Originally posted by mental modulator
" The plan allows states, small businesses, associations, and other organizations to band together and offer health insurance at lower
costs."
How is this different than Osatans Health insurance exchange???
Notice that it says "
allows" co-ops. This avoids the "states rights" problem I noted above if such were "
required."
Exchanges are places to
sell insurance. "Groups"
buy insurance.
There already are some similar "groups" allowed in some states. When a carrier can sell coverage to a larger group of peole, it spreads the risk
and lowers costs by counting on the larger number of healthy members to subsidize the unhealthy ones.
The "exchanges" will be places to choose among insurers, and will help those who don't belong to a "group." The co-op will be an opportunity to
join a "group" that can get better rates from the exchange or an individual carrier.
"(3) GUARANTEED ACCESS FOR INDIVIDUALS- The State Exchange shall ensure that, with respect to health insurance coverage offered through the Exchange,
all eligible individuals are able to enroll in the coverage of their choice provided that such individuals agree to make applicable premium and cost
sharing payments.
(4) LIMITATION ON PRE-EXISTING CONDITION EXCLUSIONS- The State Exchange shall ensure that health insurance coverage offered through the Exchange meets
the requirements of section 9801 of the Internal Revenue Code of 1986 in the same manner as if such coverage was a group health plan."
A negative for me - Same ol on the preexisting conditions in regards to access to the exchange.
OK, first things first.
Insurance of ANY kind is GAMBLING!
If you know the odds, you make an intelligent bet. If the "house" or a "player" knows something that changes the odds, that is CHEATING.
The P-EC exclusion argument is a red herring.
A valid PEC provides that if you become ill with a condition you knew about and didn't disclose, or were being treated for for "X" years before a
NEW policy takes effect, the carrier's obligations are limited or waived.
It serves a legitimate purpose. Suppose "Bob" finds out tomorrow he's
HIV+. He immediately goes out and fills out an application, but denies he's been a needle user, engaged in unprotected sex with multiple partners,
and has not been diagnosed with an illness (assuming they ASK).
When he makes a claim for AIDS treatment, the carrier can deny coverage for that. If he makes a claim for a broken leg from skydiving (which he DID
disclose (assuming they ASKED), the carrier cannot use the HIV info to deny paying for his leg.
If he makes a "material misrepresentation" on the application, they can terminate the policy at anytime, claim or not.
The carrier assesses the "risk" it is betting on, based on the information made available to it at the time of application.
That's why there are "smokers" policies, and "non-smokers" policies. The ODDS are different for either type of BET the carrier is making.
The problems arise when you go from State A to State B, or policy 1 to policy 2. La. will not allow a Texas carrier to cover its residents, so if you
move there from TX, you have to get a new policy.
You should be able to get the same coverage in La. at the same cost as you had in Texas. THAT's where PEC can hurt. What if you get a job and
insurance in Texas. Then you get pregnant. If your boss moves you to La., you would have a "pre-existing" condition (pregnancy) under your new
policy.
Same problem if you change jobs (and carriers/policies) in Texas.
The Republican plan (S 1324) would allow you to keep the same coverage, or at least limit the PEC not to apply to your "new" condition.
Very simple logic, but a needed common-sense application. Most carriers/policies already recognize this. The "reform" would require ALL insurers
to do so.
"Still trucking."
At least it's not 1,000+ pages!
But the there is a high risk pool
Just like for auto insurance. NO carrier wants to insure a risky driver, but states require them to write these "minimum coverage" policies if they
want to write "preferred risk" coverage.
Same for health insurance. If you want to underwrite the "good" risks, you will have to contribute to cover the "bad" risks.
And so it SHOULD be. Most people need the same basic and preventive care. So those basic costs and services should be roughly equal over a large
group. People should be able to bargain with their own (tax-free) money to buy those services from competing providers with basic-care overhead and
equipment.
But some people skydive, ride bulls, drive drunk, or enter the convent.
The likelihood and costs of "catastrophic" illness or injury varies widely between them.
For regular folks, there should be a "pool" of money to cover car crashes, heart attacks, et c. Employers, carriers and the Feds. could pay into
that pool for those types of expenses.
For skydivers, et al, there should be "parachute taxes" to add to the pool. Just as "drunk drivers" pay a higher rate for liability insurance, so
should high-risk insureds pay extra for the pool.
my eyes are bleeding... will get back to it
Take a break! It's a good sign that some people at least WANT to know the alternatives, much less compare them!
"An informed citizenry is the bulwark of democracy." (attributed, inaccurately, to T. Jefferson, but good sense nonetheless)
jw
[edit on 13-9-2009 by jdub297]