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Pre-existing Condition Danger Zone

Pre-existing Condition Danger Zone

The uninsured. They’re getting plenty of coverage in the debate about the health care reform bills pending in Congress. How do so many people end up uninsured, anyway? 

Lots of reasons, not the least of which is the dreaded “pre-existing condition.” I have one. You may have one, too. If not, you probably will at some point. None of us gets through this life unscathed.

If you have a group insurance policy, and your job is secure, you may not be particularly concerned. But what if you lose your job… and COBRA is beyond your means… or you were able to take advantage of COBRA, but time has run out. What if you haven’t found a job that comes with employer-based coverage… or with few options left, you decide to freelance or are otherwise self-employed.

Through no fault of your own, you find yourself seeking an insurance policy on the individual market. You’ve had medical coverage your whole life and never really thought much about it outside of complaining about your out-of-pocket expenses. But now you’ve got a problem. Your pre-existing condition(s) make you undesirable to insurers. They are not particularly interested in your business or your problems.

In many states, insurance companies can and do discriminate based on pre-existing conditions for those seeking individual policies. They can deny coverage, charge higher premiums, or refuse to cover a particular medical condition.

Some states have a high-risk pool for those who cannot get insurance on the private market, but high-risk pools often have higher rates than healthy people in the individual market. Some pools have annual caps on enrollment or allow only people who had prior group health coverage in the preceding 63 days. High-risk pools also may have pre-existing condition exclusions for six months to a year, during which time that condition is not treatable.

Then there’s the practice of insurers canceling insurance for sick policyholders. Three of the nation’s largest insurers recently told legislators that they did not plan to discontinue the practice. Paying your premiums in good faith in times of health is no guarantee that you will get the medical care you need in times of sickness. Not a very comforting thought.

A Congressional investigation into this practice found nearly 20,000 rescissions from three large insurers over five years, saving them $300 million in medical claims, and at least one insurance company has been found to evaluate employee performance based in part on the amount of money an employee saved the company through rescissions.

The American Cancer Society Cancer Action Network reports that one in four families affected by cancer delayed care due to cost barriers; in the last twelve months, nearly one-third of cancer patients in treatment cut pills or skipped doses; nearly one-quarter delayed a recommended cancer screening or treatment; and one in five did not fill a prescription. It’s hard to fight for your life while fighting your insurance company.

That’s the system we have now –  everything’s great — as long as you don’t get sick. If you do, you might just find yourself in the danger zone, branded with the “pre-existing condition” clause. If you think it can’t happen to you, you are overly optimistic — or a member of Congress.

 

Resources:

The American Cancer Society Action Network

EnergyCommerce.House.Gov

HealthReform.gov

Kaiser State Health Facts

From the Petition Site:

Fighting Cancer Requires Health Care Reform

People with Diabetes Need Health Care Reform

We Need Health Care Reform Now Because…

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26 comments

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1:20PM PDT on Aug 23, 2009

"Three of the nation’s largest insurers recently told legislators that they did not plan to discontinue the practice [of rescision]."

Of course they don't, they would be breaking the law if they did. Not once have I heard mentioned in this discussion the legal obligation of any corporation to seek profits as its primary objective--even before lives . That's not greed, that's just following the law.

In most industries, corporations are not faced with a choice between making a profit or providing life-saving services. If somebody can't afford a shirt or a TV or a car, etc., they're not going to die. However, in industries where the service is literally a life/death matter (emergency services like police and fire departments), we have turned them over to the public sector...except for health care.

The dirty little secret being left out of this discussion is that as long as private insurers exist, governed by corporate law, they are legally obligated to seek every legal way to avoid paying for treatment. And a legal obligation combined with the profit motive and competition are sure to keep the insurance industry several steps ahead of government regulation at all times.

And as far as Bill G and other anti-govt types...it ain' perfect, but govt kept us safe from Nazis & Soviets, provided us with highways & the Internet, and provides people over 65 with a single-payer system with higher patient satisfaction ratings than any private US health delivery syst

5:24PM PDT on Aug 19, 2009

Sorry, Bill G. I should have looked before speaking. Your pop-up profile says: I care about... and then nothing.

Got it. Carry on.

Jim

5:22PM PDT on Aug 19, 2009

Bill G,

Are you capable of saying anything of substance? Or are you just going drone on with your government-hate whining?

Jim

6:01AM PDT on Aug 19, 2009

Remember the big corporate executives that head the insurance and pharmaceutical companies flight off on a moments notice in their private jets (costing tens or hundreds of thousands of dollars to operate) to meetings or upscale vacation locales with their families. So your insurance money collected by your corporate employer is going to pay for your coverage and the rest of the premiums paid $$ will help foot the bill for the lavish lifestyle these executives and their families have grown accustomed to enjoying. Meanwhile, your claims may go DENIED or subject to further review etc. The system is broken and we CANNOT believe that the insurance companies and pharmaceutical behemoths have the American people's best interest. VOTE for a public option.

And remember grandma isn't getting the best care now because these executives -- hospitals, nursing homes, durable medical equipment manufacturers, pharmaceuticals, insurers and others ALL benefit from keeping the status quo -- are getting their BIG share of the profits.

We have a horrible record at many US hospitals of unsanitary conditions with diseases like MRSA and women's high rate of death during childbirth (due to sepsis and other infections) are among the world's worst especially in the developed world.

We Americans need to demand better healthcare at a reasonable price -- from our government (that should work for the taxpayers and not the lobbyists).

11:29AM PDT on Aug 18, 2009

The health insurance companies are the ones who have proven themselves to be untrustworthy denying up to 20% of claims and with CEO's making many thousands of dollars per hour. If you trust government less than you trust them, they got you right where they want you. Why on earth do you think they GIVE MILLIONS of dollars to GOVERNMENT officials each year who then turn around and tell you not to trust GOVERNMENT? Are you starting to see a light go off in the depths of your ignorance? Lord I hope so, because there are millions of people for whom this is a life or death situation, and you could be a pink slip or a sickness away from finding YOURSELF among the ranks of the uninsured.

3:15PM PDT on Aug 16, 2009

This is amazing. It looks like you completely trust the federal government to be all and fix all. When did any government, local or DC, receive AAA ratings on love and compassion? Most of them are lawyers and used car salesmen (OK not the used car thing) and your willing to let them decide your live or die decisions?

I do not trust any party, right, left, or birthday to make these choices for me! There will be grave consequences for giving that power to any organization. Think this through very carefully.

9:51AM PDT on Aug 16, 2009

I am one of the lucky ones. I am a veteran and get my medical care from the VA. The health care providers I see are excellent & very caring. I don't have to wait months or years to see a specialist if I need to. The appointment is scheduled within 30 days of the referral. I sometimes have to make a 500 mile round trip drive, but I do get to see a specialist. The amount that I pay is based on my income.

However, there is a downside to my health care and that's the VA's prescription formulary which hasn't been updated in a coon's age. (Congress is too busy running for reelection to update it.) I have asthma but my doctor can't prescribe a "newer" drug like Advair, even though it works better than the medicine I'm on now, because it's not on the VA's prescription formulary. I email my Congresspeople regularly, begging them to update the formulary, but so far, my pleas have fallen on deaf ears. The pharmaceutical companies need to be reigned in just as much as the insurance companies do. If they didn't spend so much time advertising & convincing people that they have this or that disease, the drug prices would be lower. Then vets & everyone else could get the medication they need at a decent price.

I'm hoping & praying that health care reform includes the pharmaceutical companies as well as the insurance companies. Nobody should have to do without medication that would improve their quality of life or keep them alive because of the cost.

9:21AM PDT on Aug 16, 2009

I am 41 and havent had the opportunity to get health insurance since I was 16. I was in a car accident with a drunk driver and was put in a coma. Of course brain damage, nerve damage and depression afterwards. It took me 12 years to hold an itelligent conversation.

Insurance companies dont even come knocking on my door! I have been blacklisted from any form of insurance for life! Its not right. I am all for Obama's plan mainly because it would actually help me. Few plans actually address any concerns I actually have so I must make the most of this one!

12:31PM PDT on Aug 15, 2009

Amen to that Joseph!

Support HR676 in order to eliminate health insurance companies all together.

http://www.opencongress.org/bill/111-h676/text

This bill (28 pages long) proposes a single payer system in which the Medicare program pays all bills to private medical offices. There would be no government run medical offices or hospitals under this bill. The government would have no say at all in the type of care you get or which doctors you get to see. Medical care would still come from the private sector. This bill only proposes to eliminate health insurance companies in order to cut out the "middleman" as far as payment goes.

9:43PM PDT on Aug 14, 2009

Since the Republican Revolution in 1994, a Republican-controlled congress (until 2006), two Democratic presidential administrations, and two Republican presidential administrations have failed to reform health care in the US.

Now the Republicans and Democrats favor market-based approaches for reigning in ever more expensive health care in the US. If these approaches are so good for the market, why didn't all the interested patients, companies, and providers that make up the market naturally gravitate toward them and adopt them long ago? Why isn't health care already more accessible, affordable, and inclusive instead of the profit-hungry behemoth it has become?

Anything short of national health care will be nothing more than a compromise between the health care industry and the government that will allow the industry to continue to take the profits they are accustomed to. Profiteers and middlemen love deregulated markets. Denied that, they seek legislation and regulations that preserve their abilities to take profits. The only way government can cause the health care industry to shift to being principally interested in providing health care instead of taking profits is by removing the profit motive.

One of the main reasons national health care has not been established in America is because the American people have not insisted on campaign finance reform and publicly funded elections.

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