Hacker News Reader

Comment by oxymoran | Hacker News Reader

It’s the preexisting injury part that jacked up the prices. They aren’t allowed to deny enrollment or charge significantly higher premiums if some was has cancer or something. And that totally makes sense morally, but that causes the risk burden to be offset on the aggregate of the subscribers resulting in higher premiums for everyone.

It would be kind of similar to forcing auto insurance carriers to afford coverage to cars they didn’t previously insure after they had already been in an accident.

View on HN

The insurance mandate was supposed to solve that problem.

And the requirement that 80% of premiums paid had to go to paying for care was supposed to prevent insurance companies from jacking up prices to increase profits.

Neither actually made an attempt at fixing the underlying problem of health care being expensive.

I've NEVER seen an employee denied (or asked) about their medical conditions ever. The enrollment paperwork to the carrier is like basic address / name / effective date for coverage. That is it.

Last year I went to Mayo Clinic. I have ACA insurance, but it is HMO-only (all ACA insurance in Indiana is HMO, not PPO), and Mayo is not in network. I actually considered getting married just so I could get PPO insurance (life change event) and be covered at Mayo.

Since the insurance companies now have to cover pre-existing conditions, and don't want to do that, they came up with another plan: don't answer the phones except during open enrollment. I tried calling several insurance companies (major carriers) just to get quotes for health insurance, and none returned my call. Some had phone trees that went in a circle so you could not get to a person. I did get one broker to talk to me, and he said pre-existing conditions weren't covered for 24 months. First, that's a lie, and 2nd, it's illegal (ACA outlawed this practice).

By only accepting applications during open enrollment, the insurance companies have effectively done an end-run around the law against pre-existing conditions.

Note: this is for an individual to get insurance. I'm sure companies can get insurance for their employees any time they want it.

Follow-up: it turns out that if I did have PPO insurance and was covered at Mayo, then with the same bill from Mayo it would have cost me $8000 more with coverage than it did without insurance, paying cash. That's truly f'd up!

The ACA prohibits pre-existing condition exclusions for all insurance plans, not just Obamacare plans.

And prior to the ACA rule taking effect, denial for preexisting conditions was common practice. See more here https://en.wikipedia.org/wiki/Pre-existing_condition

> And prior to the ACA rule taking effect, denial for preexisting conditions was common practice

Bigger than denial was recission, where if you ended up with an expensive to cover condition, your insurer would fine-tooth-comb your history for evidence that you had a preexisting condition that has not been revealed, cancel your coverage, and leave you uninsured and uninsurable; recission for reasons other than proven intentional fraud was prohibited by the ACA, which is a pretty big deal.

I've been at a small company (circa y2k) that looked at group insurance, and decided against it specifically because of one employee's pre-existing conditions would have made the plan more expensive. Boss was a little too forthcoming with that information, and sure enough, when the employee moved on, we all got insured. Thankfully, that's illegal now.

Yep; I knew a few small businesses where an employee got cancer or whatever and their insurance company let them know that their plan would become significantly more expensive and "hinted" that, to avoid this, maybe the employee in question could be fired for some reason...

And before ACA, the prospective employee would normally have to show evidence of continuous creditable coverage before being added to the new employer group plan. This is how pre-existing conditions were handled - if you had always had coverage, OK, but if you went uninsured for a while and then tried to re-join a group, tough luck.

Reply on news.ycombinator.com