If you challenge them correctly then you would be pummeling ignorance in a public forum.
That is a definition of the good to me.
Because his treatment was in 2013. Before the ACA went into effect.
Itās literally in the last sentence of the paragraph.
4 Likes
Thereās a straightforward remedy here, and it goes something like this: every elected Federal representative is kicked off of their Federal healthcare plan. Theyāre given 30 days notice, then the option of paying for continuing coverage under COBRA, at the standard inflated rates. After that, they have to find coverage for themselves and their families in the open market. Obama and his family get to keep their Federal coverage, because heās the President, and because Congress will then have the experience of being treated unfairly by the system while someone in a higher station of life doesnāt have to worry about it.
The U.S. healthcare system would be fixed in two years.
7 Likes
You do realize that this is exactly the biggest thing the ACA fixed, right?
Itās just that itās not retroactive for treatments that happened before the law went into effect.
8 Likes
Hey Rider, there are lots of problems with the ACA, but this isnāt one of them. Brandon bought this plan before the ACA went into effect and, in fact, had the ACA been in effect sooner Humana would have HAD to cover him. The very loophole that allows them to screw him here was made illegal by the ACA. The problem is that itās not a retroactive illegality. Iām just saying, complain about the stuff in the ACA thatās worth complaining about. This isnāt one of those things.
19 Likes
This:
Iād told them that Iād had stomachaches at any point in the past five years, whether or not Iād gone to a doctor for it ā Iād fallen under a fine-print pre-existing condition clause that said that any signs of illness that could possibly have led a doctor to a diagnosis since 2008 were cause for denying any compensation for any ailment of pretty much my entire alimentary canal.
I think is what youāre looking for? Itās right there in the article.
ACA would prevent this kind of loophole, policies dated Jan 2014 and later will not have this fine print and new policies cannot do this. But itās not retroactive and he signed up for healthcare in 2013, so his policy is from before ACA.
1 Like
And donāt forget to remove Viagra as well as all urological work from being covered. Some congressmen have an aversion to supporting womenās pregnancy and reproductive healthcare (perfectly reasonable, since theyāll never use it); same should be applicable to menās healthcare.
4 Likes
ACA would prevent this kind of loophole, policies dated Jan 2014 and later will not have this fine print and new policies cannot do this. But it's not retroactive and he signed up for healthcare in 2013, so his policy is from before ACA.No. You are not understanding. It is NOT the case that his policy predates the ACA's ban on excluding coverage due to pre-existing conditions and so he isn't covered for pre-existing conditions. As of January of this year, policies can no longer exclude coverage due to pre-existing conditions, and so as of January of this year he is covered to obtain the care he needs - going forward. However, through the end of last year this aspect of the ACA had not come into effect, and so his health insurance provider had a legal way not to pay the medical bills he accumulated last year. That the insurance company can no longer refuse to pay newly generated medical bills doesn't help him with the medical debt he accumulated before this aspect of the ACA came into effect.
4 Likes
If we adopted a system similar to Israel we could save around $1.449 trillion per year from private and government health spending.
Here is my reasoning:
US Spends 17.6% of GDP on Health
Israel spends 8%
Difference is 9.6%
US GDP, 2012: 15,094 billion
.096 x 15,094 = $ 1449.024 billion
That is more than the twice 2013 DOD budget of 672.9 billion
"Our health care costs are completely out of control. Do you realize what health care spending is as a percentage of the GDP in Israel? 8 percent! You spend 8 percent of GDP on health care, and youāre a pretty healthy nationāā¦ Mitt Romney, in Israel, 7/30/12 (Israel has socialized health care) We spend 17.6%
āIt doesnāt make a lot of sense for us to have millions of people without health insurance who can go to the ER and get free care, particularly if they are people who could pay. . They get free care paid for by you and me. If thatās not a form of socialism, I donāt know what is, so my plan did something quite different. It said, you know what? If people can afford to buy insurance ā¦ or if they can pay their own way, then they either buy that insurance or pay their own way, but they no longer look to government to hand out free care. That is ultimate conservatism.ā
ā Mitt Romney, 60 Minutes, 09/23/2012
I recently had some stomach issues, and I figured that as long as I was going to a gastroenterologist, I might as well schedule my colonoscopy screening. It turns out that, because I presented with symptoms, it was not billed as a screening (covered 100%), but as a āmedical procedureā (subject to a deductible). I was on the hook for about $625. Luckily my company reimburses you for the deductible, but the logic behind this mystifies me. If you donāt need it, you are covered. If you do need it, and would be more likely to benefit from it, you are penalized. They are discouraging people from seeking care that could save lives (and save them money in the long run).
2 Likes
I think a question that hits closer to the mark might be "How much of the American public actually cares enough about their fellow citizens to insist that the health insurance industry be effectively fixed for good? My guess is that it would be close to 50/50, much like the major political party lines
4 Likes
I donāt think this is really true. I do think that we are gerrymandered into safe districts for each party which leads to the actual voice of the people getting divided to the point where we donāt actually get representation.
That, and red states get too many senators compared to their population & economic contributions to the union. Stupid Founding Fathersā¦
If you look at the nationwide polling America is a pretty progressive nation. We just canāt ever do anything that most people want because the system is currently stacked for obstruction.
No it wasnāt itās still privatized for profit insurance and stories like this will continue.
For profit corporate run health insurance is doomed to corruption and failure.
4 Likes
Obamacare could have helped him pre-2014 if he had signed up for the Pre-Existing Condition Plan (PCIP). https://www.pcip.gov/ It wasnāt perfect, but it did pay for most of my medical needs 2010 to the end of 2013. PCIP stopped taking new enrollees on Feb 16 2013. To enroll in PCIP, you needed to submit to the plan a letter from an insurance company denying you coverage because of a pre-existing condition (hence the name.) So why did Humana approve him for an insurance plan if they thought he had a pre-existing condition? That is the question.
1 Like
Ah! Got it, thanks.
He should negotiate with the hospital. My brother was very ill and had bills afterward for something like $700,000. He was able to negotiate it down to 10% and thereby saved his home from the auction block. Prices are inflated because of . . . well, you know the rest.
Oh, he did not have insurance because he definitely needed it and that disqualified him. Go figure.
And a lot of people hate Obama for fixing this. Go figure again.
3 Likes
The private insurance companies will just find new loopholes. They used this one just because it was open to them and an easy way out.
Okay. But thatās a different argument than blaming the ACA for what happened to Brandon.
5 Likes
I appreciate the clarification, and Iām sure Brandon has more on his mind than timelines, but can I get at least an acknowledgment from someone that the sequence of events isnāt clearly laid out here?
First, ok, so why would āpre-existing conditionsā be a āfine-print clauseā when clearly, the ACA was battling it? Iām not saying Brandon should have known, but if this was some fine print, then it wouldnāt have been one of the central points of the ACA, not something you get ambushed by.
Second, he says he got insurance in 2013. The timeline of when he got insurance, when he got sick, and when he got bills wasnāt laid out in either of the original pieces. He could have:
a) signed up in 2013 when the ACA enrollment was happening (October+), had the stomach aches in January, and then gotten the bill this month, thus being surprised.
b) signed up in 2013 BEFORE the ACA enrollment was happening (before October), gotten sick well before this (last year some time), and then gotten the bill recently.
Nothing in the article clarifies those two cases. Nothing in his descriptions clarifies those two cases. And since everyone keeps mentioning āWait, I thought the ACA solved this,ā isnāt it somewhat reasonable to ask if maybe he signed up thru the ACA? He doesnāt clarify if his stomach aches were in early 2013, or whether he was diagnosed early this year. He doesnāt clarify whether the policy or his ailments were previous to this. He doesnāt state that heās not on an ACA policy. Talks about what is ācoveredā by the ACA, which is an ambiguous useā¦the law covers the policy or the policy covers the condition?
Even the quote above: āIād fallen under a fine-print pre-existing condition clause that said that any signs of illness that could possibly have led a doctor to a diagnosis since 2008ā could easily be construed as something thatās still fine print under the ACA, which would make it more of a travesty.
And if it was still there under the ACA, would anyone here be surprised?
All we have seen is, he signed up last year, came down with cancer, and Humana is denying coverage (oh, thatās another fact most people might not knowā¦at least in Illinois, Humana was the biggest one I saw to offer coverage: another reason I possibly assumed he went through the exchange).
Heck, Iām not even a lawyer and Iāve had trouble following whether or not he got screwed by the ACA. Iām assuming now he did not, but clearly, the complaints against the ACA here mean Iām not the only one having problem with context here.
I totally blame the ACA for what happened to him and what will continue to happen under privatized insurance.
Heās in the hospital now and is being screwed over by a privatized for profit company and I havenāt even mentioned insanely inflated hospital costs.
If the ACA was effective this would not be happening. Not to anyone, not to people who accidentally signed up on some arbitrary date and had no clue they were not covered for preexisting conditions.
We need to deal with the real issue. Healthcare in the US is a giant for profit industry that is largely out of control, signing up everyone with private insurance companies jsut makes to behemoth larger and is doing little if nothing for the root causes of the issue.
1 Like
