Before ACA ?

[naughtybear]

This is worrying to me. Health insurance was always a top priority, from military coverage to making sure each and every job EXH or I had offered coverage. Now I am going to be without if ACA goes. What were the rules to get individual coverage before the ACA, why couldn't people do that? Was it cost? I hear about pre existing could prevent coverage too? I never needed individual coverage so never looked into, so what were the barriers to calling BCBS (for example) and purchasing an individual healthcare policy.

[buystoys]

Pre-existing conditions were one barrier.  Cost was (and still is) another barrier.  My folks had individual policies.  Dad was in the state pool due to his pre-existing condition.  The states would take all high risk patients and put them into a pool for coverage.

There were no subsidies, so many people didn't purchase insurance due to the cost.  Even with the subsidies, many people enroll every year on the exchange, but never obtain coverage because they can't/don't pay the first month premium.

[taz157]

You could still purchase health insurance even if you weren't with an employer who offered health insurance coverage.  My DH was able to purchase it when he was self-employed and paid a reasonable amount.  I Since it's been several years, I don't remember what the coverage was like.  He hardly went to the doctor so he had just in case.

Right now, we have ACA and the deductibles are high along with the premiums.  I can't wait for DH to get a job that offers health insurance for hopefully better coverage. 

[naughtybear]

What's a state pool? Any examples of cost? So anyone with pre existing conditions just weren't able to purchase individual coverage?

[Deleted]

I have good insurance through work, but I'll be sad to see some of the stuff that goes along with the ACA go away.  Mainly free preventive care.  The last two years I've had almost no out of pocket costs because most of we get done are annual exams, flu shots, mammograms...

[Deleted]

State pools have been almost obliterated I think, and when they existed had like two year wait lists around here anyway. Daughter was on chip because no pre existing condition clauses on chip. That's where we will likely go after finishing out the year on this plan? I'm assuming they can't boot her this year? 

[buystoys]

State pool is where the state of residence (for my folks that was OK) gathers all the people who wouldn't qualify for insurance (usually due to pre-existing conditions) and creates a pool of them for insurance purposes.  So dad was in a group with all the other people in OK who had pre-existing conditions that insurers wouldn't underwrite individually.  He had no waiting list to get onto the state pool when he was on it.  He got put into the state pool because of the severity of his condition.  (He has a disease that is making him go blind and deaf.)  Mom was able to purchase individual insurance for herself without the pool.

One of the pieces of ACA forced insurers to ignore pre-existing conditions, so state pools pretty much disbanded when ACA took effect. 

[Miss Tequila]

Jan 12, 2017 8:45:51 GMT -5 deminmaine said:

Before the ACA everything was all roses and happy songs. It will be again, don't worry.

Simply buy a private insurance policy.  Or, you can self insure.  If you have a medical problem, simply pay the medical costs out of pocket.  That way you don't have to worry about paying pesky premiums.

Of course not. But do you really think everything is all roses and happy songs now? I have a very good income but if I were to become unemployed I honestly couldn't afford the co-pays that come along with obamacare plans...and unfortunately I'm not poor enough to get these major subsidies. So healthcare is no more affordable for me than it was before. The one major bonus is the pre-existing condition is now gone.

Edited....hahaha...I think part of an email if I was typing got pasted into here...I wasn't actually thanking people for reading my post!

[swamp]

I'm pretty sure he was being sarcastic.

[Deleted]

First, I don't think they can just ACA.  Too many people rely on it and the economic consequences (to individuals as well as to providers and taxpayers) of yanking coverage from a huge group of the population would be a disaster.

Anyway- pre-ACA they could also have lifetime caps on what they paid- which you wouldn't know till they stopped paying on your chemo in the middle of it, or whatever.  There was also the nasty practice of "post-claim underwriting".  The sleazier companies would insure you but when you developed something expensive they'd go back through your medical records with a fine-toothed comb and find something you left off the application and say that your policy was void and give you back all your premiums.  One example I read about:  a single mother insured herself and her 3-year old son.  He developed leukemia.  They determined that she hadn't mentioned that she'd been on anti-depressants once years ago, so her application was fraudulent and they had no coverage.

[swamp]

We have some of the best health care facilities, equipment, and personnel in the world. I don't know why anyone expects it to be cheap.

[OldCoyote]

Jan 12, 2017 8:45:51 GMT -5 deminmaine said:

Before the ACA everything was all roses and happy songs. It will be again, don't worry.

Simply buy a private insurance policy.  Or, you can self insure.  If you have a medical problem, simply pay the medical costs out of pocket.  That way you don't have to worry about paying pesky premiums.

I have several friends that do just that, When they go in tell that they will be paying cash, the cost drop a lot!

[Deleted]

Jan 12, 2017 8:58:39 GMT -5 swamp said:

We have some of the best health care facilities, equipment, and personnel in the world. I don't know why anyone expects it to be cheap.

This is true, but I wish they had some cheaper options.  Someone on another thread mentioned a true liability waiver.  Hospitals are so worried about being sued that they're doing everything thing they can to cover their asses including lots of testing.  I just want my migraine meds refilled.  Period.  I need to get a PAP tomorrow to get them, AND my doctor's office called me last week to tell me they scheduled a mammogram for the same time.  All so I can get my damn $15 generic headache meds. 

[swamp]

Jan 12, 2017 9:06:00 GMT -5 minnesotapaintlady said:

Jan 12, 2017 8:58:39 GMT -5 swamp said:

We have some of the best health care facilities, equipment, and personnel in the world. I don't know why anyone expects it to be cheap.

This is true, but I wish they had some cheaper options.  Someone on another thread mentioned a true liability waiver.  Hospitals are so worried about being sued that they're doing everything thing they can to cover their asses including lots of testing.  I just want my migraine meds refilled.  Period.  I need to get a PAP tomorrow to get them, AND my doctor's office called me last week to tell me they scheduled a mammogram for the same time.  All so I can get my damn $15 generic headache meds. 

I agree with you on that. 

[justme]

Jan 12, 2017 9:06:00 GMT -5 minnesotapaintlady said:

Jan 12, 2017 8:58:39 GMT -5 swamp said:

We have some of the best health care facilities, equipment, and personnel in the world. I don't know why anyone expects it to be cheap.

This is true, but I wish they had some cheaper options.  Someone on another thread mentioned a true liability waiver.  Hospitals are so worried about being sued that they're doing everything thing they can to cover their asses including lots of testing.  I just want my migraine meds refilled.  Period.  I need to get a PAP tomorrow to get them, AND my doctor's office called me last week to tell me they scheduled a mammogram for the same time.  All so I can get my damn $15 generic headache meds. 

You mean like gyn pap to get migraine meds?

[Deleted]

Jan 12, 2017 9:33:32 GMT -5 justme said:

You mean like gyn pap to get migraine meds?

Yes!

[Deleted]

Do you see them for any other routine thing? Could your GP prescribe them instead? 

You can refuse a mamogram.

[Deleted]

She was the one that originally prescribed the meds.  I don't have a GP.  I go to the doctor as little as possible. 

I'm worried because I have this lump in my leg.  I should show her, but I'm afraid I'll end up with an MRI too. 

[Mardi Gras Audrey]

Jan 12, 2017 8:23:55 GMT -5 naughtybear said:

What's a state pool? Any examples of cost? So anyone with pre existing conditions just weren't able to purchase individual coverage?

I can give you an example of cost.  I applied for an individual plan in 2010 in CA. They wouldn't approve me under a regular plan but Healthnet offered coverage under the "we don't look at pre-existing conditions" (I don't know if it was the official CA state pool or just what they offered).  It was like $450 a month for one person with a $3k deductible.

I take migraine meds which were pretty pricey (The cash price was around $30 per pill and I usually got 9 per month) and had just gotten some physical therapy done.  I could see why they thought I was a risk.

[Deleted]

Yeah, that's why. They are suppose to see you annually giving meds. If there is no other reason they schedule whatever they do annually. I have one med my gp prescribes, one my gyn, I've been thinking of consolidating so that I am only forced to see one person, lol. Although my gp has gone 18 months, and what do you know my meds were off for months before I realized it, so maybe it's not a horrible thing, sigh. Stil, I think I could just do labs and adjust by phone call, not have to actually go in.

[Deleted]

Jan 12, 2017 9:02:54 GMT -5 OldCoyote said:

I have several friends that do just that, When they go in tell that they will be paying cash, the cost drop a lot!

And how affordable is the cash price for a compound fracture or chemotherapy?

[swamp]

Jan 12, 2017 10:12:18 GMT -5 @athena53 said:

Jan 12, 2017 9:02:54 GMT -5 OldCoyote said:

I have several friends that do just that, When they go in tell that they will be paying cash, the cost drop a lot!

And how affordable is the cash price for a compound fracture or chemotherapy?

I'm not sure, but the local hospital has a few canandians paying cash for chemo. I'll ask.

[hsclassic]

Pre-ACA, DH and I purchased health insurance policies directly. It was a bit more OOP than we paid in our employer-supplied insurance (we retired very early), but manageable. ACA caused our premiums (for effectively the same policy) to be 2.5x our pre-ACA policy.   Yes, there are a couple of things included in an ACA policy at no charge (e.g. annual checkup) that would have been paid OOP (but still at the insurance-company negotiated rate). However, our insurer had started to cover some things that were preventive in nature at no- to little-cost.

Don't get me wrong - I believe that something needs to be done that effectively coveres those with pre-existing conditions. And the program that existed to reimburse hospitals for covering those unable to afford payments should be reinstituted (and probably expanded to include walk-in health clinics).   However, purchasing health insurance should be an option as opposed to mandatory - IMO that would get health insurance premiums back down to a reasonable amount so that other taxpayers do not have to subsidize the rest of us so significantly. Just my $.02.

[giramomma]

Jan 12, 2017 9:02:54 GMT -5 OldCoyote said:

Jan 12, 2017 8:45:51 GMT -5 deminmaine said:

Before the ACA everything was all roses and happy songs. It will be again, don't worry.

Simply buy a private insurance policy.  Or, you can self insure.  If you have a medical problem, simply pay the medical costs out of pocket.  That way you don't have to worry about paying pesky premiums.

I have several friends that do just that, When they go in tell that they will be paying cash, the cost drop a lot!

Around here, costs doesn't drop a lot.

If you pay in cash for the ortho or the dentist, you get a 5% break. That's it. For routine cleanings for the kids, it would be about $8. The ortho makes it worth it. Unfortunately, we didn't have the money to part with when treatment started.

And, then in my city, most places will only take insured folks. There's only two clinics specifically for people who are uninsured. So there's that.

[NomoreDramaQ1015]

Jan 12, 2017 9:02:54 GMT -5 OldCoyote said:

Jan 12, 2017 8:45:51 GMT -5 deminmaine said:

Before the ACA everything was all roses and happy songs. It will be again, don't worry.

Simply buy a private insurance policy.  Or, you can self insure.  If you have a medical problem, simply pay the medical costs out of pocket.  That way you don't have to worry about paying pesky premiums.

I have several friends that do just that, When they go in tell that they will be paying cash, the cost drop a lot!

Not here it doesn't.   If you want to pay in cash you have to pay 100% of the costs UP FRONT.   That's non-insurance adjusted costs too.   

So if DH had wanted to pay cash for his MRI that would have been $5725 at the desk upon sign on  or they would have refused to do the procedure.

Sometimes hospitals will negociate with you rather than put you on a payment plan but it has to be a certain percentage of what you owe as determined by the hospital.  You don't get to set the price.

[Deleted]

Jan 12, 2017 9:11:17 GMT -5 deminmaine said:

The pre-existing condition stipulation was good. Why should I have to subsidize someone else's problem?

I hope you're not serious. The short answer is that insurance is structured so that the many with no or few losses subsidize the misfortune of others. Do you resent "subsidizing" those whose houses burn down every year via your homeowner's insurance?

It can happen to any of us. Despite my being normal weight, active, eating a very high-fiber diet and having no family history of colon cancer, they find polyps every time. One, found 15 years ago, probably would be cancerous by now had they not removed it.

I, OTOH, am not thrilled about subsidizing people who smoke, don't exercise, don't get preventative care and snack on Ho-Hos and pork rinds.

[emma1420]

Pre-ACA when I was unemployed I went uninsured as I had a pre-existing condition and I couldn't afford the premiums.  

And the state pools were collapsing even before the ACA were introduced.  The health insurance companies couldn't adsorb that level of risk.

[emma1420]

Jan 12, 2017 10:58:29 GMT -5 @athena53 said:

Jan 12, 2017 9:11:17 GMT -5 deminmaine said:

The pre-existing condition stipulation was good. Why should I have to subsidize someone else's problem?

I hope you're not serious. The short answer is that insurance is structured so that the many with no or few losses subsidize the misfortune of others. Do you resent "subsidizing" those whose houses burn down every year via your homeowner's insurance?

It can happen to any of us. Despite my being normal weight, active, eating a very high-fiber diet and having no family history of colon cancer, they find polyps every time. One, found 15 years ago, probably would be cancerous by now had they not removed it.

I, OTOH, am not thrilled about subsidizing people who smoke, don't exercise, don't get preventative care and snack on Ho-Hos and pork rinds.

ICAM about this.   

One of the things I liked the most about the ACA was that preventive care didn't have co-pays.   And that there was a provision in the bill for health outcomes, which I personally thought was important as the model is now fee-for-service and so financially rewards physicians for conducting unnecessary tests and procedures.

I believe whatever the GOP comes up with next needs to include preventive care with no co-pays, no lifetime caps, and inability to discriminate against pre-existing conditions.

[The Walk of the Penguin Mich]

Jan 12, 2017 10:00:58 GMT -5 oped said:

Yeah, that's why. They are suppose to see you annually giving meds. If there is no other reason they schedule whatever they do annually. I have one med my gp prescribes, one my gyn, I've been thinking of consolidating so that I am only forced to see one person, lol. Although my gp has gone 18 months, and what do you know my meds were off for months before I realized it, so maybe it's not a horrible thing, sigh. Stil, I think I could just do labs and adjust by phone call, not have to actually go in.

Exactly.  I have no need to see my doctor.  I'm healthy, my BP is under control and everything is good.  But I need to put in some face time so I can get meds for another year.

[The Walk of the Penguin Mich]

Jan 12, 2017 11:15:41 GMT -5 emma1420 said:

Jan 12, 2017 10:58:29 GMT -5 @athena53 said:

I hope you're not serious. The short answer is that insurance is structured so that the many with no or few losses subsidize the misfortune of others. Do you resent "subsidizing" those whose houses burn down every year via your homeowner's insurance?

It can happen to any of us. Despite my being normal weight, active, eating a very high-fiber diet and having no family history of colon cancer, they find polyps every time. One, found 15 years ago, probably would be cancerous by now had they not removed it.

I, OTOH, am not thrilled about subsidizing people who smoke, don't exercise, don't get preventative care and snack on Ho-Hos and pork rinds.

ICAM about this.   

One of the things I liked the most about the ACA was that preventive care didn't have co-pays.   And that there was a provision in the bill for health outcomes, which I personally thought was important as the model is now fee-for-service and so financially rewards physicians for conducting unnecessary tests and procedures.

I believe whatever the GOP comes up with next needs to include preventive care with no co-pays, no lifetime caps, and inability to discriminate against pre-existing conditions.

The problem is that the GOP has had 8 years to come up with a plan to replace the ACA, and have not.  What makes you think that they will have a replacement next month....or even next year?

The fact that they just repealed the pre-existing exclusions last night is scary as shit, because there is NOTHING waiting in the wings.