Democrats & Liberals Archives

Lawyers with Pre-existing Conditions

Now that we passed a healthcare reform law, it’s time for lawyers in the insurance industry to do their thing - which is, “interpret” the law. And they are attacking this task with relish. Never mind that those who wrote the law and those who argued the law and those who passed the law are all here. Insurance-industry lawyers have a different “interpretation” because they have pre-existing conditions to protect.

The New York Times reports:

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”

I don't know what Schiffbauer means by "the fine print." The whole bill is printed the way all such bills are printed. "Fine print" is something insurance companies have bestowed on us for the simple purpose of preventing us from "interpreting" what they promise to do and to not do. Maybe they would like it otherwise, but there is no "fine print" in the healthcare reform law.

Contrary to what all those people involved in the production of the legislation have told us, Schiffbauer insists that an insurance company "does not have to sell to somebody with a pre-existing condition." So there. You can write whatever you want into the law. But smart insurance lawyers like me know how to "interpret" the "fine print" properly.

This is another horrible example of the way insurance companies treat Americans, another example of their cruel antagonism toward the sick, another example of a thoroughly selfish industry - another example why healthcare reform is needed. Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, said:

The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.

Healthcare reform has not yet been won. We won the first battle in Congress. Now we have to fight the next battle in court against insurance lawyers with pre-existing conditions.

Update: The health industry has since decided to conform to whatever regulations the government enacts. That's a small ray of sunshine.

Posted by Paul Siegel at March 30, 2010 2:39 PM
Comment #298221

Even the auto insurance ind. has high risk policies which cost more. It may not seem fair but how long do you think an insurance co would stay in business before they would go belly up. I have a grandson that was born with a heart deffect and has had two surgeries already and he is only six to the tune of a half million dollars and needs more. It sucks but I can understand where the insurance co.s stand. I can understand paying more for a policy when I have a child or an adult with a preexisting condition.

Posted by: MAG at March 30, 2010 4:11 PM
Comment #298222

I think that the regulators might have something to say about those outrageous statements. From what I understand a lot details like that one will be handled on the enforcement end. I’m not sure how that exactly works.

I didn’t expect those rats to give up easily.

Posted by: tcsned at March 30, 2010 4:18 PM
Comment #298223

MAG - where does it end? Do you think that these companies should have unlimited rights to jack rates as high as they see fit? That is what they have been doing. Now they jack up a sick person’s rates so high that they cannot afford coverage so they go away. In the process of dumping them they squeeze a few more dollars out of them. Then these same people get denied coverage by every other company because of a pre-existing condition. It may be profitable but is is immoral and that should count for something too. What healthy people pay for coverage is probably about where someone with a serious illness should be paying. What someone with a serious illness is paying is something that no one should have to pay.

Posted by: tcsned at March 30, 2010 4:27 PM
Comment #298227

Do you think it’s fair for a healthy person to pay the same rates that a person with a preexisting condition that uses that policy 10 times more often at higher medical costs? All I’m saying is that we have high risk in the auto ins. ind. the same should apply to Health Care.

Posted by: MAG at March 30, 2010 5:20 PM
Comment #298228

I would say that within reason that is ok. But it is not now anywhere near within reason. I have a friend who has had cancer and pays now close to $1,000 a month. His wife, who is healthy pays about $600 a month. That is almost 20k a year for insurance which, when he got sick also hit him for more than 10k out of pocket expenses. His policy was about $300 a month before he got sick. He can’t get coverage through another carrier at all that will cover any type of cancer. He is paying close to 50% of his income on health insurance. Are you telling me that is just? or reasonable?

Posted by: tcsned at March 30, 2010 5:43 PM
Comment #298231

tcsned, No it is not just. Reasonable that could be debated depending on where you live. I know between N.Y. and Calif. ins. rates are ridiculous even for a healthy person. The high risk pools could be an answer or selling across state lines. Even with Obamacare the answers aren’t there.

Posted by: MAG at March 30, 2010 6:16 PM
Comment #298239

“Do you think it’s fair for a healthy person to pay the same rates that a person with a preexisting condition that uses that policy 10 times more often at higher medical costs?”

Yes, I do. We are all mortal. We will all experience a catastrophic health condition. For some, it will be a short term event. Unfortunately, for others it will be an extended problem. But it will always occur. I think that it is only reasonable that we recognize that reality and equally share the risk across the population pool.

Posted by: Rich at March 30, 2010 6:49 PM
Comment #298242

Let me pose a hypothetical. Suppose we have an insurance pool of 100 persons, which for my purposes represents every single American.

This pool collects $10K per year from each of the hundred or $1 million regardless of their age or health. For the sake of clarity let’s assume there are no insurance administration costs or profits and the entire $1 million is available for benefits among the pool.

If one person requires $1 million of care in any given year there are no benefits remaining for the other 99 persons. If 3 persons each require $500K of care the insurance pool is short of funds and must raise premiums by $500K. Now, everyone will have to pay an annual premium of $15K to restore the fund.

At what point will those who require no benefit in a given year tolerate the probability of substantial premium increases to pay for those who are using huge benefit amounts?

As MAG asked in his post…Do you think this is fair?

Posted by: Royal Flush at March 30, 2010 7:32 PM
Comment #298246

Health insurance lawyers helped write this legislation. They know where all the loopholes are. This is the standard that politicians work with.

Posted by: jlw at March 30, 2010 8:32 PM
Comment #298249

Royal Flush,

If there is a point at which, we as a society are unwilling to pay a pro-rata share of another American’s unfortunate health problems, then it is time to formally institute death panels. The alternatives are clear, either we pay for it through private insurance premiums, pass the cost onto the general tax payer or let the person die.

Posted by: Rich at March 30, 2010 8:54 PM
Comment #298260

High risk pools, besides tax payers are going to pay for it anyway. We have been paying for it through medicare and medicaid or have you forgotten about them and you want more entitlements.

Posted by: MAG at March 30, 2010 9:46 PM
Comment #298273

There are some states that even allow being a victim of domestic violence as a “pre-existing” condition for insurance carriers. Now THAT is unfair. Remember that insurance companies do NOT provide health care,not so much as one band aid. In order to increase profits they have set up large departments for the express purpose of denying claims. This in turn has led to care providers to set up their own departments to fight these denials. All this has led to a great deal of litigation and paperwork at the expense of rate payers.

Your scenario is too small to reflect the HC system.
Another point,those who require no care for the year have no garentee that they will not need a good deal of care next year. They can be pretty sure that at some point they will need a good deal of care. That is why its called insurance.

IMO, It was a mistake to keep the insurance companies involved at all. They do not provide HC. They have no interest in cost control so long as they can pass the cost onto consumers. Sure it was politically expedient but still,having them involved in reform is like asking the local burgler over to discuss home security.

Posted by: bills at March 31, 2010 6:54 AM
Comment #298276

Neither does the GOVERNMENT.

Posted by: MAG at March 31, 2010 8:37 AM
Comment #298278

Not so. There are thousands of government care providers. In the VA for one. Public hospitals, prisons,the military. I do not know why you feel that is pertinent,but it is not so.

Posted by: bills at March 31, 2010 8:55 AM
Comment #298282

Public hospitals still ask for your Ins. at least the one here in my town does and the care there is more expensive then the private hospitals. The VA here wants a co pay in some cases. The prisons and military are really the only government run health care providers. In the private sector the government has no business being there other then to regulate. Medicare and medicade are good examples of why government should stay out of health care.

Posted by: MAG at March 31, 2010 9:44 AM
Comment #298284

Whoa, because the VA wants a co-pay for some services does not mean the doctors there do not work for the government. As for medicare, it has been a Godsend for my family in caring for my 87 yo. mother.The program needs to be made cost efficient for sure. The CBO estimates project the HCR law as helping do that.
The HCR law is primarily a consumer protection measure. It is the regulation you speak of as a legitimet government function.

FYI The government has long been involved with HC. Adams signed the first law setting up hospitals and care for private,merchant mariners in 1798. The law also collected a mandatory 20 cents a month from the sailors.

Posted by: bills at March 31, 2010 10:08 AM
Comment #298286

bills, Medicare and Medicaid are good programs and need repair. So why start a whole new entitlement? Yes, the doctors get paid by the government to provide services but they are on part time at most of the VA hospitals. You are right about the CBO, if and that’s a big if they were given all the facts and that is debatable.

Posted by: MAG at March 31, 2010 10:31 AM
Comment #298299

bills wrote; “RF Your scenario is too small to reflect the HC system.”

Pick any number scenario you wish to reflect the actual larger numbers and the premise remains the same.

Without underwriting insurance premiums to reflect the very real risk of health history or age, it becomes just a huge socialistic scheme. At some point the healthy will either revolt by refusing to pay ever increasing premiums or benefits will be reduced to reflect ever increasing costs.

If one considers the low cost to me, and others receiving Medicare, they must know that my premiums are being subsidized by million of workers not yet on Medicare.

This scheme allows the few (those on Medicare) to be subsidized by the many. Should national health care ever be realized it will be different; with the many not having any others to subsidize them. One could then argue that the rich could then be forced to subsidize the majority however that brings us back to underwriting…but in this scheme, we would underwrite policies for wealth, not age or health.

I read the London Times nearly every day and it is common to find articles that speak to the reduction of benefits and ever increasing scarcity of care in their NHS system.

If one adds up the cost of all care provided under a national care system and divides by the number of persons contributing to the premium pool one finds the cost per individual. As the benefit pool is enlarged it can only be paid for by enlaraging the premium pool. The socialist would keep everyone’s premium and benefit equal. Without underwriting, this can only be accomplished by increasing premium or reducing benefit.

Some speak of fairness in our health care system. Consider for a moment how our nation delivers and pays for “long-term care”. The wealthy can self insure or purchase LTCi (Long-term care insurance) The average American can purchase LTCi (which I and my wife did when in our late 50’s) or go without insurance. The low income and poverty level American’s must rely upon Medicaid. Medicaid provisions for long-term care is means tested. Those with means beyond Medicaid limits must provide for their own care. Those with assets beyond Medicaid limits must first “spend down” those assets to set levels before they can qualify for Medicaid LTC.

There is a huge difference in the care setting between self-insured, insured, and Medicaid. Visit a few nursing homes and compare the difference in staff, setting and care. You might be unpleasantly surprised.

Is this fair? Why should the poor or those without private insurance have to spend down their assets or spend nealry all their income to pay for their care?

Answer: Both Medicare and Medicaid are already deep in the red in unfunded liability. Adding all American’s to either program would only speed up the bankruptcy of both. There is no free ride and a socialist solution to the problem of both health care and long-term care is doomed to eventual failure.

Posted by: Royal Flush at March 31, 2010 3:14 PM
Comment #298302

In line with what i wrote about long-term care…here is a short quote from an article in today’s London Times.

“The NHS was created because the great mass of the population could not afford to see doctors or seek treatment, not anyway without sacrificing money they needed to support their families. That is not so for long-term care today. More than half those in receipt of care, the poorer half, are already paid for in full by the state. It is ironic that just as some experts are doubting whether the NHS can be sustained completely free at the point of use, this Government is proposing a brand new burden on taxpayers to pay for free care.”

Posted by: Royal Flush at March 31, 2010 4:47 PM
Comment #298305

CBO estimates that enacting all three pieces of legislation (the amendment to H.R. 4872), the Senate-passed health bill (H.R. 3590) and the Medicare Physicians Payment Reform Act of 2009 (H.R. 3961), would add $59 billion to budget deficits over the 2010-2019 period.

Rather than cut the deficit by $1 trillion over two decades as Obama claims, the full health care package increases the deficit by $59 billion over one decade. The CBO only does budget estimates for 10-year periods.

CBO estimates spending for new bureaucracies to carry out the HC bill will lead to “at least $50 billion” in new spending over 10 years that was not included in the health care bill itself.

The CBO did include in its analysis of the health care bill $53 billion in new Social Security tax revenues it believed would come to the government when employers drop expensive health care plans that will be subject to a new federal tax and use some of the money saved on premiums to pay their employees higher salaries that will be subject to higher payroll taxes. The problem with counting this $53 billion in Social Security tax revenue against expenditures in Obama’s health care plan is that Social Security is already in deficit and faces a multitrillion dollar long-term shortfall.

CBO says his fiscal 2011 budget proposal will increase the national debt by $9.8 trillion over the next 10 years. He is running a record $1.5 trillion deficit this year, and the smallest deficit he will ever run is $724 billion in 2014 — the year his individual insurance mandate kicks in.

Posted by: Royal Flush at March 31, 2010 6:23 PM
Comment #298313

HR 3961 is not part of the health care reform package.

Posted by: Warped Reality at March 31, 2010 9:21 PM
Comment #298344

The Democratic Party has disconnected itself from the average American’s sense of political modesty. The party’s members and theorists now defend expanding government authority with the same arrogance that brought Progressive Era reforms down upon untethered industrial interests.

In such times, this country has an honored tradition of changing direction. That time may be arriving.

Faced with corporate writedowns in response to the reality of Congress’s new health plan, an apoplectic Congressman Henry Waxman commanded his economic vassals to appear before him in Washington.

Faced with a challenge to his vision last week, President Obama laughingly replied to these people: “Go for it.”

They will!

Posted by: Royal Flush at April 1, 2010 2:09 PM
Comment #298347

Royal Flush-
You won’t save a dime here by nixing the Medicare Physicians Payment Reform Act, because while all things equal, we’d be spending less if we didn’t pass it, but it wouldn’t count anything towards lowering the Deficit.

How’s that work, you ask?

Sometime around 1997, the Republicans thought it would be a good idea to save taxpayers money by pushing the Medicare compensation for Doctors below market value. They were too successful, and found that many doctors would simply abandon the program if they were so seriously underpaid.

So, being the brave political souls that they were, every year after that, they passed a “doc fix.” They kept the expenditure off the budget, but it was being spent anyways.

Keeping this going would not affect what we were spending one way or another. It would only affect the nominal amounts of spending in the budget. But you and I both know, it’s what we actually spend that counts, not what we pretend we’re spending.

So, in essence, Representative Ryan has told you and people like you that he was going to save you money that was never actually going to get saved. Essentially, his Party has lied to you for the last decade and a half that this item was off the budget, and now he’s going to blast the Democrats for having the honesty and guts to be transparent about what we were actually spending.

But worse yet, he adds the cost of this permanent fix to a budgetary problem that wasn’t going away to Healthcare Reform. He included irrelevant information about the cost of the Healthcare Reform Bill, as submitted, with its changes, and by doing so lied to you.

Got that? You’re being lied to. You were being lied to about the budget, about this item and more, while your folks were in power, by people who wanted to look better than they actually were at saving you money.

If you are glad to be lied to, if it makes you do backflips of joy, please, go on quoting Ryan’s numbers.

As for Repeal? The trouble is, the Healthcare Reform Bill is a political minefield for Republicans Want to fight for the right of insurers to knock people out of contention for individual insurance over their pre-existing conditions? Want to enable Scrooge Insurance to kick Tiny Tim off his parent’s policies, due to his pre-exising condition?

48% of people polled, when they heard about the passage of the Healthcare Reform bill, said it was a good first step.

There’s a market for what we’re selling, and Republicans know it. That’s why it’s going to be difficult for the Republicans in the coming elections. Tea Partisans are going to push for full repeal. But Democrats can push from the other side on the positive benefits that people will lose in the repeal, making that a political liability.

The Democrats have them on the horns of a dilemma, especially since Republicans really failed to bargain in good faith. They can’t claim credit for bills that they voted against on a party line. They can say it was their idea (in fact, much of the bill WAS their idea), but their unthinking obstructionism required them to even shoot their own darlings, in opposing the Healthcare Reform effort.

So, they have a lot of difficult explaining to do, and that is not a strong point from which to campaign. Democrats can campaign on what they have done, Republicans can neither wholeheartedly campaign for nor against it.

Posted by: Stephen Daugherty at April 1, 2010 3:34 PM
Comment #298359


Yes they can, and yes they will…they will lie, then lie some more, then lie again, until Americans are so confused…blah…blah…blah. And, they can now depend on unlimited corporate funds to enhance those lies…thank you Supreme Court.

Posted by: Marysdude at April 1, 2010 7:40 PM
Comment #298386


Atlanta freeway billboards are already filling up with anti-Obama trash. I don’t suppose this has anything to do with the Supreme’s ‘corporate as citizen’ finding?

Posted by: Marysdude at April 2, 2010 1:36 PM
Comment #298387


Conservative dumbing down and trashing of everything American, continues non-stop.

I wonder what will be left when they’ve had their way…three billionaires and masses living in squaller?

Posted by: Marysdude at April 2, 2010 1:39 PM
Comment #303004

I have worked and paid into health insurance for a little over 40 years with no major claims of my own. However, I have a 24 year old daughter who has multiple severe health problems. Her health care costs have been about $600,000 per year for the past 9 years. As she approaches 25 the rules of her policy will have it terminate in Nov. Without affordable health insurance. Her drugs alone cost in excess of $20,000 per month. Without some solution she will die. Even with the stop gap high risk pool the 6 months of no insurance will impoverish my family or kill my daughter. There are many thousands of hardworking families that are in our situation. You will excuse me if I feel that my daughter’s life should be worth more to this society than a wealthy persons 2nd luxury car or third home or second country club membership. There is no pool of covered individuals that will be sufficient other than the entire population. More than enough financial capacity exists in our spending for cosmetics and luxury items not to mention the DOD.

The pandering of the GOP to the racism and intolerance of the right is a greater threat to America and the world than al Qaida could hope to be.

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Comment #348993

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