Pre-Existing Conditions Coverage

If you’re a health industrial complex voter, familiarity with the workings of AHIP, the insurance company lobby will probably be more productive and predictive regarding what’s coming next in the health industrial complex than listening to any party-line candidates, based on our experience with Obamacare. Yet this election season, partisan politics are “pretending” to inform and warn consumers.

Today CNN does some of its partisan warning and catastrophizing about pre-existing conditions, in Tami Luhby’s article, “The real reason Trump is talking about pre-existing conditions,” 10/24/2018. Luhby indicates within her article that Trump is talking about pre-existing coverage because of consumer worries about “losing” Obamacare’s pre-existing conditions coverage guarantee.

Ultimately, the article is flimsy and relies on Obamacare architect’s Jonathan Gruber’s reveal that passing Obamacare relied on the “stupidity” of the American voter and for consumers, we should not do this again.

Our deconstruction of the statements made in the article helps us realize that actually, using a few “facts,” Luhby strings them together to take us down the rabbit hole that requires that we suspend disbelief in order to heed her “warnings” and vote Democrat, in other words, remain stupid. 

Under Obamacare today, no one can be DENIED health insurance coverage based on pre-existing conditions or charged more in premiums for OBTAINING that health insurance coverage. But, this likely isn’t really an issue if you examine the health insurance lobby, AHIP, and if you judge from Luhby’s fantastic machinations to construct her catastrophe scenario.

What we know today is that Obamacare, Obama’s political “win” was at the cost to consumers of being forced to purchase the consumer financial product of health insurance or face an IRS tax penalty, the partnership between the insurance lobby and government. This was clear, but not publicized in 2008 when in 2008, AHIP, the insurance lobbyist published, “Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate.”

Sadly we realized over time that Obama had teamed up with insurance companies to feed his pet exchanges, a project that at best accommodated 11 million people in a given year at an enormous cost to most consumers and at untold and uninvestigated and undocumented costs to taxpayers as the federal government used our tax dollars to pay insurers, pay for new infrastructure, pay for changes in other laws (CBO Publication 49892, 1/15/15, page 1, “…estimates address only the insurance coverage provisions of the ACA and do not reflect all of the act’s budgetary effects…”)

That Obamacare partnership of government and insurance companies also took away any possibility of requiring that insurance companies NEGOTIATE and obtain the best price and best coverage for insurance policies for groups of individuals based on the traditional tradeoff of, “Our customers for your better rates,” and instead combined the massive power of the insurance industry and government to squeeze consumers and force them to purchase health insurance with no provisions in Obamacare to control one of the key drivers of the health crisis, the fees charged by providers. That’s why our expenses have skyrocketed under Obamacare.

Eight years later, in 2016, not to be undone by the possibility of Obamacare repeal or the chances that a Republican would take the political reins, the insurance lobby REFRAMED its deal with government and the insurance company lobbyists were back at work producing their ideas to satisfy the new political agenda of repealing Obamacare but STILL protecting themselves with the idea of CONTINUOUS COVERAGE, “Making Health Care Work for Every American, Solutions to Deliver More Competition, Market Stability and Affordable Coverage,” AHIP, 2016.

The insurance company lobby there revealed that even if Obamacare was repealed along with its individual mandate, they were not going to retire their victory and lose their power to FORCE people to purchase their product or face a penalty. Instead the insurance lobby informed that they’d do it themselves by charging people MORE if consumers had a gap in coverage, CONTINUOUS COVERAGE. This is the same as their original 2008 deal, “We won’t deny coverage for pre-existing conditions as long as we can force people to purchase our product every year.” Now that the individual mandate is repealed, certainly we’ll see those continuous coverage requirements come into play. There would be no reason, therefore, to outrage everyone and get rid of the pre-existing condition coverage.

Instead of the government collecting money (the individual mandate) when working Americans failed to purchase health insurance, the insurance companies themselves would charge a surcharge in PREMIUM when Americans have a gap in coverage called CONTINUOUS COVERAGE.

Ms. Luhby gives a nod to reality noting that under Obamacare, in addition to a no-denial, no premium increase price for pre-existing conditions that “Also, carriers are required to offer comprehensive benefits, including maternity care, mental health services and prescription drugs.” Simplistically, Luhby defends the Obama governmental partnership and defends insurance companies saying, “The provisions are one of the main reasons why policies on the individual market have become so pricey. Insurers had to raise rates for everyone because they could no longer cherry-pick only healthy applicants and because they had to cover a wide array of services.”

Stop right there. Lumping together the Obamacare essential health benefits of maternity care, mental health services and prescription drugs, which COST all consumers who use these “benefits” MORE under Obamacare (see pricing below) with the Obamacare pre-existing condition guarantee of health insurance issuance, GETTING not using health insurance, is nonsensical for two reasons.

First, because the grouping refers to “essential health benefits,” coverage plans must include in some way but that consumers PAY FOR, out-of-pocket expenses for USING the services versus pre-existing condition protections under Obamacare which refer only to obtaining health insurance (PREMIUMS). 

In fact, the “protection” of NOT denying individuals health insurance when they have pre-existing conditions was part of the insurance company deal, “We’ll cover pre-existing conditions, you force everyone to purchase our product,” that has hurt consumers.

The government-insurance company Obama deal only hurt consumers because insurers no longer needed to improve their product to get customers when every working American became legally forced to be their customer, but Obamacare’s tradeoff of not only prohibiting denial for those with pre-existing conditions but prohibiting increased costs for OBTAINING such insurance, premiums, merely shifted where those increased costs could be recouped by insurance companies legally.

Under Obamacare ONLY TWO groups that represent statistical cost centers to insurers could be charged more, tobacco users and older Americans, each group being charged 1.5 times what everyone else is charged.

In its partnership with insurance companies, the Obama government engaged in cherry-picking, giving the OK to insurers to charge more in premiums, at a rate of 1.5 times what everyone else was charged to these two groups.

This not only is ageist, but singles out and cherry-picks these two groups when taken with the rest of Obamacare that prohibits charging other groups that statistically cost insurers more such as drug abusers, legal and illegal, alcoholics, obese individuals, those who choose to become pregnant and those with pre-existing conditions, all who represent groups statistically likelier to “cost” insurance companies more and therefore charged more in PREMIUMS to obtain health insurance.

If Obamacare had truly been about fairness or a single risk pool, tobacco use and age would NOT have been singled out for charging higher premiums.

Second, the cost of USING health insurance remains untenable for many Americans, exacerbated by Obamacare which left insurance companies able to raise deductibles, raise copays, raise coinsurance, the out-of-pocket cash expenses charged to consumers and leaving medical expense bankruptcy in America as the number one reason for declaring personal bankruptcy. 

The cost of USING health insurance for pre-existing conditions is vulnerable to the same pretty bad track record of Obamacare in USING the essential health benefits. 

For instance, under Obamacare’s convoluted recipe for prescription drugs as an essential health benefit, drug prices have skyrocketed, up 13.1 percent in 2014 and 12.2 percent in 2015, and 4 of the top 10 prescription drugs have gone up in price 100 percent since 2011. CSRXP.org also reports that in 2016 Pfizer raised prices on 133 of its products.

Maternity care expenses have also gone up in addition to being an example of Obamacare sexism and ageism. Maternity care is a required essential benefit, spreading the cost of women making the choice to have babies to everyone, and as Luhby confesses one of the reasons plans are so pricey, but it’s also an ageist requirement, charging older people more even though biologically there will be no maternity expenses. For older Americans the provision is especially burdensome because Obamacare ALREADY permits charging people higher premiums based on AGE to the tune of 1.5 times premium.

Aside from “including” the coverage in policies, “using” the coverage likely costs women more who are also paying higher deductibles and copays and coinsurance under Obamacare and who face rising prices of having a baby.

Mental health parity provisions under Obamacare have also not worked. NPR, completely left-leaning, reporting in November of 2017 that “Health Insurers Are Still Skimping On Mental Health Coverage,” Jenny Gold, 11/30/2017.

The essential health benefits provisions of Obamacare have been lose-lose, higher insurance plan prices to include them and higher prices paid with rising out-of-pocket expenses in the form of deductibles, copays and coinsurance. 

Luhby also states “Promising to protect those with pre-existing conditions also conflicts with another Republican health care promise— lowering costs.” “Costs,” referring to the insurance coverage costs of “The provisions are one of the main reasons why policies on the individual market have become so pricey.”

Luhby nicely skips over the uncomfortable truth that the Democrats’ “Affordable” in “Affordable Care,” turned out to be more about saving government and insurers as payers money, not about consumer dollars and that Obamacare’s exchanges and forced purchase actually resulted in stunning increases in premium costs and-or reductions in coverage for MOST Americans.

The most condemning piece of evidence of the deceptive goals of Obamacare is that lawmakers, Democrats and Republicans alike, made very sure they would not be forced into Obamacare, with special legislation following and reinforcing the de facto exemption of public employees from the law. Without a stake in being authentic, we’re left listening to blowhard public employees and diehard partisans about matters that are being steered by the private financial industry of health insurance or asuransi kesehatan and their lobby, AHIP.

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