecessary. You want the homeowner’s policy for when the house burns down.
One of the problems with that analogy is that most people would fix the broken windows, while a lot of people do not have preventative care, office visits, flu shots, etc. even if they could manage to afford it. Just easier to let it slide and spend your money elsewhere.
Well…if someone had a chronic not their fault issue with broken windows, they would probably want insurance.