What health insurance reform?

I think it basically comes down to "if there's not sufficient legal or organizational protection in place, eventually enough people in a row will either indulge their bigotry or look the other way." The health care industry is simply no exception. (And the insurance part of health care is probably no worse than the other parts—there are plenty of horror stories about doctors etc. too.)

It's the kind of thing that happens much more often to people who are more vulnerable, which is extra sh*tty.

And it's likely that the excuse of "pre-existing condition of being trans" is just a convenient one in this specific case. You hear people getting denied treatment for sh*tty reasons all the time—this is just a super obvious case of that.

Which ties back to why the PPACA is super important. Anybody who isn't familiar with the protections it has (and will) put in place should really look into it.

Kehama wrote:
Hypatian wrote:

... decide to stop covering me because I have a pre-existing condition of being trans.

WTF? How in god's name do they justify that as a "condition" which has a direct impact on potential future medical exposures outside of the norm? Mind you, I'm saying this as an insurance guy so it's not the standard knee-jerk "all insurance companies are evil and want to steal everyone's money" mindset.

Maybe they think you're going to want costly hormone therapy and surgery?

Nope—situations where this have occurred, surgery, hormones, therapy, and the like are already explicitly not covered.

As of earlier this year, that's illegal in California: If a given procedure is covered for cis people, it must also be covered for trans people. (i.e. hormones are prescribed for some women and men, therefore they must be able to be prescribed for trans women and men. Genital reconstruction surgery is available to cis women and men in cases of severe injury and the like, so it must also be available to trans women and men.) As far as I know, the exclusion is legal everywhere else in the U.S. (and the PPACA will have no effect on this.)

Then I have no idea why it's considered a pre-existing condition.

sometimesdee wrote:

Then I have no idea why it's considered a pre-existing condition.


The why kind of sucks, insurance operates on all manner of ways to deny people the coverage they in fact have or think that they have. Some even have a policy of denying all claims up front.

With nothing overt, I can tell you that the hospitals and the insurance companies are really grasping for any ways in court, with clever policies, to skirt a lot of the ACA, to keep up court challenges, or lobby and influence for favourable changes. I suspect that many will even disobey parts of the law, and keep matters up in appeals for years.

The insurance companies *backed* the ACA, I don't think you're going to see them torpedoing legislation that will bring them tens of millions of new clients...

Not so much, from what I have read, and some of the jobs they are offering.

KingGorilla wrote:

Not so much, from what I have read, and some of the jobs they are offering.

According to Neera Tanden, who served as the senior advisor for health reform at the Department of Health and Human Services and was a member of the Obama White House health reform team, it was all about the Medical Loss Ratio (MLR)—the provision of the ACA that not only requires the health insurance companies to spend 80 percent of your premium dollars on actual health care expenditures, but further requires that they refund to their customers any amounts they fail to spend as required by the MLR.

OK, so they wanted the customers, just not the part where they have to spend money on healthcare? Shocking.

KG, your link isn't working for me for some reason...

They like that they get more customers, that they don't have to pay as much for services, and that they can operate in the entire country, not just a particular region or state. There are a lot of advantages for them; again, it's largely a *Republican* plan, ie, based on private businesses doing most of the work. And what do we know about privatization, boys and girls?