5 ms·

Now self-employed people with pre-existing conditions can actually buy insurance. That is different and better than before the ACA.

by jdblair 10y ago

icantdrive55 10y ago
Yes--anyone with a pre-existing condition can buy health insurance, but insurance companies can charge Whatever they feel like. I'm sure they will be reasonable? Expect to be a bit suprised. My hope is Americans finally wake up, and in four years, have a form of Single Payer. (In the mean time, my hope is prescription prices come down.)
pasbesoin 10y ago
Before the ACA, I barely managed to purchase an individual policy. As I rolled off of COBRA from my last full-time corporate job, a condition mis-diagnosed for a number of years by a urologist was finally -- at my independent urging of an ultrasound technician and their going "above and beyond" to look further than the prescribed test -- diagnosed as a minor hernia. A surgeon fit me in the same day for an initial appointment -- working with the fact that my COBRA term was ending. But after an examination, he said he wouldn't operate. The hernia was too mild. So, per a very well-regarded surgeon, there was nothing to be done. Nonetheless, my application for an individual policy was rejected. It was only because I had a long-term personal professional relationship with someone with significant seniority and status in another insurance company having a cooperative agreement with the company in question, that my rejected application received a second review. They'd made two minor mistakes in processing it, and ultimately, at a very high level within the company, they decided to remedy this by writing me the individual policy -- with exclusions for my allergies and for this minor hernia, along with the urologist's prior, incomplete diagnosis. THIS is how the insurance market was, before the ACA. Oh, and that employer-provided health insurance? You'd better not have had a gap in coverage in the... I forget, now, two? years prior. Otherwise, any and all pre-existing conditions could be excluded for coverage... for a year, I think, perhaps two, under that employer-provided coverage. Most of the bitching I hear and read about the ACA, is simply unfounded. Or, it is based on incomplete where not simply wrong information. For example, the big spike in premiums for marketplace plans, and reduction in participating insurers and plans? That was not the ACA, per se. The law had provision for making insurers whole for the first two or three years (two, I think, and I think it should have instead been five) for losses they experienced. This was to allow time for them to learn what the newly covered population was composed of and to develop actuarial studies of it by which to set more accurate future pricing. Well, you can pass any law you want. It is a separate law -- the "budget process" -- that ultimately pays for it. And the Republican Congress chose to ignore this provision of ACA law in the budget process, leaving it unfunded and thereby stiffing the insurance companies. The ACA is a failure because the Republicans wanted it to be a failure and went to great lengths to make it so. Because, to them, politics and power are more important than effective policy and public health. One other thing: The ACA has saved insurance companies lots of money (compared to estimated costs absent the ACA) in areas outside of the marketplace plans, e.g. in their traditional group coverage. Of course, they don't factor those savings in when complaining about the costs they've borne as a result of the marketplace insurance plans -- said costs, again, having been greatly exacerbated by the Republicans sabotaging the law and stiffing them, in the budget process.
- koolba 10y ago
  The ACA is a failure because it did nothing to reduce costs and did nothing to share the burden of high risk/unhealthy people beyond the individual market. The combination is a shit storm where costs keep rising and the suckers forced to get individual coverage without subsidies have to pay for everybody that got kicked off employer coverage.
  - pasbesoin 10y ago
    My first two years of ACA coverage were comparable both in price and in coverage to the high-end corporate group plan I'd had prior. (Remember, I ended up paying for it via COBRA, whereby I ended up knowing exactly what it cost.) The ACA was a starting point -- the most that could be passed in the face of "the Party of No" that from the initial days of Obama's presidency declare total obstruction to be their over-riding, primary policy objective and political strategy. Like any law and program -- just like those in private sector business -- it required management and improvement. Unfortunately, we instead got obstruction. Law and regulation aren't magic, and they aren't "set and forget". You have to manage them, just like everything in this world. I agree that traditional group insurance should not be separated from the individual market. Insurance companies shouldn't be permitted to cherry pick, neither by population selection nor by pricing. Frankly, I don't see private profit as basically compatible with what I see to be a public investment in the public's health. But with law and regulation, we seem to get at least partway there. But then, the public's not too rational about this, itself. As I mentioned elsewhere, I spent a lot of my time and effort helping an addict of 20+ years, with two kids to care for, get clean, this past year. This included thousands of dollars of in-patient hospital treatment and aborted rehab program attendances, paid for by Medicaid that was greatly expanded, including especially drug and alcohol treatment, under the ACA. In addition to the ACA's contribution, I stepped up personally, when this person couldn't hack the rehab programs, and I spent 3 months basically full time getting them to AA meetings, helping them find and get to work, covering with child care, etc. They managed to stay clean, and as far as I know, about one year out, now, they still are. This fall, after they got back with their big "C" conservative significant other, I had to endure a long flurry of Facebook posts expressing their vehement support of Trump. The face of the very fellows (and yes, I use that gender choice somewhat specifically) who want to choke and kill off the very programs that helped this person get clean. AND that have enabled me, as I explained to them at one point, to be able to purchase health care insurance at all -- with no subsidy, for me. In short, in my personal, anecdotal experience, I've found opponents of the ACA to be irrational people acting against their own self-interest. And selfish people, who take aid and have no concern for the next person who's going to come along and need it. And while the ACA is far from perfect and has had to struggle, the preponderance of rhetoric against it is equally ill-informed and selfish. IMO and experience. It was born in Massachusetts under the Romney government. Nationalized as the ACA, it was meant to be a middle of the road proposal that left the existing powers in place. It was proposed as a first year initiative at a time when not just individuals but businesses were making great outcry about increasing health care expenses -- year upon year double digit percentage increases in insurance premiums -- saying they wouldn't be able to compete with businesses in other nations having national health care and so much lower health care costs. It was obviously planned and queued up before the Obama campaign and nascent administration were made aware of the full depth and severity of the financial crisis. (Something for which I am still upset with Obama for not turning the FBI and Justice loose as was done in the wake of the Savings and Loan scandal in the '80's.) Republicans initiate their selfish, self-serving doctrine of "No". ('We're going to make his a one-term presidency.' That was not just their politics but their operating policy.) They label the health care initiative "Obamacare". They make up the incendiary, false rhetoric of the supposed "death lists" that would be forthcoming. They, up through Trump's election, eight years later, have presented no and have no sign of possessing any alternative plan for health care. Despite the endless rhetoric that they would "fix" health care. If you're not part of the solution, you're part of the problem. The ACA wasn't perfect, but it was a serious attempt to move towards a solution. All the rest -- well, all it's proven itself to be is the problem. All it's offered is a big pack of lies.

Now self-employed people with pre-existing conditions can actually buy insurance. That is different and better than before the ACA.

by jdblair 10y ago

Now self-employed people with pre-existing conditions can actually buy insurance. That is different and better than before the ACA.

icantdrive55 10y ago

Yes--anyone with a pre-existing condition can buy health insurance, but insurance companies can charge Whatever they feel like. I'm sure they will be reasonable? Expect to be a bit suprised. My hope is Americans finally wake up, and in four years, have a form of Single Payer. (In the mean time, my hope is prescription prices come down.)

pasbesoin 10y ago

Before the ACA, I barely managed to purchase an individual policy. As I rolled off of COBRA from my last full-time corporate job, a condition mis-diagnosed for a number of years by a urologist was finally -- at my independent urging of an ultrasound technician and their going "above and beyond" to look further than the prescribed test -- diagnosed as a minor hernia. A surgeon fit me in the same day for an initial appointment -- working with the fact that my COBRA term was ending. But after an examination, he said he wouldn't operate. The hernia was too mild. So, per a very well-regarded surgeon, there was nothing to be done. Nonetheless, my application for an individual policy was rejected. It was only because I had a long-term personal professional relationship with someone with significant seniority and status in another insurance company having a cooperative agreement with the company in question, that my rejected application received a second review. They'd made two minor mistakes in processing it, and ultimately, at a very high level within the company, they decided to remedy this by writing me the individual policy -- with exclusions for my allergies and for this minor hernia, along with the urologist's prior, incomplete diagnosis. THIS is how the insurance market was, before the ACA. Oh, and that employer-provided health insurance? You'd better not have had a gap in coverage in the... I forget, now, two? years prior. Otherwise, any and all pre-existing conditions could be excluded for coverage... for a year, I think, perhaps two, under that employer-provided coverage. Most of the bitching I hear and read about the ACA, is simply unfounded. Or, it is based on incomplete where not simply wrong information. For example, the big spike in premiums for marketplace plans, and reduction in participating insurers and plans? That was not the ACA, per se. The law had provision for making insurers whole for the first two or three years (two, I think, and I think it should have instead been five) for losses they experienced. This was to allow time for them to learn what the newly covered population was composed of and to develop actuarial studies of it by which to set more accurate future pricing. Well, you can pass any law you want. It is a separate law -- the "budget process" -- that ultimately pays for it. And the Republican Congress chose to ignore this provision of ACA law in the budget process, leaving it unfunded and thereby stiffing the insurance companies. The ACA is a failure because the Republicans wanted it to be a failure and went to great lengths to make it so. Because, to them, politics and power are more important than effective policy and public health. One other thing: The ACA has saved insurance companies lots of money (compared to estimated costs absent the ACA) in areas outside of the marketplace plans, e.g. in their traditional group coverage. Of course, they don't factor those savings in when complaining about the costs they've borne as a result of the marketplace insurance plans -- said costs, again, having been greatly exacerbated by the Republicans sabotaging the law and stiffing them, in the budget process.

koolba 10y ago
The ACA is a failure because it did nothing to reduce costs and did nothing to share the burden of high risk/unhealthy people beyond the individual market. The combination is a shit storm where costs keep rising and the suckers forced to get individual coverage without subsidies have to pay for everybody that got kicked off employer coverage.
- pasbesoin 10y ago
  My first two years of ACA coverage were comparable both in price and in coverage to the high-end corporate group plan I'd had prior. (Remember, I ended up paying for it via COBRA, whereby I ended up knowing exactly what it cost.) The ACA was a starting point -- the most that could be passed in the face of "the Party of No" that from the initial days of Obama's presidency declare total obstruction to be their over-riding, primary policy objective and political strategy. Like any law and program -- just like those in private sector business -- it required management and improvement. Unfortunately, we instead got obstruction. Law and regulation aren't magic, and they aren't "set and forget". You have to manage them, just like everything in this world. I agree that traditional group insurance should not be separated from the individual market. Insurance companies shouldn't be permitted to cherry pick, neither by population selection nor by pricing. Frankly, I don't see private profit as basically compatible with what I see to be a public investment in the public's health. But with law and regulation, we seem to get at least partway there. But then, the public's not too rational about this, itself. As I mentioned elsewhere, I spent a lot of my time and effort helping an addict of 20+ years, with two kids to care for, get clean, this past year. This included thousands of dollars of in-patient hospital treatment and aborted rehab program attendances, paid for by Medicaid that was greatly expanded, including especially drug and alcohol treatment, under the ACA. In addition to the ACA's contribution, I stepped up personally, when this person couldn't hack the rehab programs, and I spent 3 months basically full time getting them to AA meetings, helping them find and get to work, covering with child care, etc. They managed to stay clean, and as far as I know, about one year out, now, they still are. This fall, after they got back with their big "C" conservative significant other, I had to endure a long flurry of Facebook posts expressing their vehement support of Trump. The face of the very fellows (and yes, I use that gender choice somewhat specifically) who want to choke and kill off the very programs that helped this person get clean. AND that have enabled me, as I explained to them at one point, to be able to purchase health care insurance at all -- with no subsidy, for me. In short, in my personal, anecdotal experience, I've found opponents of the ACA to be irrational people acting against their own self-interest. And selfish people, who take aid and have no concern for the next person who's going to come along and need it. And while the ACA is far from perfect and has had to struggle, the preponderance of rhetoric against it is equally ill-informed and selfish. IMO and experience. It was born in Massachusetts under the Romney government. Nationalized as the ACA, it was meant to be a middle of the road proposal that left the existing powers in place. It was proposed as a first year initiative at a time when not just individuals but businesses were making great outcry about increasing health care expenses -- year upon year double digit percentage increases in insurance premiums -- saying they wouldn't be able to compete with businesses in other nations having national health care and so much lower health care costs. It was obviously planned and queued up before the Obama campaign and nascent administration were made aware of the full depth and severity of the financial crisis. (Something for which I am still upset with Obama for not turning the FBI and Justice loose as was done in the wake of the Savings and Loan scandal in the '80's.) Republicans initiate their selfish, self-serving doctrine of "No". ('We're going to make his a one-term presidency.' That was not just their politics but their operating policy.) They label the health care initiative "Obamacare". They make up the incendiary, false rhetoric of the supposed "death lists" that would be forthcoming. They, up through Trump's election, eight years later, have presented no and have no sign of possessing any alternative plan for health care. Despite the endless rhetoric that they would "fix" health care. If you're not part of the solution, you're part of the problem. The ACA wasn't perfect, but it was a serious attempt to move towards a solution. All the rest -- well, all it's proven itself to be is the problem. All it's offered is a big pack of lies.