Federal government releases long-awaited health reform rules

Helix · Nov 21, 2012

we could have avoided much of this if we had just let people buy into basic coverage with Medicare. unfortunately, we chose the heritage foundation's solution. hopefully we can take another look at this situation again in the future and make the appropriate tweaks. until then, given the stupid system of employer specific, for-profit health insurance as the primary gateway to coverage, expect prices to go up.

Tigger · Nov 21, 2012

Helix said:
we could have avoided much of this if we had just let people buy into basic coverage with Medicare. unfortunately, we chose the heritage foundation's solution. hopefully we can take another look at this situation again in the future and make the appropriate tweaks. until then, given the stupid system of employer specific, for-profit health insurance as the primary gateway to coverage, expect prices to go up.

Expect them to go up quite a bit. Expect them to REQUIRE you to get a physical every year, and to REQUIRE your doctor to forward information on any potentially surchargeable issue directly to the insurance company. Heaven help the family that has a newborn child with Down's Syndrome, MS, or any other sort of genetic disability like that. Their premiums are going to shoot through the roof.

Fisher · Nov 21, 2012

Basically everybody now will be paying the premiums of rated people. Welcome to the world of Obamacare. The reason I never created health insurance for my employees when I do not have to was because a couple people would have been rated enough to drive up the cost for everybody so I assist with a fixed amount per employee toward private policies. On the plus side, smokers won't be getting screwed I suppose.

buck · Nov 21, 2012

roughdraft274 said:
it averages the cost of men and women,

Just curious on your thoughts... Women are known to use more health care then men, so why should they pay the same premium?

jonny5 · Nov 21, 2012

This is no surprise given that the goal is to push the nation into single payer healthcare plan. These rules basically help take the profit and market forces out of insurance.

AdamT · Nov 21, 2012

Harry Guerrilla said:
Yea, rescission touted as a huge problem, was nearly nonexistent.

Yes, it was really only a problem for people who needed insurance the most. You know -- those people who got really really sick and then got dropped when they actually needed the insurance they'd been paying for all their lives.

jonny5 · Nov 21, 2012

Deuce said:
Yes, like how earthquake codes mean we have "one size fits all buildings."

It would be a better metaphor if the earthquake code applied to regions that dont have earthquakes.

buck · Nov 21, 2012

AdamT said:
Yes, it was really only a problem for people who needed insurance the most.

Not really. Mainly just a problem for those few individuals that lied on their application for insurance and those lies were material to the issue of the policy. With very few exceptions (that easily could have been corrected with a much less intrusive law) everyone else was not affected.

AdamT · Nov 21, 2012

Harry Guerrilla said:
The facts are, alcohol is a carcinogen, aka it causes cancer.
Increased premiums for tobacco users don't differentiate between light users and heavy users.

Sorry bud, I know it's easy to let go when your ox isn't being gored, but you need to pay your share of the risk to.

Light Drinking May Cause Dementia - Page 2 - Technorati Lifestyle

Medscape: Medscape Access

Even light drinking increases cancer risk - Health News - Health & Families - The Independent

If you made exceptions for every substance that may arguably increase the risk of cancer you'd need a rule book that would fill the Library of Congress. Meanwhile, moderate drinking also has some salutary effects.

Drinking Alcohol And Benefits

jonny5 · Nov 21, 2012

AdamT said:
Yes, it was really only a problem for people who needed insurance the most. You know -- those people who got really really sick and then got dropped when they actually needed the insurance they'd been paying for all their lives.

If the sickness happened before you got dropped (your contract expired), it wont matter. Your insurance will pay out. Theres also no reason that you couldnt have negotiated a better insurance contract which had the services you desired.

AdamT · Nov 21, 2012

buck said:
Not really. Mainly just a problem for those few individuals that lied on their application for insurance and those lies were material to the issue of the policy. With very few exceptions (that easily could have been corrected with a much less intrusive law) everyone else was not affected.

In many cases it's used by insurance companies to try to avoid paying based upon technicalities. But if, as you claim, it was extremely rare, then the new rules should have minimal impact. :shrug:

buck · Nov 21, 2012

AdamT said:
In many cases it's used by insurance companies to try to avoid paying based upon technicalities. But if, as you claim, it was extremely rare, then the new rules should have minimal impact. :shrug:

"Many" is rather nebulous. Break it down in percentages for us. It was rare that the insurance company misused recission provisions. In probably 99% of cases, the recission was accurate and based on a material misrep on the application that resulted in a rating other then what it shoudl have been.

There were a small percentage of abuses by the insurance company where they used the recission as a technicailty, and I have already stated that could have been corrected with a better, more pointed law.

I am not the one that said it was rare. But as a percentage of total policies issued, it was a small percentage, but still a large number.

AdamT · Nov 21, 2012

jonny5 said:
If the sickness happened before you got dropped (your contract expired), it wont matter. Your insurance will pay out. Theres also no reason that you couldnt have negotiated a better insurance contract which had the services you desired.

Not necessarily. In some cases policies can be rescinded retroactively if the company claims, e.g., that the insured failed to report a preexisting condition. There have been cases where insurance companies have paid agents bounties to root out alleged preexisting conditions so that the insurer can avoid paying out on a claim. Sometimes these are legitimate cases of fraud, but other times it's the insurance company trying to manufacture an out.

lizzie · Nov 21, 2012

Harry Guerrilla said:
So they can charge smokers up to 5x more, but what about obese people, people with diabetes that can be controlled with diet, alcohol drinkers?

Exactly. As a long-time RN, I see a much higher percentage of obesity-related illness than smoking-related illness.

jonny5 · Nov 21, 2012

AdamT said:
Not necessarily. In some cases policies can be rescinded retroactively if the company claims, e.g., that the insured failed to report a preexisting condition. There have been cases where insurance companies have paid agents bounties to root out alleged preexisting conditions so that the insurer can avoid paying out on a claim. Sometimes these are legitimate cases of fraud, but other times it's the insurance company trying to manufacture an out.

So since both sides abuse each other, why does only one side get punished?

Harry Guerrilla · Nov 21, 2012

AdamT said:
If you made exceptions for every substance that may arguably increase the risk of cancer you'd need a rule book that would fill the Library of Congress. Meanwhile, moderate drinking also has some salutary effects.

Drinking Alcohol And Benefits

So because it's complicated, we should only pick on select groups?

Bar none, alcohol is a carcinogen.
It causes cancer.

Nicotine has benefits as well, does that mean it should be exempt from higher premiums to?

MaggieD · Nov 21, 2012

Harry Guerrilla said:
So they can charge smokers up to 5x more, but what about obese people, people with diabetes that can be controlled with diet, alcohol drinkers?

You made up that 5X. I have insurance through Illinois' ICHIP program. My premium is $670/month for a $5,200 deductible policy. (Six years ago it was $850/month for the same coverage through American Family Insurance.) I'm telling you this in order to tell you that in Illinois' ICHIP program the premium was $710 for smokers.

You do raise an interesting point that's always troubled me. Life insurance companies often rate people depending upon their occupations, even their hobbies, because it makes actuarial sense to do so. It'll be interesting to see how AHA deals with those because it will certainly stress the system. But I guess it'll probably just be "spread the cost around."

We're also likely to see more litigation as insurance companies try to recoup their losses when an accident is someone else's fault besides the insureds.

It'll be interesting...

Harry Guerrilla · Nov 21, 2012

MaggieD said:
You made up that 5X. I have insurance through Illinois' ICHIP program. My premium is $670/month for a $5,200 deductible policy. (Six years ago it was $850/month for the same coverage through American Family Insurance.) I'm telling you this in order to tell you that in Illinois' ICHIP program the premium was $710 for smokers.

You do raise an interesting point that's always troubled me. Life insurance companies often rate people depending upon their occupations, even their hobbies, because it makes actuarial sense to do so. It'll be interesting to see how AHA deals with those because it will certainly stress the system. But I guess it'll probably just be "spread the cost around."

We're also likely to see more litigation as insurance companies try to recoup their losses when an accident is someone else's fault besides the insureds.

It'll be interesting...

The NBC story said it, I quoted the story directly.

The NBC story, with the relavent portion highlighted,

NBC said:
“In most states, these consumers can be denied individual health insurance coverage or have benefits for medical conditions excluded by insurance companies. In addition, individuals and small employers often find that they have few protections against exorbitant premiums increases.”
charge the oldest customers as much as five times more in premiums as the youngest adult customers. HHS stuck with a proposal that allows insurers to charge the oldest patients three times as much as they charge a 21-year-old. And the rates can go up a little bit with every birthday. But smokers can be charged premiums that are five times higher under the new rules.

AdamT · Nov 21, 2012

Harry Guerrilla said:
So because it's complicated, we should only pick on select groups?

Bar none, alcohol is a carcinogen.
It causes cancer.

Nicotine has benefits as well, does that mean it should be exempt from higher premiums to?

Yes, I think there is value in simplicity, and in limiting how much insurance companies can jerk people around. Alcohol, used in moderation, is not in the same league with cigarettes when it comes to negative health effects. That's crystal clear.

Harry Guerrilla · Nov 21, 2012

AdamT said:
Yes, I think there is value in simplicity, and in limiting how much insurance companies can jerk people around. Alcohol, used in moderation, is not in the same league with cigarettes when it comes to negative health effects. That's crystal clear.

So consuming some carcinogens is ok, as long as more people find it acceptable, even if it increases your risk of cancer?
Sounds like excuse making to me.

AdamT · Nov 21, 2012

Harry Guerrilla said:
So consuming some carcinogens is ok, as long as more people find it acceptable, even if it increases your risk of cancer?
Sounds like excuse making to me.

You are intentionally igoring the relative risk. Cigarettes are a far more powerful carcinogen, and also have many other serious health consequenes -- heart disease being a major one.

Meat is also a carcinogen. Do you think you should be charged a higher insurance rate because you eat meat? Cancer Project / Factors Contributing to Cancer / Meat Consumption and Cancer Risk

Harry Guerrilla · Nov 21, 2012

AdamT said:
You are intentionally igoring the relative risk. Cigarettes are a far more powerful carcinogen, and also have many other serious health consequenes -- heart disease being a major one.

Meat is also a carcinogen. Do you think you should be charged a higher insurance rate because you eat meat? Cancer Project / Factors Contributing to Cancer / Meat Consumption and Cancer Risk

Sure, considering that we're deciding to charge people more based on behavior.
Hell alcohol is pretty darn expensive, since we can't deduce who is an excessive alcohol user, from a light user, all users of alcohol, must pay like all tobacco users.
It's only fair.

"CDC reports excessive alcohol consumption cost the U.S. $224 billion in 2006"

CDC Online Newsroom - Press Release: October 17, 2011

lizzie · Nov 21, 2012

Harry Guerrilla said:
So they can charge smokers up to 5x more, but what about obese people, people with diabetes that can be controlled with diet, alcohol drinkers?

The obesity problem is one that nobody really wants to address, and my suspicion, is that it is because so many people are personally effected directly or indirectly. Our obesity rates are climbing, to the point that one in three will be considered obese in just a few years. Smokers and drinkers have been marginalized into a minority, and as we all know, it's okay to penalize smokers and drinkers, because they are the exception and not the rule. If we penalize the obese, then 1/3 of the population will have to take a look at themselves as a part of the problem, and God knows, we can't have that many people claiming personal responsibility. We just want to collectively point at the smokers as the derelicts who are ruining health care.

Using nationally representative data on adults, the study estimates the effect of the increasing prevalence of obesity on total direct health care costs. Estimates are controlled for age, gender, race, ethnicity, marital status, education, income, health insurance status, geographic region and smoking status.
Major Findings:
Obesity is growing faster than any previous public health issue our nation has faced. If current trends continue, 103 million American adults will be considered obese by 2018.
The U.S. is expected to spend $344 billion on health care costs attributable to obesity in 2018 if rates continue to increase at their current levels. Obesity‐related direct expenditures are expected to account for more than 21 percent of the nation’s direct health care spending in 2018.
If obesity levels were held at their current rates, the U.S. could save an estimated $820 per adult in health care costs by 2018 ‐ a savings of almost $200 billion dollars.
http://www.nccor.org/downloads/CostofObesityReport-FINAL.pdf

The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows.
As America's waistline expands, costs soar | Reuters

MaggieD · Nov 21, 2012

Harry Guerrilla said:
The NBC story said it, I quoted the story directly.

The NBC story, with the relavent portion highlighted,

That's outrageous. I hope that's just one more misunderstanding. If that is the case, this bill is a disaster as it will hit 19.3% of our population -- and they won't be able to afford 5X's no-way-no-how. So YOU and I will be paying for their insurance. What a debacle.

Harry Guerrilla · Nov 21, 2012

MaggieD said:
That's outrageous. I hope that's just one more misunderstanding. If that is the case, this bill is a disaster as it will hit 19.3% of our population -- and they won't be able to afford 5X's no-way-no-how. So YOU and I will be paying for their insurance. What a debacle.

I don't know exactly what the 5x as much is, but either way, it's grossly unfair to smokers (like me, self admitted drug user), when there are tons of other vices and behaviors that go "unpunished."