A recent Daily Camera editorial and a letter to the editor both leave the distinct impression that if you have, one would assume, serious acne that individual insurance is not available to you.
First of all, there IS an element of truth to this statement when it comes to individual insurance. Some individual insurance plans have to cover any pre-existing medical issues if your gap in coverage is less than 63 days. Even if you have had a larger gap, they must cover the pre-existing condition in a year. The issue is that specialized acne medication such as accutane is expensive, average cost is $403 although the dosage is unclear at the link. Other links indicate this would be a months supply.
An insurance company simply isn’t going to charge an other wise healthy young person $125 per month and pay their acne medications at a cost of $400 per month. So what happens is the applicant is denied coverage, is that the end of the story? Well it is in the local paper, but as it turns out, not so fast. So what are the solution(s)?
- Select covearge from an alternate company that is allowed to rider out coverage of a specific condition.
- Sign up for the Colorado risk pool, Cover Colorado
- Sign up for the Federal Risk pool in Colorado
Options 2 and 3 will get the insured prescription coverage (i.e. accutane). Option 1 will provide coverage for everything but acne at a lower cost than options 2 and 3.
Let’s take a look a few statements from the Daily Camera’s editorial…
Like people with pre-existing conditions. In America, you can be denied health care coverage for life-threatening diseases if you had acne as a teen; or coverage for cancer treatments if you were born with diabetes.
When it comes to acne, not true, the above solutions are available. You are not uninsurable for life threatening diseases if you have acne. Also, if treatment has been successful the insurance companies that can’t rider out conditions will most likely offer coverage. The implication that having acne as a child will prevent you from having coverage as an adult is nothing short of ignorance or stoopidity, not to mention irresponsible journalism.
Now diabetes is another, more serious matter. In general, diabetes is not insurable in the individual market, with some rare exceptions for well controlled Type 2 diabetes, which is not what is being referred to in the editorial. Once again, the solutions are either…
- Cover Colorado or the
- Federal risk pool
Unlike acne, no diabetic is going to pay for major medical coverage for an uncertain event of future cancer when the available coverage doesn’t cover their day to day battle with diabetes. Not to mention that having diabetes does increase the risks of cancer. Also, just think what the Daily Camera would say if an insurance company offered such coverage!?
Of course, the Federal risk pool is an outcome of the initial implementation of Obamacare, I would like to make that very clear. However, the State risk pool, Cover Colorado has been available for many years and most other states have risk pools as well,
So people with high risk diseases or illnesses having major medical insurance options is simply not true. That said, neither of these options are close to “free”, although Cover Colorado does offer some income based pricing.
Let’s examine the next few paragraphs…
Or like the young unemployed or underemployed Americans under age 26, who were extended the right to pay, or have their parents pay, to have them included on family policies.
But most repeal-supporters don’t dare talk about this. Because it sounds callous, even immoral. It’s easier to spat out “government takeover” or “Obamacare” than pesky details like 32 million people who will be excluded from coverage if the law is repealed.
Being able to stay on a parents policy is a key feature but it’s not made clear why in the editorial. In general, the cost difference between a young adult staying on their parent’s policy or purchasing an individual policy (even if parents pay for it) is slight. Where it comes into play is if the young adult has a pre-existing condition such as diabetes they are now able to maintain coverage for a few more years by staying on on their parents plan, be it group or individual, until age 26. Did you know that there was an individual insurance company that was already doing this well before Obamacare? To be specific they allowed children to stay on their parents individual policy until age 26 and they would then be issued a similar policy without medical underwriting.
But the next paragraph is at least misleading. If Obamacare were repealed today, 32 million people would absolutely not be excluded from coverage. Yes, I realize the CBO is being “quoted” but it’s not clear if the implication is 32 million would immediately not have access to health insurance or if we’re comparing today to the full 2014 implementation of Obamcare. Repealing Obamacare today would not change the insurance situation of 32 million people today.
I also think that both parties “game” the CBO. The CBO doesn’t render judgement, it simply reports based on the inputs it is given. To quote the CBO without some discussion of the inputs demonstrates a lack of critical thinking (hey, it is an editorial after all!).
The Camera editorial goes on to do their favorate thing, which is to demonize Republican’s. If Obamacare were repealed, I believe the changes made so far would be implemented in a similar fashion. These changes are that all major medical plans must include the following:
- Mandatory coverage for preventive/wellness benefits (see healthcare.gov) at no charge
- Unlimited lifetime maximums
- Children staying on parents policy to age 26
- Implementation of the Federal risk pool
I suspect that these laws would take all of 20 pages, not the 2200 that Obamacare does.
The other issue is of course the cost of treatment (and insurance). I don’t believe the Daily Camera editorial staff would hide their belief that the only real solution is the single payer system. Somehow that’s going to reduce cost, and it may well, although it’s not clear how (yes I now it’s clear to “them”, cut out the evil insurance companies). But there is no straightforward, simple way to contain costs. Undoubtedly tort reform pays a part due to expensive defensive medicine practices.
I believe a first step is full disclosure, make it easy for the patient to shop for services. No one cares when someone else is paying. As an example, a few years ago my wife needed an MRI. We were in a “donut hole” in our insurance plan and had about $900 until 100% coverage. So we did some shopping. It turned out we could go to conveniently located Boulder Community and the cost would be $1400 or we could go to a facility in Denver where it would cost $900. Well the cost to us, either way, was $900 so you guessed it, we (well she) went to Boulder Community. If it had been out of our pocket, we would have saved $500 and went down to Denver.
Getting back to acne for a moment, let’s take a look at some key phrases from the letter to the editor titled “Benefiting from new regulations” …
…Then, my daughter was denied coverage due to the pre-existing condition of acne.
With the Affordable Care Act, she is no longer without insurance and since graduating from college continues to be covered under my insurance, though still at a catastrophic level only due to cost, which have continued to rise.
Note: the daughter was able to stay on the parents plan since she is under age 26 thanks to Obamacare. I believe the letter writer’s prejudices against ‘the system’ have caused her to not seek out the correct options for her daughter. Here’s why:
- Major medical insurance is available for her daughter, it would have a rider for acne medications
- The writer notes that her daughter is now covered at a catastrophic level due to the expense of the monthly premium.
This tells me her daughter has high deductible coverage, so for practicial purposes the acne condition is not being covered. So she would be much better off getting her a policy from a company that will rider out coverage for acne and have much better overall coverage for the same or less expenditure.
The writer goes on to state:
I work with people with disabilities and have also seen the enormous benefits already coming to those families who had experienced denial of coverage and also were unable to take advantage of job promotions for fear of losing their insurance with any move.
I suspect there’s an element of truth here but it leaves the wrong impression. If you are changing employment to a different company that also offers group insurance, they must cover pre-existing conditions with no waiting period as long as the gap between the ending of the first policy and the beginning of the 2nd policy is less that 63 days. This is existing law and is not part of Obamacare. There is the issue of changing jobs to an employer that doesn’t offer benefits and not being eligible for an individual plans (but Cover Colorado would be an option as well as COBRA). Of course, that get’s us into the discussion of insurance being tied to employment. That can wait for another day.
’nuff said for now.
