Preexisting demagoguery

Politico reports, in contrast to what you’ve read:

Health and Human Services Secretary Tom Price on Sunday defended the health care legislation just approved by the House against charges that many people with pre-existing conditions could have trouble getting insurance or see their premiums rise.

Asked about the staunch opposition to the bill, particularly its provisions dealing with pre-existing conditions, Price said on NBC’s “Meet the Press”: “What I believe they are not recognizing is this is a different and, we believe, better way” to cover those individuals.

“I think it’s absolutely true that the president is fulfilling his promise to the American people,” Price said, “and that is to make certain that every single American has access to the kind of coverage that they want for themselves and for their family, not that their government forces them to buy, and make certain that we ensure that individuals with pre-existing illnesses and injuries and conditions are covered, but covered in a way that they want. Again, not that Washington forces them.”

“Look, nobody wants folks who have a pre-existing illness or injury not to be covered,” Price went on. “We want to make certain that we can do it at a lower price and broader choices for patients. So, that again, they’re able to see the doctor that they want to see. They’re able to go to the hospital that they want to go to and to the clinic that they want to go to, not that Washington forces them to participate in.”

The goal, Price said, “is make certain that every single person has health coverage.”

“Our desire is to make certain that we have a system that works for patients,” he said, “not for government, not for insurance companies, but for patients. That’s the goal.”

Need more explanation? (Capitals, boldface and italics are the writer’s.)

Let me begin this post by stating I am a licensed independent insurance broker with no allegiance to a single company or lobbyist group. I represent my CLIENTS and MYSELF and my goal is to find suitable and affordable insurance products that people will want so I can make a living and so that I will have happy customers who will refer me to friends and family. That is my only agenda. If people don’t have good insurance options and don’t want to buy it I don’t win. Basically if they don’t win I don’t win. …

What exactly are “Pre-Existing Conditions”? The Democrats would have you believe it includes hangnails and that those mean Republicans are going to have everyone evaluated for hangnails and if they find one on you they will throw you off of your current insurance. This is of course not true. First off “Pre Existing Conditions” don’t even apply to about 85% of the population. If you are in one of the following categories “Pre Existing Conditions” don’t even apply to you.

  • If you have Medicare or a Medicare Advantage Plan (65+Seniors & under 65 Disabled)
  • If you have Military health benefits through VA benefits or Tri Care
  • If you have Medicaid
  • If you have insurance through your employer and do not allow a gap of 63 days between your old plan and your new plan
  • If you have individual insurance and do not allow a gap of 63 days from your old plan to you new plan

So if you are in one of these categories you cannot be underwritten for those types of plans.

So What are Pre Existing Conditions then and who DO they apply to?

Now that we have covered who Pre Existing conditions DON’T apply to and now that we have determined that the majority of the country will be unaffected by this change in the law lets look at what Pre Existing conditions are who WILL be affected by the changes in the law.

Who needs to pay attention to the Pre existing condition law changes?

  • People who are uninsured and have gone more than 63 days without insurance
  • People who allow their insurance to expire and do not secure new insurance coverage within 63 days

Remember these are NOT Seniors, Disabled, Medicare, Medicare Advantage, VA benefits, Tri Care or Medicaid people. It also NEVER applies to a group health insurance plan through an employer. This is for private individual or family insurance only for non disabled people who make ABOVE poverty level. These are NOT old people, disabled people or poor people.

What the heck are “Pre Existing Conditions” anyways?!

Pre Existing Conditions are not hangnails. Heck, they are not even high cholesterol. Pre Existing conditions are major illnesses/conditions like Cancer, Aids or Diabetes. Epilepsy is a condition that some companies will cover and others will not. Some companies will deny an entire policy based on Pre Existing conditions, while other companies might only impose a rider on the condition itself and cover the rest of your care (Ex: you injured your back, chiropractic or orthopedic benefits may be limited). Some companies may issue a policy but have a waiting period until the Pre Existing condition is covered.

OK, now that we know that, some people may be ok with a limited policy but other people who are sick and need immediate care might need something more. What are their options?


So what happens to these folks with Pre Existing conditions? Do we send them to Mars? Do we leave them to die in the streets like Bernie Sanders says? Of course not. There will be “High Risk Pool Insurance Plans” that cover people with Pre Existing conditions available under the New GOP health law.

What are “High Risk Pool Plans”?

High Risk Pool plans are not a totally new concept. Before Obamacare, High Risk Pool plans were available in 33 states in the US. The problem was 17 states did not have this option. The plans were largely successful in the states that did have them. Under the new Republican all 50 states will have one. The High Risk Pool plans are there for people who get denied by an insurance company for a Pre Existing condition or have a rider issued for that Pre Existing condition. The person will receive a letter of denial from the insurance company with instructions on how to apply for the High Risk Pool plan. The plans will be run by the states with block grant funding from the Federal Government. This insurance will be GUARANTEED ISSUE and IMMEDIATE COVERAGE for the Pre Existing condition and other healthcare needs.


States will even have premium assistance available for lower income members to help afford the monthly payments.

So what else is in this bill besides Pre Existing conditions modifications and who will it affect?

  • Because the bill repeals Obamacare, the $700 billion that was stolen from Medicare & Medicare Advantage will be returned to those programs. The folks on Medicare & Medicare Advantage (Seniors & Disabled) will be helped.
  • Insurance companies will be able to offer a wider variety of plans. Because the bill repeals Obamacare’s taxes on insurers and repeals the “mandated benefits” packages people will once again be able to choose plans with higher ow lower deductibles and choose what they want their plans to cover. This will stop people from paying for things they will never use (pediatric dental, maternity care, etc.) You can still get those covered if you want them but you will no longer have to buy plans that include benefits you will never use.
  • Abortions are no longer mandatory coverage.
  • New applications for Medicaid will only include people UNDER THE POVERTY LEVEL. Under Obamacare, people above poverty level were allowed to get Medicaid under the Medicaid expansions in states that took the expansions. This will cease. It will not kick off the people who got Medicaid from the expansions though. They will be “grandfathered in”.
  • If you go more than 63 days without insurance or let your current plan expire and do not get new coverage within 63 days, an insurance can choose to charge you 30% more on your premium. It pays to keep your insurance if you can. This does not mean that you WILL be charged 30% more, it means that they CAN choose to. Keep in mind though there will be more competition for your business so companies will try to keep rates low to get new customers.
  • Premiums will be lower overall for most people. Especially if you are healthy or younger. With more plan choices and less pressure on insurance companies to cover large bills from extremely sick members, the premiums will plummet for a good portion of the population.
  • Tax Credits will help people afford their insurance. Republicans have included a “Tax Credit” system based on age and filing status. For example a single 30 year old male would get a $2,000 tax credit to help with healthcare costs.
  • Health Savings Accounts will be expanded. Limits for HSA deductions will increase under this plan. This will lower your tax burden.
  • Association Health Plans will be allowed again. Association plans are group health plans from organizations such as fraternal organizations, professional organizations etc. You or your family cannot be denied coverage for Pre Existing conditions on these plans. These are wonderful for folks who don’t get insurance through their employer. Group rates are sometimes lower than individual rates for health insurance.


In Conclusion this bill stops robbing Peter to pay Paul. It is much more fair in pricing and rewards responsible consumer behavior. It does all of this while still protecting our poorest, sickest and most vulnerable consumers.

U.S. Rep. Cathy McMorris Rodgers (R–Washington):

Hearing late-night host Jimmy Kimmel’s emotional monologue this week about his son’s condition and his family’s experience in the moments after his birth, I had a flashback to the day my son was born and we learned he had Down syndrome.

My husband and I had a lot of questions about Cole’s future. Whether he’d have health care shouldn’t have had to be one of them. When you’re facing years of doctor’s appointments, you want to know that having a preexisting condition, such as an extra 21st chromosome or a heart defect, won’t prevent you or your loved ones from accessing the care you need.

Protections for children such as Cole Rodgers and Billy Kimmel have long existed, as they should. And despite what people are saying, House Republicans aren’t seeking to strip these protections — or anyone’s protections — away.

It’s the people we love — our children, friends and neighbors — who are the inspiration behind our American Health Care Act, which we passed in the House on Thursday.

We’re working hard to build a health-care system that puts the American people back at the center of their health decisions. We’ve had conversations — tough conversations — with people from all walks of life, and we’ve passed a bill that we’re confident will improve lives.

When Obamacare was introduced, Republicans and Democrats knew the status quo wasn’t working. But Republicans rejected the notion that to help 2 million people with preexisting conditions get access to care, we needed a 2,000-page bill that transformed one-sixth of the economy.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s