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Is anybody really surprised? When the concept of insurance is transmorgrified into a healthcare shopping card, this is what happens.
I saw this one coming a mile away.
The requirement to cover kids with pre-existing conditions was one of the dumber parts of health care reform, IMO. It was one of those "sounds good on paper" things, that gets completely ed when it comes to implementation. The things that the story talks about are happening, and I have some first-hand knowledge of that. I think a better way to have done this was simply to have set up an insurance pool of some sort, with (gasp) some government funding to subsidize any company that wanted to take the kids on.--RG
http://www.npr.org/blogs/health/2010...ent-for-kidsby Julie Rovner
Starting late this week, parents of children with pre-existing health conditions were expecting to breathe easier.
That's when a provision of the federal law overhauling health care takes effect and bans insurance companies from denying individual policies for kids with a history of health problems. But families counting on the change could be in for a shock.
The Denver Post reports, "at least six major companies — including Anthem, Aetna, Cigna, and Humana — have said they will stop writing new policies for individual children" in Colorado. The companies "blamed health reform mandates taking effect Thursday requiring companies that write such policies as of that date to also cover sick children up to age 19," the paper said.
The Washington Post reports that three big insurers — WellPoint, Cigna and CoventryOne — made their decisions because of "uncertainty in the health insurance market."
By dropping all new children-only coverage before the effective day of the new mandate, the companies effectively sidestep the new requirements.
The advocacy group Health Care for America Now was the first to bring the action to widespread attention. "Even for the insurance industry this behavior is surprisingly brazen," HCAN Executive Director Ethan Rome wrote in a blog entry for the Huffington Post. "They don't like the rules, so they're going to take their ball and go home."
But the insurance industry trade group America's Health Insurance Plans rejected HCAN's contention that the companies' refusal to sell to all comers is somehow a violation of a promise made earlier this year by AHIP CEO Karen Ignagni that insurance companies would comply with regulations regarding children and pre-existing conditions.
In an interview, AHIP spokesman Robert Zirkelbach said Ignagni was responding only to promises that children wouldn't be excluded from their parents' plans and that if the kids are covered, the policies would include treatment of their pre-existing condition.
What emerged in the regulations, however, Zirkelbach said, was, in effect, a requirement that insurance companies accept children even if they are already sick. That, he said, would be tantamount to exactly what companies want to avoid with the adult population — letting people wait until they are sick to sign up for insurance. Which is exactly why the insurance industry is so insistent on a coverage mandate: It needs premiums of healthy people to help cover the costs of those who are not.
Thus, he said, the companies in question "are having to make some difficult decisions" to stop offering coverage to all new children rather than take the chance that only the sick would enroll. At least until 2014, when everyone is supposed to be covered under the law.
Is anybody really surprised? When the concept of insurance is transmorgrified into a healthcare shopping card, this is what happens.
I saw this one coming a mile away.
Health insurance MUST be handled exclusively by orgs whose priority is delivering health care, NOT in maximizing profits while minimizing services and payouts.
US health care is ed up and exorbitantly expensive because of the profit motive, and those $Bs in profits buy Congress to protect and increase those profits.
Let's see if the Repugs even address health care in their campaign announcement Thursday.
More lip service on repealing it, maybe.
And if insurance companies didn't do this?
A child with Leukemia/diabetes/other cancer is IMMEDIATELY enrolled on their plan (probably by the hospital/doctor that is treating them) - the insurance company is limited in the premium they can receive and is no longer allowed to limit maximum benefit; so the insurance company can collect a couple hundred bucks a month in premium (again probably paid by the provider, not the family), and immediately be saddled with a claim with absolutely no ceiling. 5, 6, 10 million dollars? How much do you think the hospitals/labs/docs/etc... are going to bill now that those bills can be limitless?
It would be irresponsible to all of the carriers other insureds to leave themselves open to that.
Who gets hurt by this?
Healthy children.
Unintended consequences suck.
Group coverage (where the VAST majority of people get their coverage from) are moving forward with amended plans eliminating pre-x exclusions for children, or just continuing as they have - several carriers did away with any pre-x exclusion years ago, anyway.
Eh, this is no big deal. People are going to love Obamacare once they get used to it.
You stay classy Health Insurance Companies...
It really doesnt matter what providers bill for considering that the insurance company is only going to pay a percentage of that. Simply not having a lifetime maximum isn't going to somehow magically drive up the prices in the medical field.
I don't understand what's the difference, risk wise, from a kid with preexisting conditions who just got enrolled on a group coverage plan vs an individual plan.
the fear (probably justified) is that all of the sick kids w/o insurance will enroll, and none of the healthy kids w/o insurance will enroll, this will cause them to raise premiums on all insured, or lower benefits. If a sick child enrolls in a group program, presumably others in that group are not sick, and this could offset the cost of that child. Additionally, that group would be considered (premiumwise) as a separate en y from their general insured's pool. They could, therefore, raise rates on JUST that group, without affecting all other group and individual policies.
under the new healthcare system obama advocated kids may be covered under parents healthcare till their 26 birthdays which imho demonstrates how delusional and quixotic the kenyan president is. if a 22yr old is married and has a couple kids, where would his/her kids get the healthcare coverage? from their grandparents?
if a kid is sick, 90% of chance is he's suffering some severe obesity & consequent syndromes like diabetes which are all the results of bad lifestyle & laziness. all these lazy asses deserve no cure but a coffin & funeral, and there's no cure for inferior genes you know.
Ive said it before, and I'll say it again.
Liberal policies do not account for full circle thinking.
Liberals are destroying this nation because they go by "feelings" rather than "thinking."
Why only kids enter the equation though? I would think the insurance pool includes both kids and adults? And sure, after doing risk-assessment, they'll probably conclude that the risk is X and that the premium needs to be Y.
Even if the price of said policy would be astronomical, why would they just flat out not offer it?
But if they can adjust the premium in a group after assessing the risk, why wouldn't be able to do the same on individual policies, instead of flat out not selling policies (however astronomical the premiums would be on those)?
A kid could suffer from many different things that have nothing to do with laziness and bad lifestyle. Things like Poliomyelitis, Autoimmune diseases, Congenital disorders, Autism, etc etc etc...
Any why is that an insurance companies responsibility, when it's common underwriting practice to use all factors to determine a price?
Liberals are simply dumb when it comes to real work economics.
What are you babbling about? The problem was insurance companies refusing to insure kids with pre-existing conditions. There was no risk assessment or price calculation since no policy was offered, period.
Because conservatives like Reagan really knew how to rein in spending and reduce the country's debt...
the insurance pool does include both kids and adults. However the reason why this discussion is focusing on kids is because insurance companies as of a certain date (I think the end of this week) cannot decline a child for pre-existing conditions.
As far as your "risk x, premium y" question, they cannot price a policy individually. You are always a part of some group. If a bunch of sick kids enter the pool, the EVERYONE in the pool suffers a higher premium.
I explained this above, but want to add that if I remember correctly it is actually illegal to price a policy individually.
But if they can adjust the premium in a group after assessing the risk, why wouldn't be able to do the same on individual policies, instead of flat out not selling policies (however astronomical the premiums would be on those)?
I think he covered all those with the inferior genes comment.
Insurers didn't say they wouldn't take ANY children; they simply said they wouldn't write policies for ONLY a child in a family; they want at least one parent w/that child; or, presumably, all the children. In group plans; by definition; a child must be included with at least one parent, as well as his/her brothers and sisters.
What the insurance companies are, ostensibly, guarding against is severe selection against them. Say a family or Medicaid has a single (really) sick child; it is VERY likely a provider would pay for that child's coverage on a private plan, because that provider would stand to make much more than he could under Medicaid - hypothetical, but I can imagine that is the kind of abuse the companies are worried about; the family has to have more skin in the game, essentially.
Also, under group policies; the premium difference is exponential vs. what a single child on a single policy would produce (children are, by far, the least expensive people to insure - although inexpensive treatments are common (vaccinations, ear infections, etc...) REALLY expensive stuff is very rare - they haven't had time to screw up their bodies like adults have.
I might or might not have answered your actual question. Let me know.
Classically, insurance has been nothing more than a hedge against a future problem(s). Insurance companies still operate and underwrite somewhat as if this were the actual practice today. Unfortunately, the role of insurance has become distorted as a result of being forced into a facilitator/mediator role. Alot of the slop in contemporary healthcare is the result of trying to pound this square peg into a round hole. The Fed's approach? Pound harder, of course.
IMO, there are two roles for contemporary healthcare provision.
1. Routine and common health maintenence, much like the HMO model.
2. Catastrophic and serious health coverage, which used to be the purview of insurance companies.
We keep trying to force these two roles on an industry that was built to work successfully with only one. I think this dysfunction is what drives alot of the pricing opacity that is part of the foundation of our healthcare crisis. It's a pricing crisis, essentially. The quality of healthcare is not the main issue...it's simply the cost. Until we stop trying to force insurance companies into becoming healthcare facilitators, we will never address the underlying cost issue...indeed, as is likely to be the case with mandatory coverage of pre-existing illnesses, costs are likely to rise for all of us. Simply putting money in the hands of those who can't afford health insurance is not addressing the root causes. Instead, it's a weak bandage on a symptom...one that will be inadequate and will cause more damage in the long run.
Now I am, literally, going to join our (weekly) meeting with my senior staff, TWO new employees, and a secretary to record it all to determine where we stand on keeping ourselves AND our clients in compliance with the Healthcare Reform act.
The topic of this weeks meeting? Establishing a worksheet for each client with the fourteen criteria necessary to determine whether or not their plans qualify as "grandfathered" - AND setting up the model notices that need to be sent to each employee telling them that (the notice will be at least two pages, and must be included with ALL correspondence). Also on deck is reports of our claims processing, as well as claim's appeals practices which MUST be filed with the Director of HHS for each plan we administer. That's THIS week.
Sure, this is gonna save a TON of money.
Start. Drinking. Nao.
VP (Marketing) is running late; while waiting I read this post - great one.
Addressing the cost issue inevitably comes back to some form of price control such as you see with Medicare. Good luck having anyone in this country listen to that once you go there.
I don't disagree with what you're saying Teysha, but you can't act like the insurance companies don't have a hand in this situation either. They fought tooth and nail against any form of the public option and even the high risk pools because of how it would affect their business model so I have very little sympathy for them.
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