What health insurance reform?

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Interesting exercise I've gone through. I left my job in April to branch out on my own, single member LLC as a consultant. Now my accrued benefits from my former position are expiring, and I was looking for some health insurance, something high deductible because frankly I haven't used more than a few thousand in benefits over the last decade...

Except that I was diagnosed with sleep apnea in 2009. Now, studies show that untreated apnea can lead to some pretty nasty stuff down the road, but I have treatment (cpap) which I use as I'm supposed to, and my health is great. I'm 33 years old, non smoker, average height/weight, work out regularly, no conditions other than the one that hasn't cost me a dime since acquiring the cpap machine.

Come to find out, I'm uninsurable in the private market. Denied for everything, even $5000+ deductible plans. Well shoot I think, well there are the high risk pools that the new legislation created to bridge until 2014 when the pre-existing denials go away, I'll just jump on one of those. Check the price schedule, $184 a month for someone my age with a $2500 deductible. Perfect.

Not so fast buddy, those plans are only available for those who have been uninsured for 6 months and I was covered under a group health plan at my last job. Well crap. I did have one company offer me a plan with awful coverage and exclusions for anything related to apnea for $1200 a month, but fark that...

So bottom line, I guess I'll go on Cobra through my former employer to maintain my coverage, and I have 18 months to live my life of self-employed, and then I'll be forced to take a job with group benefits so I can have health insurance... depending on the legislation not getting rolled back in that time.

I can't imagine what it must be like for someone who is actually ill to get insurance.

So yeah, I'm considering voting straight ticket democrat this year.

I'm pretty irked actually. I'm highly skilled in my field and as an independent consultant I'm on track to nearly double my former salary. I may have to just tough it up and work for a corporation... sigh.

Welcome to my world. This is just one of the many things I hate about our health care system.

I don't understand, why can't you just not have insurance for 6 months and then get the $180 a month plan? Also many of the health insurance reform changes don't go into effect until 2013 and 2014.

LeapingGnome wrote:

I don't understand, why can't you just not have insurance for 6 months and then get the $180 a month plan?

At least until the health reform changes go into effect (and even then this may be a concern), keeping continuous coverage is important with regard to pre-existing condition coverage, not to mention just HAVING coverage in case you need it.

Bandit's being smart here; you don't want to go without any health coverage if you can help it.

I'm pretty irked actually. I'm highly skilled in my field and as an independent consultant I'm on track to nearly double my former salary. I may have to just tough it up and work for a corporation... sigh.

At this point, benefits are more important than salary for me, within reason. Large corporations in the tech arena have *excellent* health care offerings, and my family definitely makes use of them.

I guess the difference between us, as regards the ACA, is that my father being a minister, I've watched families struggle with health care for decades. I already had that experience, and frankly I'm deeply afraid of having to sink or swim in those waters. With the economy the way it is, I'll stay in my safe harbor as long as possible, and be thankful for it, but I'll also go for just about any plan that improves things. Doesn't have to make them perfect; as long as it helps slow cost increases and helps more people get insurance, I'm gonna be on board, because I've seen people *die* from lack of insurance and the resultant problems in treating what for me would be a temporary inconvenience.

The funny thing (sorry, I know it's not funny bandit, but you know what I mean) is the side screaming that this is socialized medicine. "Obamacare" and all that nonsense. Bill Maher does a bit on his show about how conservatives live in a bubble that truth can't penetrate and this is one of the best examples. Whatever "Obamacare" was it most certainly wasn't socialized medicine. It wasn't even meaningful reform. Painting it as some Stalinist plan is beyond comical given the reality.

On this specific topic I feel really bad for you, bandit? Do you have a spouse on whom you can lean for healthcare? I'm a contractor and that's what I've done. I'd be worse off than you otherwise between my multiple car accidents, sleep apnea and being overweight. I'd never get health insurance nor any preventative care outside of going to ZoomCare and paying for everything with cash.

To add to this and it maybe sort of a tangent but even with insurance it is a spiraling cycle of confusion.

Bills
Things that look like bills that show how much the insurance isn't covering but yet say in bold lettering that they are not bills (but how is the cost differential going to be addressed?)
Calls from nickel and dime collectors for unpaid fees from every tom, dick and harry associated with the care provided only 2 months after
New bills arriving months after that are paid, only to be reimbursed a month after that (sometimes followed up by a collector call for said amount)

The red tape and hands not talking to eachother is monumental (the polite way of saying colossal clusterf*ck)

edit: on topic, you have my sympathies for sure bandit...

Yup. My wife is bipolar. That is the reason that I'm not going to leave my corporate drone job, because we'd be screwed for getting insurance in the private market.

To add to this and it maybe sort of a tangent but even with insurance it is a spiraling cycle of confusion.

Bills
Things that look like bills that show how much the insurance isn't covering but yet say in bold lettering that they are not bills (but how is the cost differential going to be addressed?)

It's my belief that this is a way to tell you what to expect to be billed for. "Your doc submitted this procedure, which cost $300, and we're paying $250 of it directly to him. Don't send us money, just be aware that it's been processed."

Robear wrote:
To add to this and it maybe sort of a tangent but even with insurance it is a spiraling cycle of confusion.

Bills
Things that look like bills that show how much the insurance isn't covering but yet say in bold lettering that they are not bills (but how is the cost differential going to be addressed?)

It's my belief that this is a way to tell you what to expect to be billed for. "Your doc submitted this procedure, which cost $300, and we're paying $250 of it directly to him. Don't send us money, just be aware that it's been processed."

It also give you a chance to begin an appeal process.

bandit0013 wrote:

$184 a month for someone my age with a $2500 deductible. Perfect.

That's pretty good for individual insurance. I am guessing this is state or federal subsidized somehow? What is the logic behind making you go uninsured for 6 months?

PoderOmega wrote:
bandit0013 wrote:

$184 a month for someone my age with a $2500 deductible. Perfect.

That's pretty good for individual insurance. I am guessing this is state or federal subsidized somehow? What is the logic behind making you go uninsured for 6 months?

Yeah, part of the act was the creation of these pools for high risk people until the reform kicks in in 2014. There was money set aside to subsidize the premium, but the chart shows it is by age and tobacco use. I'm young and non smoker, so it's low. If I was 65 it would be more like $600 a month. Sleep apnea or not, being I'm compliant with the cpap my chances of dropping dead or having issues at 33 are exceedingly slim.

The uninsured for 6 months thing is really bizarre. The guy on the phone was like well, you could just let your cobra lapse and go on it, but you'd be rolling the dice. Being I'm the sole fiscal person for my family I can't ride on anyone else's insurance so that would be taking a major risk, not worth it especially if the republicans roll back the reform. The pre-existing coverage part was tied heavily to the individual mandate, so if they lose the mandate, the pre-existing thing is also likely to go bye bye or if it states will become abhorrently expensive. Funny part is I saw some articles about how many people they expected to go into the high risk pools and how few they actually got, which is throwing the numbers off. Well, I bet a lot of those not people are like me and they would like to get in, but can't forsake their undesired insurance for 6 months.

Nothing to feel bad about though, I will stay on cobra through my former employer and enjoy making money hand over fist for a while, then go back to the corporate world. It's just a real shame that the perspective in our country is such that employers get all the perks for group plans, etc, but individuals get the shaft, when individual opportunity is one of the golden things you grow up hearing about what is great about America.

It's just a real shame that the perspective in our country is such that employers get all the perks for group plans, etc, but individuals get the shaft, when individual opportunity is one of the golden things you grow up hearing about what is great about America.

Start an insurance company?

LeapingGnome wrote:

Start an insurance company? :D

I'm guessing that is one of those businesses you can't get into without massive capital to start.

I do find it very ironic that the GOP tried (are they still trying?) to label Obamacare as "job killing" somehow, when many of us (myself included) would be significantly more encouraged to start our business if not for our dependency on our employer's group insurance. Small business is where job growth is coming from these days. Of course insurance alone doesn't solve all the medical care problems our country is facing.

PoderOmega wrote:
LeapingGnome wrote:

Start an insurance company? :D

I'm guessing that is one of those businesses you can't get into without massive capital to start.

I do find it very ironic that the GOP tried (are they still trying?) to label Obamacare as "job killing" somehow, when many of us (myself included) would be significantly more encouraged to start our business if not for our dependency on our employer's group insurance. Small business is where job growth is coming from these days. Of course insurance alone doesn't solve all the medical care problems our country is facing.

You are correct. I worked for a P&C insurance start up.

Basically, insurance makes their money on economies of scale. It takes a lot of marketing etc to break into the existing market and "build the book". Once you get a big enough book as long as you can maintain it then the money starts flowing in. It's massively expensive to get there though.

I like to think you worked for a Politics and Controversy insurance startup.

It's just a real shame that the perspective in our country is such that employers get all the perks for group plans, etc, but individuals get the shaft, when individual opportunity is one of the golden things you grow up hearing about what is great about America.

Go read the "Why Elites Fail" thread.

As to the 6 months without insurance requirement, it's meant to prevent health plans and employers just "dumping" covered individuals off of their plans as the pre-existing coverage plans ramp up, to keep their profits up in their existing plans. Unfortunately, until 2014, you *can* be turned down for pre-existing conditions, and that seems to me to be like a compromise solution until the law goes into full effect. In 2014, it won't be an issue, obviously.

Robear wrote:
It's just a real shame that the perspective in our country is such that employers get all the perks for group plans, etc, but individuals get the shaft, when individual opportunity is one of the golden things you grow up hearing about what is great about America.

Go read the "Why Elites Fail" thread.

As to the 6 months without insurance requirement, it's meant to prevent health plans and employers just "dumping" covered individuals off of their plans as the pre-existing coverage plans ramp up, to keep their profits up in their existing plans. Unfortunately, until 2014, you *can* be turned down for pre-existing conditions, and that seems to me to be like a compromise solution until the law goes into full effect. In 2014, it won't be an issue, obviously.

It wouldn't have been all that hard to put in something for people who left their employer for whatever reason.

It wouldn't have been all that hard to put in something for people who left their employer for whatever reason.

You maybe forgot the nearly a year spent negotiating this huge law with one side acting in bad faith? Not only would it have been hard, but given the fact that the health insurance companies had to be on board with a solution that requires private companies to implement it, it would have been *impossible*. The alternative is that Congress pulls money from the implementation of the PCIP; companies dump millions of people from coverage in 2011; and there's nothing there to catch them, giving the entire act a massive black eye and leaving those millions in limbo for a lot longer than six months. Imagine if you'd lost your insurance a year ago, while employed, *because* you had a pre-existing condition, and then discovered that the Republicans had defunded the PCIP safety net specifically to make the ACA look bad. That's not hyperbole, that's how unpopular programs have been handled in the past.

This stuff is not simple. If it had not been phased in over four years, then yeah, it's unreasonable, but with a phased in approach, it becomes a check on a worse abuse. It sucks, but it sucks less than the alternative, in the aggregate. At the individual level, it just plain sucks.

Seems to me that if the Democrats had cojones they would have let it happen. The new millions of uninsured would have screamed for a solution, and likely pushed something in like a single payer system after a bloodbath in congress.

Democrats? Cojones? Riiiiight... The very nature of the party is such that they can't agree on very much of anything across the spectrum. It's a group of people who question authority as a base standard for living. That's one of the Republican structural advantages; they have no problem lining up behind a leader when they see the need, even if they disagree with them.

bandit0013 wrote:

Seems to me that if the Democrats had cojones they would have let it happen. The new millions of uninsured would have screamed for a solution, and likely pushed something in like a single payer system after a bloodbath in congress., been funneled into blaming the Democrats anyhow, by the right wing bullhorn, and elected a Republican demagogue to put in place an even more corporatist version of it.

I don't think Obama would have gone for single-payer. Clinton did; Gore would have; Romney might have in the early 90's, when fiscal responsibility was still a plank for the Republican platform, and people still believed in bipartisan legislation (until Gingrich killed that idea dead). But Obama is too conservative for that.

Robear wrote:

But Obama is too conservative for that.

I'm not sure I would call him too conservative. While I personally found healthcare reform lacking, the plain facts are what we got was a practical solution to the massive problem of 50 million uninsured Americans.

Republicans would have never considered anything that even smelled like a single payer system so Obama's choices were either to compromise on a gimped system that at least allowed millions of citizens to get health insurance or go for the brass ring of Medicare for all, have it stopped dead in its tracks by Republicans, and had the entire issue of healthcare reform become something that we don't talk about at all for another 25 years, just like what happened after Clinton's first year in office.

No, I said "too conservative for that". He's always maintained support for a *practical* universal health care plan, which in the US, right now, has to be based on private health care in order to get anywhere. He's got about a decade, a little more, of on the records comments and speeches making that clear. He's not with Clinton and the Progressives; he's adopted what was a mainstream Republican plan in the late 80's/early 90's in most of it's attributes because he's more comfortable with that than with the Progressive alternative.

Your second paragraph is why he spent nearly a year negotiating with Republicans on the bill in the first place, only to find out that they were using that time to ruin public opinion of it. That's why when the talks broke down just as it was completed and ready for voting, he came up with the lame-duck Congress scheme to pass it; kind of a "Yeah, you don't want to play fair, we won't either" approach to the Republican tactics. Heck, that's when I knew what this election cycle would look like - ugly and divisive. Because when Republicans pass up an opportunity to take credit for extremely popular social *policies* (the actual parts of the ACA have about 65% or more approval, excepting the individual mandate, when people are asked about them out of context), you *know* they are not going to stop at anything to take the election that follows.

Speaking of Obamacare, the Supreme Court is expected to rule on the plan soon. In-trade betters are going 80% with the court striking down the individual mandate.

Anyone want to post a guess on the outcome before the news breaks? I'm up on the fence.

I've already done so, back in May I think; individual mandate goes down, everything else is kosher.

Robear wrote:

I've already done so, back in May I think; individual mandate goes down, everything else is kosher.

Sadly, that probably won't be the impetus needed to push through single payer

Robear wrote:

I've already done so, back in May I think; individual mandate goes down, everything else is kosher.

If everything else stays, new laws have to be passed or the insurance agencies go bankrupt. I'm curious to see if Congress can pull themselves together long enough to do anything about it should the court toss the mandate out.

Kraint wrote:
Robear wrote:

I've already done so, back in May I think; individual mandate goes down, everything else is kosher.

If everything else stays, new laws have to be passed or the insurance agencies go bankrupt. I'm curious to see if Congress can pull themselves together long enough to do anything about it should the court toss the mandate out.

I didn't think it would even before for many reasons, but I really don't think it will now that we've figured out that it seems Obamacare does not have continuously open enrollment.

To me this was utterly fascinating.

http://www.cbsnews.com/8301-18560_162-57451721/insiders-the-road-to-the-stock-act/?tag=contentMain;contentBody

60 Minutes did a piece on insider trading in congress. During part of the segment they mentioned that as the health care bill was being debated members of congress were buying stock in health care companies.

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