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    Senior Member lorrie's Avatar
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    Why Republicans Must Repeal Obamacare’s ‘Pre-existing Conditions’ Provisions Read mo

    Why Republicans Must Repeal Obamacare’s ‘Pre-existing Conditions’ Provisions



    November 15, 2016 4:00 AM

    Keeping the unsustainable pre-existing-conditions provisions would accelerate the insurance ‘race to the bottom’ created by Obamacare.

    Donald Trump hadn’t been president-elect for a week when he appeared to abandon his oft-repeated pledge to repeal Obamacare in its entirety. In interviews with the Wall Street Journal and 60 Minutes, Trump appeared to want to keep, or at least to be willing to accept, the Affordable Care Act’s centerpiece: it’s supposed prohibition on discrimination against health-insurance applicants with pre-existing conditions.

    Ramesh Ponnuru, my friend and a senior editor of these pages, says the downside of Trump’s triangulation is that retaining those provisions “makes it much, much harder to get rid of the individual mandate” — as if the mandate were the bigger problem. On the contrary, the pre-existing-conditions provisions are the centerpiece of Obamacare. They are the reason the individual-mandate exists. It is those provisions, more than the mandate, that are driving premiums higher. It is those provisions, and not the mandate, that are destabilizing health-insurance markets, reducing choice, and causing insurers to flee. Most important (see below), it is those provisions, not the mandate, that are causing a race to the bottom where sick patients are seeing the coverage they value disappear from their Obamacare plans. If you want the sick to have more secure access to care, if you want to repeal Obamacare, the pre-existing-conditions provisions must go.

    Yet Ponnuru argues “you don’t have to get rid of protections for people with pre-existing conditions altogether to scrap Obamacare.” Congress could simply modify this central provision of the law by forcing insurers “to cover people with pre-existing conditions on the same terms as everyone else so long as they had maintained insurance coverage beforehand.” In other words, Obamacare imposes price controls on premiums for both previously insured and previously uninsured applicants in the individual market. This approach would allow actuarially fair premiums for previously uninsured applicants, but continue to impose price controls on premiums for the previously insured who switch plans. As I wrote when House Republicans floated this idea, it could create an even faster race to the bottom than Obamacare already has.

    If the sickest patients can hop from plan to plan knowing that insurers could charge them no more than anyone else, then each year many will choose whichever plan offers the most attractive coverage for their ailments. Whichever insurer provided the most attractive coverage to the sick would end up with lots of enrollees who pay far less in premiums than they generate in claims. That’s not sustainable. To keep from going out of business, insurers would start competing to not offer the best coverage to the sick. Year after year, sick people would find their coverage getting progressively worse, not better. Just like under Obamacare. In fact, the race to the bottom could happen even faster, because Republicans would jettison mechanisms Obamacare uses to slow the degradation of coverage. Or should Republicans retain those parts of Obamacare, too?

    Insurers would start competing to not
    offer the best coverage to the sick.

    Speaking of retaining parts of Obamacare, Ponnuru suggests Trump’s replacement plan could offer refundable health-insurance tax credits to help consumers afford individual-market coverage. As I explain here, such tax credits would preserve much of Obamacare’s entitlement spending and are indistinguishable from an individual mandate. Both a mandate and a health-insurance tax credit effectively penalize taxpayers who fail to purchase a government-defined health-insurance plan. The effective penalty under a Republican tax credit would in many cases be higher, and in all cases would be more strictly enforced, than Obamacare’s mandate penalties.

    As if all that weren’t enough, the combination of health-insurance tax credits and the repeal of Obamacare’s employer mandate could cause many employers to drop coverage, which would mean the approach Ponnuru suggests could trap potentially tens of millions more Americans in that quicker-than-Obamacare race to the bottom.

    We’re not talking about a “repeal and replace” plan, here. This is a plan to entrench Obamacare’s worst features into federal law, permanently, by giving them a Republican imprimatur.

    Congress and President Trump should eliminate Obamacare’s pre-existing conditions provisions because they are the principal barrier to providing secure access to coverage for the sick. Any repeal bill will of course provide some safety net for victims of Obamacare — i.e., patients with expensive conditions for whom Obamacare failed to provide secure, sustainable access to care. There are ways to do so without preserving Obamacare’s most harmful and unpopular features.

    If any Republicans want to keep the pre-existing-conditions provisions, try this: Have Congress send Trump the partial-repeal bill Obama vetoed earlier this year. It would have repealed Obamacare’s individual mandate, employer mandate, exchange subsidies, Medicaid expansion, many of the taxes, and much of the corporate welfare, but left the pre-existing-conditions provisions alone. If Trump signs it, Americans will see the actual costs of those supposedly beneficent and popular provisions when they cause insurance markets to collapse. The damage would be so swift and severe, Congress would quickly repeal the pre-existing-conditions provisions, filibuster or no filibuster. — Michael F. Cannon is director of health-policy studies at the libertarian Cato Institute.

    Read more at: http://www.nationalreview.com/articl...orst-component
    Last edited by lorrie; 11-16-2016 at 03:01 AM.
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    Senior Member Judy's Avatar
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    No, pre-existing conditions must be covered. That is why you have insurance, that's why people pay premiums is to pay the medical bills of sick people in their families.
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    MW
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    Quote Originally Posted by Judy View Post
    No, pre-existing conditions must be covered. That is why you have insurance, that's why people pay premiums is to pay the medical bills of sick people in their families.
    IMO, your thinking is wrong on this. People paying insurance premiums for themselves and their healthy family members shouldn't be penalized because a person halfway across the state has a host of illnesses, some of those illnesses being brought on by bad life choices (homosexuality, smoking, illegal drug user, over-eater, heavy drinker, etc.). Those with health issues should be paying more, however, unfortunately many of them can't afford more. That's where the problem lies. Honestly, I don't have the answer, but common-sense tells me that one person shouldn't be forced to jeopardize the financial well-being of his family to help another. This is why charities, churches, and groups dedicated to helping others exist. It's all about choice. If I choose to help a less fortunate individual or family, that's my choice. I do it because I want to, not because our government is forcing me to. Heck, all taxpayers already pay to provide medicaid to the less fortunate and needy.

    Including those with pre-existing health conditions in the Obamacare law is the primary reason our co-pays and premium costs are going through the ceiling. The plan was doomed from the beginning. There has to be a better way, I'm just not sure of what it is. One thing is for sure though, those with pre-existing health problems need to be separated from everyone else participating in the health insurance market. Separating them into something like medicaid is probably the only answer. Even then, the responsibility will fall on all taxpayers. Would that be a perfect plan, of course not, but at least it will spread the cost to all taxpayers, not just those participating in the health insurance market.

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    Senior Member Judy's Avatar
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    Why should taxpayers be involved at all with private health insurance? Under Trump's plan, the government isn't involved in the private insurance, it just regulates it like it does all interstate businesses.

    For those who can't afford insurance, Trump's plan is for government to pay for hospitalization directly.

    When everything Trump wants to do gets done, there will be very few people who can't afford health insurance or have the means to pay their hospital bills directly if they want, because most everyone will have a job and good incomes. And if they have full-time jobs, then most employers will provide health insurance as a company benefit.

    The only reason we have a health insurance issue in the United States is because we have 94 million working age adults out of the work force. Solve that problem and all the other problems associated with unemployment, poverty and inadequate incomes go away.
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    Senior Member lorrie's Avatar
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    I'm with you MW!

    well said.
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    Senior Member Judy's Avatar
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    lorrie, the pre-existing condition is the result of being sick and having used your insurance. Do you really want to pay for something that if you get sick and you use it, they'll drop you and now you'll have a pre-existing condition that will prevent you from obtaining health insurance in the future?

    I've been lucky, and have never had to use health insurance, but even I understand the unfairness of someone who had breast cancer for example, got dropped because they got sick, and then they're in the pre-existing condition category and can't get insured. If you have asthma, that's a pre-existing condition. If you have atrial fibrillation, that's a pre-existing condition. If you have diabetes, that's a pre-existing condition. If you have heart disease or high blood pressure, those are pre-existing conditions. If you get shingles, that's a pre-existing condition. If you have arthritis, bad knees, bad shoulders or a bad back, those are pre-existing conditions. If you have allergies, that's a pre-existing condition.

    There needs of course to be some reasonable terms and conditions so the insurance companies aren't taken advantage of but everyone should be able to purchase insurance and not exclude people because they were sick at some time in the past.
    Last edited by Judy; 11-16-2016 at 02:03 PM.
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    While costs have been rapidly rising as new technology emerges (which is expensive to research and develop) shouldn't these costs be plateauing out? This is what has happened as other Big Technology has matured.

    So what is the big deal of covering pre-existing conditions? Yes, maybe it doesn't pencil out, strictly, in what medical providers have to pay. But there were a lot of other collateral arguments for improving healthcare coverage. Plus, there are other ways that rising healthcare costs can be controlled---such as the medical tourism I have mentioned before.

    So if, ideally, we are no longer faced with rapidly rising costs and more people can be covered is there a big problem with it?
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    MW
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    Quote Originally Posted by lorrie View Post
    I'm with you MW!

    well said.
    Thank you, lorrie.

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    In 1999 I received a letter from my health care provider (Kaiser) that I was now in the pre-existing category.

    The letter went into great detail explaining this change and what it meant. Then they ended the letter by telling me that as a long time member of the Kaiser family, that they would never deny me coverage.

    This made such a good impression on me that after retiring and trying to use my husbands health insurance for a year, we switched back to Kaiser and Kaiser honored their promise to me and never raised the price of my health care for having a pre-existing condition.

    If more health care providers treated their patients like Kaiser did me we would all be better off.

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    Obamacare Sign-Ups Outpace Last Year as 1 Million Pick Plans

    Obamacare Sign-Ups Outpace Last Year as 1 Million Pick Plans

    Katherine Doherty
    November 16, 2016 — 7:29 AM PST
    Updated on November 16, 2016 — 7:47 AM PST


    A man walks out of the UniVista Insurance company office after shopping for a health plan under the Affordable Care Act, also known as Obamacare, on Dec. 15, 2015 in Miami, Florida.

    Photographer: Joe Raedle/Getty Images

    More than 1 million people selected insurance plans through the Affordable Care Act in the first two weeks of sign-ups, outpacing last year, the U.S. Centers for Medicare and Medicaid Services said in a report Wednesday.

    From Nov. 1, when the sign-up markets opened, to Nov. 12, about 246,433 new consumers chose an Obamacare plan for next year, and 761,785 renewed their existing coverage. That amounts to about 53,000 more plans than were selected during the first 12 days of open enrollment last, year, the government said.

    This year’s sign-up process opened in the waning days of the U.S. presidential election and the surprise election of Donald Trump, who has promised to repeal and replace or amend the law.

    “The American people are demonstrating how much they continue to want and need the coverage the marketplace offers,” Sylvia Burwell, secretary of the Department of Health and Human Services, said in a statement. Enrollment figures will be released every two weeks up until Dec. 15, the deadline to sign up for coverage that starts on Jan. 1, the U.S. said.

    The sign-up figures are only for the 39 states where the federal government runs enrollment, and doesn’t include states that have opted to build their own enrollment systems.

    Enrollment can vary week to week, and in past years there has typically been a surge of sign-ups near the deadline.

    http://www.bloomberg.com/news/articl...ion-pick-plans
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