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TomCADem Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 04:34 PM
Original message
Does The Current Bill Still Allow Insurers To Discriminate Against Children Based On Pre-existing...
Conditions? I saw some lists on the new bill, and did not see this listed as a feature. Was it dropped or just not listed?
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angee_is_mad Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 04:35 PM
Response to Original message
1. No it does not
I will try to find you the link.
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TomCADem Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 04:44 PM
Response to Reply #1
4. Damn it! It Should Be A No-Brainer To Ban Denying Coverage For Kids Due To Pre-Existing Conditions
MSNBC ran a whole series on this, and talk about low hanging fruit.
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BP2 Donating Member (406 posts) Send PM | Profile | Ignore Sat Dec-19-09 04:40 PM
Response to Original message
2. Well ...

For now it doesn't.

Check back though for the next compromise. Anything's possible :banghead:

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bigwillq Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 04:42 PM
Response to Original message
3. I believe for minors
the pre-exisiting condition part of the bill will take affect right away. For adults, I believe it's not until 2013 or 2014. But things can certainly change (for better or worse). We shall see.
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TomCADem Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 07:06 PM
Response to Reply #3
12. AP - Update - Found A Story Saying That The Children Pre-Existing Condition Ban Is Immediate
Here is the excerpt:

http://www.google.com/hostednews/ap/article/ALeqM5jlMpJ...



In place of a government-run insurance option, the estimated 30 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for national plans overseen by the same office that manages health coverage for federal employees and members of Congress. Those plans would be privately owned, but operated on a nonprofit basis, as many Blue Cross Blue Shield plans are now.

Insurance companies would be barred immediately from denying coverage to children because of a pre-existing health condition. The prohibition on denial of coverage for adults would not take effect in the Senate bill until 2014, a disappointment for consumer advocates.




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lapfog_1 Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 04:45 PM
Response to Original message
5. According to the analysis
but I haven't found the supporting language yet, No. In fact, from day one, insurance companies are forced to accept children with pre-existing conditions.

Not so much for the rest of us, however.

Those of us adults with pre-existing conditions will not be included until the exchanges are up and running, in 2014. In the meantime, we are placed in a "high risk" pool and afforded health insurance by paying for it (and you know the premiums are going to be enormous). It will be subsidized, but if you are (I believe) 4 X over the poverty level, no subsidy for you. I've been quoted insurance before (I've been without for 14 years now). My premium will be at least $2000 a month, and with a $15,000 to $20,000 deductible - 14 years ago it was $1200 a month with a $10,000 deductible... and that was the best price I could find then. The high risk pool isn't going to be any better.

I've already resigned myself to no insurance until 2014. And then, well I'm over 50 now, and they are allowed to price in for age, up to 4 X the lower premiums. I probably still can't buy insurance and I still won't qualify for subsidy.

So, basically, I'll be one of the estimated 6% of all Americans who "fall through the crack".

Oh, but I'll be paying the fine for the rest of you.

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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 05:08 PM
Response to Reply #5
6. I'm in the Oregon Insurance Pool
My deductible is $500 a month. My premium is $600 a month. I pay $30.00 a month. My husband pays the same. We have 80/20 and prescription coverage. Nothing has been turned down, not even Hep C treatment. Would you like to have that?
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lapfog_1 Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 05:30 PM
Response to Reply #6
7. Let me get this straight...
You pay $600 a month for insurance that doesn't kick in until you've paid $500 ( and that resets every MONTH ). So you are out $1100 in one month before insurance picks up a dime?

And this is individual and your husband as the same plan. So, as a family, you pay up to $2200 a month before insurance covers you? What do you have, AIDS? Cancer?

That's potentially worse than my quote from years ago and I have life threatening heart problems (WPW and a prolasping mitral valve).

Whats the $30, a per visit co-pay (just to put a little more salt in that $1100 a month wound?).
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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 05:49 PM
Response to Reply #7
8. Not remotely
I pay $30 a month and $500 annual deductible. How anybody could so wildly distort that as you did is beyond me. No wonder we can't get a sensible health care bill passed.
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lapfog_1 Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 06:08 PM
Response to Reply #8
9. Wildly distort... go read your post again...
"My deductible is $500 a month. My premium is $600 a month. I pay $30.00 a month."

your deductible is $500 a month.

your premium is $600 a month.

That's $1100 a month out of pocket before insurance pays a dime ($500 in charges).

How did I distort that.

Maybe you didn't explain it very well. I'd never heard of a "per month" deductible, but hey, I've been out of the health insurance game for quite some time.

I can't read your mind (what you MEANT to type).

Let's try again...

Your deductible is $500 a YEAR. Your Premium is $30 a month? What's the $600 amount? Your first post says that's your monthly premium, but this post says $30 a month.

Try it over again, with accurate descriptions of each amount, and what its for, exactly.

Some terms defined, in case you are confused.

Deductible - the amount of out of pocket expenses you incur for a given time period (usually a year) before insurance picks up some if not ALL of the rest of the medical expense.

Premium - the amount you pay every month (or sometimes every 6 months) for your insurance.

Co-pay - the amount you pay out of pocket (usually on a per visit or per prescription basis) OVER and ABOVE your deductible.

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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 06:17 PM
Response to Reply #9
10. I apologize, I mistyped
My deductible is $500 a year.

I'll rephrase the rest.

The Oregon Insurance Pool premium is $600 a month. I pay $30, because as I've said so many times I'm boring myself with it, I have a subsidy.

Your scenario isn't necessarily what will be in place, and shouldn't be.

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lapfog_1 Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 06:49 PM
Response to Reply #10
11. Ah, you have a subsidy.
So... now let's be clear...

Your premium (what a private insurer receives) is $600 a month, of which you pay only $30, and the state of Oregon picks up $570. You have a annual deductible of $500. You don't mention a co-pay so maybe there isn't one. So the max YOU have to pay for your insurance in a year is $860 ($30 X 12 plus the $500). The state pays $6,840 out of (probably) general income fund of tax receipts.

That's a fantastic deal.

And you indicated that there is no test for or premium or deductible difference for pre-existing conditions.

You didn't mention prescriptions, but lets say you have something like a $8 or $10 co-pay for that.

Guess I should be moving to Oregon!!! I always liked the Grants Pass region, and I have old friends living in Eugene.

Anyway, my analysis on the current state of the bill (kids are covered from day 1 - pre-existing or not) AND Adults have to wait for exchanges to be up and running (2014) and that in the meantime, uninsured would be place into a high risk pool and subsidized to the SAME extent as if the exchanges were running is directly from both the manager's amendment and an analysis from a pro-bill author on HuffPo. But even though it was from someone wanting the bill to pass, I went and looked up everything in the .pdf file here:

http://democrats.senate.gov/reform/managers-amendment.p...

So I'm pretty sure my analysis is fairly accurate.

You didn't mention your income level, but from the fact that the state of Oregon is subsidizing you to the tune of $6,840 annually, I'm going to guess that you aren't in a high income bracket. The federal program is likely going to be close to your Oregon program for people earning less than, say, $18,000 to $22,000 a year. For those earning more like $40,000 a year, the federal program probably isn't as generous as your state program, but that's a guess because I don't know much about your Oregon subsidy program, who qualifies and what the amounts are, etc. Anyway, despite the CBO estimate of cost savings, the Senate program would blow a hole through the federal deficit if they heavily subsidized middle income Americans. And, according to the CBO, it not only doesn't, but it could save over $100 B in 10 years. I am highly suspicious of the CBO estimate in that I believe that the insurance companies are not "fair partners" but "evil bastards", right up there with Halliburton and Blackwater. I believe that the insurance companies will use their monopoly powers (the only industry outside of major league sports to have such) to collude and "game the system" to increase their profits. That will drive down the CBO estimate of the cost savings. What I'd love to see is a range of CBO estimates based on 3 different behavior scenarios. Insurance companies behaving like non-profits (or the Public Option), Insurance companies behaving as they do now, and Insurance companies behaving like Lockheed Martin with a Cost Plus military procurement contract (those infamous $150 hammers type contracts).


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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 08:24 PM
Response to Reply #11
13. More info
I really don't know if there's a co-pay, we've never been asked for one but I think that's because our local non-profit, Catholic, health provider has a program that they strongly encourage everyone to participate in. It will cut bills, or do away with them completely in some cases. The prescription co-pay is $10, $20 or $40, depending on the medication. I still try to get the $10 for 3 month stuff whenever I can, and we pay for it.

The subsidy program is for families who don't qualify for any other state plan. Unfortunately it isn't fully funded so not everybody gets in. If we didn't have pre-existing conditions, we could get a plan for half that, and dental and optical for just a few dollars a month more. Those plans are all offered through private insurance. The subsidy pays from 50% to 95%, on a sliding scale. A family of 4, at $3400 a month, would get a 50% subsidy. At $2750 a month, they'd get a 90% subsidy.

The pool for pre-existing conditions only has one plan, and it is serviced by BC/BS. I have no idea whether Oregon's BC/BS is profit or non-profit.


http://www.oregon.gov/OPHP/FHIAP /

As far as the subsidies bankrupting the country, see, I don't care. Once these dumbasses discover this isn't sustainable, they'll have to go back to the drawing board, and then we'll get single payer. In the meantime, I'm not about to let people die because rich fucks want to play tax and shuffle games. I just don't care. Tax their money on one hand and shovel it into their portfolios in the other. Give People Health Care. That's all.
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lapfog_1 Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 09:43 PM
Response to Reply #13
14. Yeah, I thought about supporting the bill just for the reason you stated.
Edited on Sat Dec-19-09 09:44 PM by lapfog_1
Because I really do believe it will hasten, not forestall, the collapse of the health care industry.

But a couple of things stopped me.

First, while I'm convinced that the system will fail eventually, there will be a lot of pain in the meantime, and that meantime is likely to be longer because "We just reformed health care, we have to give this at least 10 years to work the kinks out, blah, blah, blah".

Second, we are transferring even more of our wealth to these corporate bastards, and while I personally despise them, if they simply took their money and stuffed it into Cayman Island bank accounts... I probably wouldn't care that much. However, they won't do that, they will use that enormous amount to new money (some portion of it) to funnel BACK to the politicians that just sold us down the river. To consolidate their hold over our political process. We won't have another opportunity to weaken the beast. Not for a long long time. We must seize the day and do it, via reconciliation.

And now, as the third reason ( though I opposed the bill before this ), this bill will mark the first time since Roe V. Wade where there has been a significant restriction of abortion rights at the federal level. And that's not something I'm willing to bargain away for the sake of a "victory" for President Obama and a signing ceremony in the East Room.
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depakid Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-19-09 09:51 PM
Response to Reply #5
15. "I've already resigned myself to no insurance until 2014."
There are going to be a LOT of people in that boat- and my guess is that they're not going to be very pleased about the prospect come 2010 and 2012.

Boggles the mind that the Dems can't figure this out (or- maybe they have and just don't care).
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