Brainfade Posted June 29, 2009 Share Posted June 29, 2009 K_R, I well and truly want to find an answer to the pre-existing condition conundrum. I posed your question to an oncologist. He is himself a cancer survivor (at age 17), who put himself through medical school and now runs a successful practice. Here is his response. Take it for what it is worth: Such a person would qualify for Medicaid and would be able to get coverage for treatment. It is the cancer survivor who is self employed and can not get an individual policy that has the problem. If they are not self employed they can get into a group plan. I had cancer when I was 17. I took chemotherapy for two years. I have health insurance. I made sacrifices (like making sure I always worked in places that carried group health insurance even if it was not my #1 choice of job). But since national healthcare is asking some to sacrifice, I do not think asking the recipient of health`care to do the same is out of line. Link to comment Share on other sites More sharing options...
kumble_rocks Posted June 29, 2009 Share Posted June 29, 2009 K_R' date=' I well and truly want to find an answer to the pre-existing condition conundrum. I posed your question to an oncologist. He is himself a cancer survivor (at age 17), who put himself through medical school and now runs a successful practice. Here is his response. Take it for what it is worth:[/quote'] Routine google search provided me with this link without any effort- Check this link by California department of insurance which lists medical conditions which are automatically denied by insurance company . http://www.insurance.ca.gov/0100-consumers/0070-health-issues/ind-health-insurance-underwriting-ab-356.cfm There are many medical conditions that may cause an insurance company to automatically deny or not approve your application. These may include the following: * Health problems for which you have not seen a doctor; * Health problems that a doctor cannot explain; * Health problems for which you have not completed treatment. An insurance company may also automatically deny your application for the health conditions below. There may be other health conditions that are not on this list. * AIDS; * Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process; * Cancer, under treatment; * Sleep Apnea; * Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities; * Heart disease; * Renal failure or Kidney Dialysis; * Diabetes with complications; * Cirrhosis; * Multiple Sclerosis; * Muscular Dystrophy; * Systemic Lupus Erythematous; * History of transplant; * Lymphedema; * Current infertility treatment; * Hepatitis; * Hemochromatosis. Sure for certain diseases like Diabetes , Hepatitis etc one can get some sort of catastrophic insurance , but good luck finding a carrier if you are suffer from AIDS , Cancer etc. I clearly remember these patients being denied medicad in the CBS 60 minutes program I was watching . And you have to be extremely poor or bankrupt to be eligible. Some $25,000 a year for a family of four to be eligible for Medicaid. You keep talking about private insurance , tell me one good reason why they should cover a cancer patient in the open market ? Does it make any business sense to cover them especially if one can potentially incur a million dollar cost ? Link to comment Share on other sites More sharing options...
kumble_rocks Posted June 29, 2009 Share Posted June 29, 2009 I take exception to the "partisan" comment. In my initial response to mm' date=' I clearly praised Obama for bringing this issue to the forefront. But it does not change the fact that he is not honest when he first said that everyone will get the coverage that Congressmen get, but now that is off the table. It does not change the fact that he promised he will not tax healthcare benefits, but it is back on the table (did you see Stephanopolous grill Axelrod about this?). If employer-based healthcare is the way to go, why tax it more?[/quote'] Obviously , health care reform is a work in progress . One can't expect him to possibly fore-see all the pitfalls especially when being countered by hostile republicans and their cabal of insurance lobbyists. Fact is - the system is broken, not because it is a free-market system, but because it is not truly a free-market system. The big HMOs have a huge advantage. The govt will be the biggest of them all. You don't know that . It is not truly free market because insurance lobby will not let it be. Like Obama aptly put which I am quoting verbatim "If private insurers say that the marketplace provides the best quality health care ... then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" You did not answer this - if the govt gave you a $5000 credit p.a. to buy good insurance, could you buy one? Second, does the law allow insurance company to deny coverage even after the exclusion period? Sure , insurance company can and is denying coverage even after the exclusion period when it is not group insurance . Third, there are plans called "group individual" plans for folks who cannot find employment and have exhausted COBRA. Again , it's nothing but pedantry ... As for Medicaid not covering who it should - you made my point. Involve the government, mess it up. No, involve republicans and their lobbyists , health insurance is messed up. The problem with republicans like yourself is that you act as if you are part of the solution when you condemn universal health care as sort of socialized medicine. The truth of the matter is you want to encourage socialism by forcing people into a employer based group insurance . Individual entrepreneurship be damned ! Link to comment Share on other sites More sharing options...
Brainfade Posted June 30, 2009 Share Posted June 30, 2009 Obviously , health care reform is a work in progress . One can't expect him to possibly fore-see all the pitfalls especially when being countered by hostile republicans and their cabal of insurance lobbyists. You don't know that . It is not truly free market because insurance lobby will not let it be. Like Obama aptly put which I am quoting verbatim "If private insurers say that the marketplace provides the best quality health care ... then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" Sure , insurance company can and is denying coverage even after the exclusion period when it is not group insurance . Again , it's nothing but pedantry ... No, involve republicans and their lobbyists , health insurance is messed up. The problem with republicans like yourself is that you act as if you are part of the solution when you condemn universal health care as sort of socialized medicine. The truth of the matter is you want to encourage socialism by forcing people into a employer based group insurance . Individual entrepreneurship be damned ! What about HIPAA? (from the link you posted): In 1996 the federal government passed into law the Health Insurance Portability and Accountability Act (HIPAA). HIPAA law provides eligible individuals who have recently lost their employer sponsored group health plan the opportunity to purchase health insurance coverage even if they have a preexisting health condition. If you meet the definition of an eligible individual, all health insurance companies who sell individual plans must offer you health insurance regardless of your medical history. This requirement to issue insurance is called "guaranteed issue." You may not be declined coverage based on medical reasons. Who is eligible for HIPAA? In order to qualify as an eligible individual you must meet the following conditions: * You have 18 or more months of prior creditable coverage. Your most recent health care coverage must be under an employer sponsored group health plan, which includes COBRA or Cal-COBRA continuation coverage. This prior 18-month coverage is referred to as "creditable coverage." * All available COBRA or Cal-COBRA continuation coverage has been elected and exhausted. Note: When an employer terminates its existing group health plan entirely, COBRA or Cal-COBRA coverage ends and is considered exhausted. * You are not eligible under a group health plan, Medicare, Medi-Cal, and/or do not have other health insurance coverage. * You did not lose your most recent health coverage due to nonpayment of premium or fraud. When should an individual apply for a HIPAA policy? Once COBRA or Cal-COBRA has been exhausted, you have 63 days to file an application to purchase a guaranteed issue HIPAA policy with an insurance company or health plan. All carriers that sell individual health care policies must offer their two most marketed individual plans to HIPAA eligible individuals regardless of your health status. If you accept a conversion policy or a short-term policy after exhausting COBRA or Cal-COBRA, you give up the HIPAA eligibility. It is important to note that a conversion policy is not a HIPAA policy. When applying for a HIPAA policy, you can present a Certificate of Creditable Coverage from your insurance company or health plan as part of the application process. The Certificate of Creditable Coverage is a written statement from the insurance company or health plan showing the length of time you have been covered. The Certificate can be used as proof of your 18 months continuous creditable coverage when applying for a HIPAA policy. Who enforces HIPAA? HIPAA is jointly regulated by the CDI and the DMHC The problem with republicans like yourself is that you act as if you are part of the solution when you condemn universal health care as sort of socialized medicine. The truth of the matter is you want to encourage socialism by forcing people into a employer based group insurance . Individual entrepreneurship be damned Clarification: I'm a fiscal conservative, not a Republican. Not the same thing. Employer-based group insurance is not a conservative idea. It is a liberal idea that was started Roosevelt and Truman. Nixon (a Republican but hardly a fiscal conservative) then shoved HMOs down people's throats in 1973. The insurance industry is dominated by a few of these huge HMOs that wage too much power. It is not a true free-market system. I am still not sure why you are against the idea of providing a $5000 tax credit for people to buy their own insurance - wouldn't that and the enforcement of HIPAA laws take care of these issues? A random google search brought this up: http://www.usbenefitsdirect.com/ Wonder what their catch is. Also, regarding CHIP - it is not a novel idea proposed by this administration. It's been in existence since 1997. In Dec 2007, GWB signed an extension of CHIP till March 2009. Obama now extended it to give coverage to children of legal immigrants - he HAD to re-sign it Feb 2009, as it would have expired in Mar 2009. To his credit, he did it. Oh ... and to answer his "apt" quote: Mr. President, it is elementary: the government makes the rules, it has unlimited supplies of money (it prints the money too, you see, and can also borrow from China), can indulge in deficit-spending and out-compete private insurance. As kids would say ... "Doh." 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Brainfade Posted June 30, 2009 Share Posted June 30, 2009 Obviously , health care reform is a work in progress . One can't expect him to possibly fore-see all the pitfalls especially when being countered by hostile republicans and their cabal of insurance lobbyists. You don't know that . It is not truly free market because insurance lobby will not let it be. Like Obama aptly put which I am quoting verbatim "If private insurers say that the marketplace provides the best quality health care ... then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" Sure , insurance company can and is denying coverage even after the exclusion period when it is not group insurance . Again , it's nothing but pedantry ... No, involve republicans and their lobbyists , health insurance is messed up. The problem with republicans like yourself is that you act as if you are part of the solution when you condemn universal health care as sort of socialized medicine. The truth of the matter is you want to encourage socialism by forcing people into a employer based group insurance . Individual entrepreneurship be damned ! What about HIPAA? (from the link you posted): In 1996 the federal government passed into law the Health Insurance Portability and Accountability Act (HIPAA). HIPAA law provides eligible individuals who have recently lost their employer sponsored group health plan the opportunity to purchase health insurance coverage even if they have a preexisting health condition. If you meet the definition of an eligible individual, all health insurance companies who sell individual plans must offer you health insurance regardless of your medical history. This requirement to issue insurance is called "guaranteed issue." You may not be declined coverage based on medical reasons. Who is eligible for HIPAA? In order to qualify as an eligible individual you must meet the following conditions: * You have 18 or more months of prior creditable coverage. Your most recent health care coverage must be under an employer sponsored group health plan, which includes COBRA or Cal-COBRA continuation coverage. This prior 18-month coverage is referred to as "creditable coverage." * All available COBRA or Cal-COBRA continuation coverage has been elected and exhausted. Note: When an employer terminates its existing group health plan entirely, COBRA or Cal-COBRA coverage ends and is considered exhausted. * You are not eligible under a group health plan, Medicare, Medi-Cal, and/or do not have other health insurance coverage. * You did not lose your most recent health coverage due to nonpayment of premium or fraud. When should an individual apply for a HIPAA policy? Once COBRA or Cal-COBRA has been exhausted, you have 63 days to file an application to purchase a guaranteed issue HIPAA policy with an insurance company or health plan. All carriers that sell individual health care policies must offer their two most marketed individual plans to HIPAA eligible individuals regardless of your health status. If you accept a conversion policy or a short-term policy after exhausting COBRA or Cal-COBRA, you give up the HIPAA eligibility. It is important to note that a conversion policy is not a HIPAA policy. When applying for a HIPAA policy, you can present a Certificate of Creditable Coverage from your insurance company or health plan as part of the application process. The Certificate of Creditable Coverage is a written statement from the insurance company or health plan showing the length of time you have been covered. The Certificate can be used as proof of your 18 months continuous creditable coverage when applying for a HIPAA policy. Who enforces HIPAA? HIPAA is jointly regulated by the CDI and the DMHC The problem with republicans like yourself is that you act as if you are part of the solution when you condemn universal health care as sort of socialized medicine. The truth of the matter is you want to encourage socialism by forcing people into a employer based group insurance . Individual entrepreneurship be damned Clarification: I'm a fiscal conservative, not a Republican. Not the same thing. Employer-based group insurance is not a conservative idea. It is a liberal idea that was started Roosevelt and Truman. Nixon (a Republican but hardly a fiscal conservative) then shoved HMOs down people's throats in 1973. The insurance industry is dominated by a few of these huge HMOs that wage too much power. It is not a true free-market system. I am still not sure why you are against the idea of providing a $5000 tax credit for people to buy their own insurance - wouldn't that and the enforcement of HIPAA laws take care of these issues? A random google search brought this up: http://www.usbenefitsdirect.com/ Wonder what their catch is. Also, regarding CHIP - it is not a novel idea proposed by this administration. It's been in existence since 1997. In Dec 2007, GWB signed an extension of CHIP till March 2009. Obama now extended it to give coverage to children of legal immigrants - he HAD to re-sign it Feb 2009, as it would have expired in Mar 2009. To his credit, he did it. Link to comment Share on other sites More sharing options...
kumble_rocks Posted July 2, 2009 Share Posted July 2, 2009 If you read this - You have 18 or more months of prior creditable coverage. Your most recent health care coverage must be under an employer sponsored group health plan, which includes COBRA or Cal-COBRA continuation coverage. This prior 18-month coverage is referred to as "creditable coverage." It clearly states that you have to be under an employer sponsored group plan prior to be eligible for the Health Insurance Portability and Accountability Act (HIPAA) insurance . Also , it talks about group plans and the preexisting condition exclusions periods . The law defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date (which is the earlier of the first day of health coverage or the first day of any waiting period for coverage) .Group health plans and issuers may not exclude an individual’s preexisting medical condition from coverage for more than 12 months (18 months for late enrollees) after an individual’s enrollment date. . So in other words , a dialysis patient may end up dying if the wait is up to 12 months . Can you imagine a cancer patient having to wait for chemo for a year ? I seriously wish you had watched the 60 minutes program to truly understand the cherry picking that goes on by the insurance companies. You keep dodging my poignant question which is why should insurance company cover the sick and needy on the open market ? What is the incentive for them ? Also, if HIPAA was truly a magic bullet, then why did the republicans along their cabal of insurance lobbyist oppose COBRA extension beyond 18 months for those who have worked for more than 10 years with the same firm and got laid of or for those over 55 years ? Remember that the house democrats wanted to pass this bill along with stimulus early this year ! Link to comment Share on other sites More sharing options...
yoda Posted July 2, 2009 Share Posted July 2, 2009 the ideal system would be like the one which WAS in India where you didn't really need insurance, but could get by just paying out of pocket cause overall cost of "normal" care was nominal and everyone can afford a decent doctor. of course in case of serious issues is where things get complicated. Link to comment Share on other sites More sharing options...
Brainfade Posted July 2, 2009 Share Posted July 2, 2009 If you read this - You have 18 or more months of prior creditable coverage. Your most recent health care coverage must be under an employer sponsored group health plan, which includes COBRA or Cal-COBRA continuation coverage. This prior 18-month coverage is referred to as "creditable coverage." It perfectly fits the example you posted. The 20-yr old cancer patient was under an employer-group plan and lost it. COBRA will cover for 18 months. HIPAA takes over after that. You may have missed that. It clearly states that you have to be under an employer sponsored group plan prior to be eligible for the Health Insurance Portability and Accountability Act (HIPAA) insurance . See above. It fits your example case. Also , it talks about group plans and the preexisting condition exclusions periods . The law defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date (which is the earlier of the first day of health coverage or the first day of any waiting period for coverage) .Group health plans and issuers may not exclude an individual’s preexisting medical condition from coverage for more than 12 months (18 months for late enrollees) after an individual’s enrollment date. . So in other words , a dialysis patient may end up dying if the wait is up to 12 months . Can you imagine a cancer patient having to wait for chemo for a year ? I still don't understand why Medicaid won't pick this up. You don't have a job for 18 months (lost job, exhausted COBRA), you are unemployed and therefore have no income - surefire Medicaid. And I have no problems with the government being a safety net - not the primary provider. I seriously wish you had watched the 60 minutes program to truly understand the cherry picking that goes on by the insurance companies. I do, too. I could understand better where you're coming from. You keep dodging my poignant question which is why should insurance company cover the sick and needy on the open market ? What is the incentive for them ? Because, in a true free market system, they will have to offer cost-effective plans or they will not survive. Of course, they have to make a profit, but in order to do that, they need to have customers. You get customers by offering the best plans. Combined with proper checks and balances, a tax credit for choosing and purchasing one of these plans, the customer benefits in the end. If what you are saying is the case, why do car insurance companies cover accidents? Why do life insurance companies pay life insurance benefits? Also, if HIPAA was truly a magic bullet, then why did the republicans along their cabal of insurance lobbyist oppose COBRA extension beyond 18 months for those who have worked for more than 10 years with the same firm and got laid of or for those over 55 years ? Remember that the house democrats wanted to pass this bill along with stimulus early this year Why did the Rs oppose it? Because they are idiots. Like I said, I am all for the government being a safety net (Medicaid and Medicare, although they have found ways to run those programs to the ground, too). But, I do not want them to dictate my healthcare needs. It is no different than the HMO - if anything, it will be worse. I'd rather that they gave me (or anyone) $5000 as a tax break, I go and find the plan that works best for me, and live with my decision. I feel strongly that private enterprise, when allowed to properly function and kept in proper check, will solve most problems. Also, the more I discuss this with you, I feel that portability with preexisting condition exclusions is the thorniest issue. If you are being treated for something for years, you just have to get coverage for it. But insurance companies need to be protected, too: If you are 45 years old with no diagnosed problems, you lose your job and insurance, you are close to exhausting COBRA, and do not care to buy a plan before you are diagnosed with anything. So, you are uninsured because you didn't do your due diligence, get diagnosed with diabetes and then boom, you want an insurance company to foot the bill? Doesn't seem right to me. More information: Guaranteed-issue health insurance: Definition: If a health insurance plan is described as "guaranteed issue," it means that applicants cannot be turned down for coverage based on their health status. Most job-based group health plans offer coverage on a guaranteed issue basis. Also, a handful of states require insurers to offer guaranteed issue individual policies. It is important to remember that applicants for guaranteed issue plans can be turned down or have their coverage discontinued for other reasons, such as fraud or non-payment of premiums. http://www.guaranteed-issue-health-insurance.com/ Looks like some insurance companies are answering the call. Now, if only the government would support this instead of trying to take over the industry. Link to comment Share on other sites More sharing options...
kumble_rocks Posted July 2, 2009 Share Posted July 2, 2009 Medicaid eligibilty depends upon bank balance and it it ridiculously low . Some of the cancer patients they talked about in that 60 minutes program were denied medicaid as well . And yes they were unemployed. HIPAA is useless if it has a clause for preclusion up to 12 months. And it was not RS , it was the insurance lobby who wanted the COBRA extension to be stopped ! Why would you think they wanted the extension to be stopped ? Link to comment Share on other sites More sharing options...
Brainfade Posted July 2, 2009 Share Posted July 2, 2009 Medicaid eligibilty depends upon bank balance and it it ridiculously low . Some of the cancer patients they talked about in that 60 minutes program were denied medicaid as well . And yes they were unemployed. HIPAA is useless if it has a clause for preclusion up to 12 months. I checked NC Medicaid eligibility: Income is not an issue here (unemployed; so income = 0). Resources: If your bank balance is > $3000, you can get Medicaid-with-deductible. Deductible is calculated as [6x(income-income limit)]. If income is zero .... maybe they factor in unemployment benefits??? I like it - the patient takes some responsibility for his/her healthcare. I heard a discussion on NPR sometime ago, and a govt official said that 1000s of eligible kids did not have SCHIP coverage because their parents did not care to apply. And it was not RS , it was the insurance lobby who wanted the COBRA extension to be stopped ! Why would you think they wanted the extension to be stopped ? Am not sure. Why? Did you check out the guaranteed-issue insurance links? What's the catch? High premiums? Finally, with the SCHIP extension: the reason he vetoed it twice before finally passing it was because it was going to cover children over 18 and increase the income limit to above $83000. That's ridiculous. I am not paying taxes to cover someone who makes more than me. K_R: I have to politely agree to disagree with you on the government-option health insurance. It is taking us down a spending road (yes, the Repubs spent $1 T on a stupid war; but that is not the issue at hand) that we cannot afford. We can achieve many of the goals (tweak preexisting exclusions, Medicaid) by making small changes, and not investing $1.6 T of money we don't even have, and by taxing employer-provided health benefits. I was opposed to this tax when McCain proposed it, but now Obama is doing it too - pray, what is the difference? At least McC was upfront, while BHO is sliding it under his eloquence. Ideally, I would be OK if the gov't did the following with preexisting conditions: (1) Require that insurance companies provide a guaranteed-issue plan. (2) Provide a tax credit to a maximum of $x000 to folks who end up having to pay high premiums and/or deductibles to buy these insurance policies. (3) Tweak preexisting exclusion laws - define preexisting as something that was diagnosed/treated 1 or 2-months ago rather than 6 months; that way people cannot cheat. This way, you are dealing on an case-to-case basis, and not providing blanket healthcare welfare. Oh well ... I've learned a lot discussing this, and finding information about these issues. I am spent, and if I keep doing this, I'll get fired one of these days :-)!! 28 replies later, what does mm think? Link to comment Share on other sites More sharing options...
triam Posted July 27, 2009 Share Posted July 27, 2009 Does anyone, exactly what are the changes being proposed by Obama? and how will it impact the different wealth groups?? There is too much noise in the media to understand what exactly is changing. Link to comment Share on other sites More sharing options...
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