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The ACA is "guaranteed issue". It ended discrimination against those with preexisting conditions as previously defined by some states but more often delegated to the insurers.
The ACA also mandated a " community rating" meaning those with preexisting conditions could not be charged a higher premium than someone with no preexisting conditions in the same geo rating area of any state.
At the same time, the ACA eliminated annual/ lifetime caps on claims and capped annual out of pocket expenses which included the deductible.
The mandate was intended to offset the benefits.
A different approach could continue to be "guaranteed issue" while eliminating the community rating and / or allowing insurers to impose annual/ lifetime caps and/ or allowing issuers to eliminate caps on out of pocket expenses. The outcome would be that insurance would be unaffordable for most with preexisting conditions.
None of this addresses the root causes of premiums, the cost of healthcare in the US, the way healthcare is delivered in the US and that 75% of us are overweight- obese and therefore more vulnerable to diseases.
An aggressive administration and Congress could, with a stroke of a pen, do more to reduce the cost of healthcare by regulating the wholesale and retail price of prescription meds. That Congress chose not to do so twice during the Bush 2 Admin, be damned.
Thank you for posting this... I know most of this already but it is good details in this thread.
The key point in this post is that
"The mandate was intended to offset the benefits". That's how insurance works and I think people who oppose the mandate quite don't understand the end result of what they are asking.
I would support essentially changes that clump those in higher risk categories into groups with higher premiums. Although I'm not convinced that would be enough to offset the cost of high premiums. Those in these higher risk categories could end up with unaffordable options.
tax credits don't help much to those on the lower income scale.
central subsidies means government funding towards the industry to help lower the cost. Where does the money come from?
I can be on board with this plan if we remove employer provided insurance and we all go into a central/universal health care. This will establish high participation numbers that are required to make it solvent. Unfortunately, that's been tried and gets defeated because it is too "socialist" for the American taste. What you are proposing is very similar to other countries....
Helicopter money. Special money/bonds created for our HC system relief.
We already take care of our poor. Tax credits and/or other tax reduction schemes are needed for our lower middle/middle class.
We can do whatever the voters want. They can want to pay X amount of money per month for HC insurance. And then central subsidies or credits make it so. It is not so much the money. Our limits are and will continue to be in our total HC productivity. Money can be created.
"it is against the law, subject to fines and/or imprisonment, to reject a persons application for health insurance based on a pre-existing condition"
the problem with the ACA was not the pre-existing clause, but the 2000 pages plus of other garbage that the democrats put in it
why not have ala-cart, for health insurance.......does a couple who are both 55 really need prenatal or pregnancy coverage??
oh and MANDATING that you have to BUY health insurance.....bad choice, I am sure these subject matter experts could have come up with a better plan
Premiums are based on many factors including the geo rating area of a given state, negotiated healthcare networks and age bands. The geo rating areas within a given state existed long before the ACA. The utilization ( claims) of healthcare, the competitiveness, or lack thereof, of healthcare providers and the competitiveness of health insurers within a geo rating area.
Actuarial Sciences know it's unlikely a 55 year old woman is going to become pregnant. They also know a 25 year old is unlikely to need hip replacement. Premiums for. 55 year old are likely to be a multiple of a 25 year old based.
As it relates to pregnancy, given that nearly 50% of all births are paid for by Medicaid ( in excess of 75% in some states) it might make some sense to consider Medicaid paying for all births and use it as an opportunity to rethink the US approach towards birthing. The Germans rely on birthing centers and midwives for most births unless risks warrant a higher level of care. Infant mortality rates are lower than in the US. While births are private, recovering mothers share multi bed rooms. This is very different from the approach in the US where most births occur in hospitals, delivered by Ob/ Gyns and Hospitals trend towards private recovery rooms with room service.
well then...how about we start with the fact that INSURANCE is not CARE
INSURANCE (risk management) is a way to have someone else (or some entity) PAY for your bill
your CARE on the other hand is provided by a Doctor, Nurse, Specialist, Hospital, and/or Clinic
INSURANCE has never been health CARE
do you call your auto insurance company every time you need tires, and engine overhaul, or even a simple oil change??? nope
do you call your homeowners insurance when you want to repaint your daughters room purple, or if you want new windows, or need a new hotwater heater???...nope
insurance has NEVER been about care... its about who is going to pay the bill, """"IF""" something CATASTROPHIC happens......not just if you are visiting the dr for the sniffles
that is why insurance is so expensive...fraud/ waste/ abuse from the users
Catastrophic HC insurance is not about HC maintenance. And this is what most young and healthy people need. But for those with or at high risk for serious chronic disease, we need HC insurance that includes expensive maintenance as well. As in Medicare.
In my limited experience, it's the family who often advocate for the so called, beyond reasonable, end of life care for relatives nearing the end stage. They typically are not paying for that care which likely contributes to emotional reactions.
I agree it's often the Primary Care doc who is the voice of reason, especially when the doc and patient have a history.
From my long and extensive experience the best set up is with a primary doc who knows the patient and family long term. Then the three of us have ongoing end of life decisions as patients get old. I have found it very uncommon for families to get way out of sensible line when these conditions are met. But I have seen it at times when they are not.
Like an air transport AZ to Boston so that essentially their own doctor agrees to pronounce the patient dead!
The ACA is "guaranteed issue". It ended discrimination against those with preexisting conditions as previously defined by some states but more often delegated to the insurers.
The ACA also mandated a " community rating" meaning those with preexisting conditions could not be charged a higher premium than someone with no preexisting conditions in the same geo rating area of any state.
At the same time, the ACA eliminated annual/ lifetime caps on claims and capped annual out of pocket expenses which included the deductible.
The mandate was intended to offset the benefits.
A different approach could continue to be "guaranteed issue" while eliminating the community rating and / or allowing insurers to impose annual/ lifetime caps and/ or allowing issuers to eliminate caps on out of pocket expenses. The outcome would be that insurance would be unaffordable for most with preexisting conditions.
None of this addresses the root causes of premiums, the cost of healthcare in the US, the way healthcare is delivered in the US and that 75% of us are overweight- obese and therefore more vulnerable to diseases.
An aggressive administration and Congress could, with a stroke of a pen, do more to reduce the cost of healthcare by regulating the wholesale and retail price of prescription meds. That Congress chose not to do so twice during the Bush 2 Admin, be damned.
The largest single impact is age. Just go to an exchange and compare the same policy at 30 and 60 years of age.
Catastrophic HC insurance is not about HC maintenance. And this is what most young and healthy people need. But for those with or at high risk for serious chronic disease, we need HC insurance that includes expensive maintenance as well. As in Medicare.
very true.
the point that I was ''trying'' to make is that insurance is not care (maybe, I am trying to make the point, in a poor manner)
IF I need care I go to DR. Hoonose , he provides the service I need or want
he EXPECTS to get paid, for the service he gave me...... I expect good service, and will pay for that good service... out of my pocket, through payments...or my insurance
but for the last 75 years, health insurance has been getting larger and larger, now everyone EXPECTS it to cover even a runny nose
not even 35 years ago..the standard was health insurance was generally called hospitalization... when you went to the DR for a annual physical, or a required immunization for school..you paid the bill out of pocket...usually is a small bill (less than 150) ........and even today, why would anyone with fiscal smarts pay 4000-16000 per year for insurance, when they go to the doctor only once a year for a physical which will cost less than 200 dollars(hmm pay 16k or pay 200...the choice for the healthy 20 somethings is pretty easy) ....but a lot has changed in the last 35 years... people and unions now expect insurance to PAY FOR EVERYTHING...even a runny nose, where DR. Hoonose will say take this Musinex , ot works great and will clear you runny nose and congestion.......really why must insurance cover a $60 office visit???
Ya know, that's wonderful advice, but I bet you would really miss all those people who do all those jobs that don't provide health insurance, should you one day not have them do do the stuff you don't want to do yourself.
There are plenty of people without pre-existing conditions to do those jobs.
with Trump's plan, people with pre-existing conditions will be covered.
How? How, how, how, how?
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