One of the largely-overlooked problems in the health care reform debate is that of exclusions for pre-existing conditions. These exclusions, common in the individual market, essentially limit the insurer’s liability to those conditions that occurred after the insured obtained coverage.
From the insurer perspective, this makes sense – they don’t want to sign up folks who found out a week ago they have asthma diabetes and other expensive conditions, and now need some help paying the bills.
From the insured’s perspective it also makes theoretical sense – individuals will be more likely to sign up for insurance before they get a case of the horribles if they know they can’t get coverage once they are diagnosed. That’s the theory.
The reality is that the older we are, the more likely we are to have a condition or conditions that will require medical attention. Mine is cataracts, a situation that is not a big deal. Those with hypertension, COPD, diabetes, asthma, or cancer are much worse off – in many states they will not be able to get any coverage for those conditions.
HIPAA addressed many of the problems of insurance portability, but this issue still exists for people who may have individual plans or who lose their coverage because they change employers.
Currently the law allows insurance companies to “look-back” on medical records for a period of six months to determine if the applicant has any pre-existing conditions and the law allows a 12 month waiting period to be enforced if a pre-existing condition is determined to be present. This legislation goes further to extend HIPAA protections to the estimated 158 million individuals who are insured through employer-based private plans and non-group, individual plans.
It is estimated that one in three Americans could be caught in this trap due to previous illnesses.
My Congressman, Joe Courtney, introduced legislation to address this. H.R. 2833 would allow a look back period of only 30 days and minimize the waiting period to 3 months. This legislation goes further to extend HIPAA protections to the estimated 158 million individuals who are insured through employer-based private plans and non-group, individual plans.
Yes, it is incremental. But it is needed, and could/should be part of any broader effort to reform health care.
I am not against a legislative mandate requiring insurers to limit both the “look-back” and/or the “waiting period”. However, let’s call it what it is–another mandate that increases cost to the health plan and, therefore, premiums. If the goal is to make individual plans more affordable, this will have the opposite result. If the goal is to make individual plans UNaffordable, then this and other “mandates” will eventually succeed in doing that.
NOW, if the goal is ALSO to eliminate MANDATED individual coverage as part of a universal health care proposal, it will also work for that. After all, if individual plans are not affordable, we can scarcely “mandate” them unless we have unlimited public funds for “subsidies”.
Little by little, anything that controls cost will be seen as reprehensible and those controls will be eroded.
As Matthew Holt as remarked several times, the health insurance business model needs to change from managing “risk” to actually managing patient care.
This is consistent also with the vision of Alain Enthoven of Stanford, whose model for “managed competition” has been adopted by the Dutch. The health insurers of the future will be large integrated entities with ties to large group practices and hospital organizations providing comprehensive care. Competition between these entities will be based on quality and cost.
It’s either that or single payer.
can anyone help everyone is denying me because i haveHPV virus?P.I.D./and fertility problems