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"You may have fended it off but I assure you there is a whole industry devoted to using claims and other health data to manage care and costs. " If by "manage

"You may have fended it off but I assure you there is a whole industry devoted to using claims and other health data to manage care and costs. " If by "manage care and costs", you mean kick people off insurance and deny claims, then sure.

dragonwriter 8y ago
> If by "manage care and costs", you mean kick people off insurance and deny claims, then sure. The prohibition of pre-existing condition exclusion and the associated practice of rescission in the ACA largely ended the “kick people off insurance” practice (and the limitation of profits to a percentage of actual paid bills eliminates some of the incentive on the other), though the current Administration’s drive to reverse those policies combined with the way the industry is vacuuming up personal data could make them return with a vengeance.
- s73v3r_ 8y ago
  Right. Given the aims of the current administration, unless something happens, I don't believe that those protections will survive. There is currently a court case in Texas which is stating that the protections around pre-existing conditions are not legal. The makeup of the courts, especially if Trump gets to nominate another justice, makes me believe they will kill it, and then we'll be even worse off than we were before.
- tunap 8y ago
  At what cost? Specifically, at what price point are the insurance co's limited to charge for PECs? Mandating w/o cost-controls is an invitation to charge as much as necessary to rid themselves of the liability, no? So my question is, where does it mandate what PEC costs are allowable to avoid abuse by providers?
  - dragonwriter 8y ago
    > So my question is, where does it mandate what PEC costs are allowable to avoid abuse by providers? The ACA prohibits denying coverage or charging additional premiums based on, or limiting in any way coverage for services because they are related to, pre-existing conditions. (Now, within the existing state and federal rules on minimal coverage, insurers may limit coverage for particular conditions, but can't differentiate based on whether they were present before the person sought coverage.) The real big deal, though, is the linked prohibition on rescission: before the ACA, insurance companies would frequently do focused investigations to find evidence of non-disclosure pre-existing conditions, however minor and unrelated to the current condition, when an insured person incurred high covered expenses, then use any discovered pre-existing condition as an excuse to retroactively cancel their insurance avoiding the high pending bills and dumping them on the patient.
- kevin_b_er 8y ago
  They will return with a vengeance. 20 Republican states are suing to remove it arguing it unconstitutional and the Republican party gutted the penalty for not having insurance it was tied to. The Republican Party President, Donald J Trump, argues this mandate is inseparable from the entirety of the ACA. The Republican controlled Judicial Branch politically favors of the Republican Party.

dragonwriter 8y ago

> If by "manage care and costs", you mean kick people off insurance and deny claims, then sure. The prohibition of pre-existing condition exclusion and the associated practice of rescission in the ACA largely ended the “kick people off insurance” practice (and the limitation of profits to a percentage of actual paid bills eliminates some of the incentive on the other), though the current Administration’s drive to reverse those policies combined with the way the industry is vacuuming up personal data could make them return with a vengeance.

s73v3r_ 8y ago
Right. Given the aims of the current administration, unless something happens, I don't believe that those protections will survive. There is currently a court case in Texas which is stating that the protections around pre-existing conditions are not legal. The makeup of the courts, especially if Trump gets to nominate another justice, makes me believe they will kill it, and then we'll be even worse off than we were before.
tunap 8y ago
At what cost? Specifically, at what price point are the insurance co's limited to charge for PECs? Mandating w/o cost-controls is an invitation to charge as much as necessary to rid themselves of the liability, no? So my question is, where does it mandate what PEC costs are allowable to avoid abuse by providers?
- dragonwriter 8y ago
  > So my question is, where does it mandate what PEC costs are allowable to avoid abuse by providers? The ACA prohibits denying coverage or charging additional premiums based on, or limiting in any way coverage for services because they are related to, pre-existing conditions. (Now, within the existing state and federal rules on minimal coverage, insurers may limit coverage for particular conditions, but can't differentiate based on whether they were present before the person sought coverage.) The real big deal, though, is the linked prohibition on rescission: before the ACA, insurance companies would frequently do focused investigations to find evidence of non-disclosure pre-existing conditions, however minor and unrelated to the current condition, when an insured person incurred high covered expenses, then use any discovered pre-existing condition as an excuse to retroactively cancel their insurance avoiding the high pending bills and dumping them on the patient.
kevin_b_er 8y ago
They will return with a vengeance. 20 Republican states are suing to remove it arguing it unconstitutional and the Republican party gutted the penalty for not having insurance it was tied to. The Republican Party President, Donald J Trump, argues this mandate is inseparable from the entirety of the ACA. The Republican controlled Judicial Branch politically favors of the Republican Party.