Posted on 10/05/2012 1:18:09 PM PDT by pgyanke
“No. 1,” declared Mitt Romney in Wednesday’s debate, “pre-existing conditions are covered under my plan.” No, they aren’t — as Mr. Romney’s own advisers have conceded in the past, and did again after the debate.
(Excerpt) Read more at nytimes.com ...
In Maryland, the state has established high risk pools for folks with chronic illness who are otherwise difficult to insure.
If I sold my business, I'd no longer have group health insurance. But because my son had a brain tumor when he was 10, it would be very difficult to get individual insurance for my family. However, through Maryland's high risk pool coverage, I could get insurance for about $1,000 per month, with a $1,200 annual deductible, modest co-pays, use-any-doctor-or-provider, good prescription coverage.
I do okay, income-wise, so I wouldn't be eligible for premium assistance, but for lower-income families, the state will also pay part of the premium.
Gov. Romney's plan explicitly includes state-run high risk pools as part of his plan.
And no one is forced by law to buy insurance they don't want.
sitetest
You're right. I elided that in my answer as I'm prone to providing more detail than most folks really want to know.
The idea of HIPAA is, “You play by the rules (keep pretty much continuous coverage), you don't get screwed.”
sitetest
Alright. So help me understand why FR hates RomneyCare. Could you direct me to a website where I can get realistic information?
“Saying that Romney doesn’t have a good, detailed plan is not being dishonest.”
Yes it is. It is an absolute LIE to say that Gov. Romney doesn't have a good, detailed plan.
I've heard both Gov. Romney and Rep. Ryan talk about state-run high risk pools. It's RIGHT ON THEIR WEBSITE. It took me TWO, count ‘em, TWO clicks to find the information.
Do they dwell on it when speaking publicly? Of course not. It's wonkishness, and most folks’ eyes glaze over when candidates get wonkish. Most folks wouldn't even understand it if they mentioned it. Or the other parts of their solutions, including reinsurance and risk adjustment.
Unfortunately, most voters just won't listen to explanations of what they view as technical subjects.
So, Gov. Romney says, “We have a plan to take care of pre-existing conditions.” Occasionally, the words “high-risk pool” will escape his mouth.
If you want to know more, go to the website.
“We can’t find the information! It’s buried under so much background noise that it’s hard to even tell fact from fiction.”
Bullshit.
It's two clicks into his website.
Anyone who wanted to know but didn't know is either stupid or lazy.
But the average voter has an excuse: the average voter IS stupid or lazy. Or both.
The folks who have no excuse are the folks like the Kenyan anti-Christ regime and campaign. Or Paul Krugman. Or all the other talking heads who tell this lie. They actually get PAID to click twice on a website to see what the candidates are saying.
sitetest
What does RomneyCare have to with state-run high risk pools?
I'm not aware that Massachusetts has a high risk pool.
I already gave you a link to the information that I presented. It's a page on Gov. Romney's campaign website.
It's not a terribly-difficult website to navigate. If you'd like information on his policies and programs, just browse it.
sitetest
If I sold my business, I'd no longer have group health insurance. But because my son had a brain tumor when he was 10, it would be very difficult to get individual insurance for my family. However, through Maryland's high risk pool coverage, I could get insurance for about $1,000 per month, with a $1,200 annual deductible, modest co-pays, use-any-doctor-or-provider, good prescription coverage.
I do okay, income-wise, so I wouldn't be eligible for premium assistance, but for lower-income families, the state will also pay part of the premium.
MHIP? I used to work in COBRA administration in Maryland. I used to get calls from folks who’s 18 months of COBRA coverage was about to run out. Some of these people had serious on-going health problems, were still unemployed through no fault of their own and could not afford a traditional individual policy and some of the stories were heartbreaking (I’m thinking of the call I got from the mother with a four year old child who had leukemia and the widow who was about 12 months from being eligible for Medicare), I would refer such people to the MHIP program. While a “state” program, subsidized by state and federal funds, I believe the coverage is actually provided through CareFirst BCBS.
I misunderstood your point. I honestly asked for clarification - I was listening to you - and you do nothing more than insult and swear at me.
You are a bad human being and I am done with you.
BTW, I WENT to the RR website for my mom last week to address this very issue and all I could find was the ‘continuous coverage’ point.
Yes, coverage is through CareFirst, which is a pretty decent insurance company, as insurance companies go.
Ironically, if I were to drop my group insurance, I'd be eligible for MHIP, my premiums would be LOWER, and my benefits BETTER.
It's often tempting.
sitetest
It was the Texas COBRA program that said that my son would have to pay $3000 a month for the program - even if he were completely broke and unemployed. No word of state subsidies or help of any kind.
“I misunderstood your point.”
I'm not sure which point you misunderstood.
“I honestly asked for clarification - I was listening to you - and you do nothing more than insult and swear at me.”
Sorry. It can't be helped. When I see nonsense like this, I'm gonna say what I think:
“Saying that Romney doesn’t have a good, detailed plan is not being dishonest.”
Yes, it's being dishonest. It's a blatant lie. Folks will either know it's not true, or have constructive knowledge that it's not true. That makes it always and everywhere a lie.
“You are a bad human being...”
Could be. ;-)
“BTW, I WENT to the RR website for my mom last week to address this very issue and all I could find was the ‘continuous coverage’ point.”
I've been hearing Gov. Romney talk about this stuff for a while. It's on his website. It took two clicks to find it. I can imagine that if you didn't go to the right link right away, it might have taken four clicks. Or five clicks.
But it's not a very complicated website. If you couldn't find it, well...
sitetest
Interestingly, if one didn’t want to work through two or four or five clicks on his website, if one googles on “romney health care,” the page on the governor’s website that describes his policy position comes up as the seventh result, and the URL listed by google is:
www.mittromney.com/issues/health-care
Which is kinda obvious.
thanks!
You know what’s really strange? Insulting someone and swearing at them really makes it hard for them to hear anything else you have to say. Sharing further information with the addition of another insult really doesn’t help the situation.
In addition, you never address MD Expat in PA’s point about this not being an effective system for the situations being described on this thread.
It was the state high-risk pool that quoted my 19 year old, single, childless son $3000 a month. No subsidies. No help to manage that amount. Just pay it or you lose ‘continuous coverage’.
I will see what updates are at the RR website, but if this is his solution, it’s not a feasible one.
I think you are misunderstanding what COBRA is. COBRA is not a premium reduction plan or a “program” to provide subsidized insurance to people who cannot otherwise afford coverage. COBRA simply allows for former employees and dependents of formerly insured employees who lose coverage because they are not longer employed, to continue on their employer’s group health plan, an employer with 20 or more employees, to elect to continue that very same coverage on the group plan for a limited time – 18 months and in the case of loss of coverage due to divorce or loss of dependent status for 36 months (some other rules apply but I won’t get into all that minutia).
Under COBRA, the COBRA participant pays the full monthly premium and often a 2% administrative fee as allowed by law, – the very same premium BTW that the employer pays for that very same coverage and coverage level and not what the employee’s share is or the employer’s share is, but what the insurance company bills to the employer for that coverage. I found a lot of people signing up for COBRA were shocked by the monthly premium as they were expecting to pay the same as what was deducted from their paycheck. But what they didn’t consider was that the employer was paying a good portion of that monthly premium, 70, 80 or 90 percent in most cases.
COBRA coverage is often cheaper, as it is a group plan with lower rates because of a larger risk pool, but is not always necessarily cheaper than obtaining individual coverage; it all depends on the size and rates the employer gets from the insurance company.
Also COBRA coverage is contingent on the employer maintaining the group health plan. If an employer’s plan is cancelled due to non-payment or they go out of business and terminate the group health plan, COBRA participants lose their coverage even if they have been paying their COBRA premiums. Also if the employer makes changes to their group health insurance, drops or adds plans, gets a rate increase, increases deductibles, etc. at renewal, COBRA participants are subject to those same changes just as active employee’s are – COBRA participants also have the right to make changes to coverage at open enrollment – add, drop dependents, switch from an PPO to an HMO if offered, just as can active employees.
“You know what’s really strange? Insulting someone and swearing at them really makes it hard for them to hear anything else you have to say.”
Could be. But sometimes, the truth must be told.
It is a blatant lie to say that Gov. Romney hasn't spelled out an answer to this question.
“In addition, you never address MD Expat in PA’s point about this not being an effective system for the situations being described on this thread.”
I didn't notice such a point being made by MD Expat in PA.
“It was the state high-risk pool that quoted my 19 year old, single, childless son $3000 a month. No subsidies. No help to manage that amount. Just pay it or you lose ‘continuous coverage’.”
I'm not crazy about dealing with posters’ specific “circumstances,” since I'm never assured of getting the actual facts. Your posts about your son seem a little fuzzy.
First you say:
“If there’s a gap in my son’s insurance, the great state of Texas said that he could join the state insurance while he looked for work...
“if he paid $3000 a MONTH.”
That's interesting. I looked at Texas’ high risk pool website, and found that the maximum premium for a 19 year-old male was something over $700 per month. With an annual deductible of $1,000. For a smoker. I then looked at the rate with a $5,000 annual deductible (roughly the deductible we have on my own insurance for myself and my employees). That was $400 per month.
I'm not sure to what you're actually referring. Which might make sense, because then you respond to another post by saying:
“It was the Texas COBRA program that said that my son would have to pay $3000 a month for the program...”
COBRA is different from state-run high risk pools. I can readily believe that a COBRA policy may have run $3,000 per month. But that's not a high risk pool policy, that's an extension of a group policy after one leaves one’s job.
I've never personally seen a rate that high, but I've seen 'em at $2K or so per month. But that rate applies to everyone who uses the COBRA option, not just to folks who have pre-existing conditions. I know that the COBRA rate on my own company's policy would be nearly $2,000 per month. But that would apply to everyone who left my employ. If I opted for COBRA coverage. Which I don't.
As well, I looked at the Texas high risk pool website, and it was quite explicit that a 50% discount is offered to folks under 200% of the poverty level, and a 30% discount to folks under 300% of the poverty level.
Again, from what you posted, I'm thinking that maybe you weren't dealing with Texas’ high risk pool insurance but rather with COBRA. Which is a whole different ball of wax.
Like I said, I dislike getting into folks’ specific situations, in part because it's tough to ascertain the actual facts of their circumstances, and I have no independent knowledge by which to check what folks report.
“I will see what updates are at the RR website, but if this is his solution, it’s not a feasible one.”
If you'd have read the page, or heck, if you'd have just read what I actually POSTED on this thread, you'd note that his proposals include assistance for the uninsured, including subsidies:
“- Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies”
Finally, I'm pretty familiar with Maryland's high risk pool. Why? I live in Maryland, I work in Maryland, I own a business in Maryland. All the info I'm getting about Texas, I'm getting off the web, without any consultation with anyone who really knows the ins and outs of Texas' program. If Texas' program has inadequacies, if folks think that Texas' program doesn't do enough, then, guess what? That's a TEXAS problem, and should be addressed by the TEXAS legislature, not the federal government.
That is part of Gov. Romney's views, too, that each state should craft the solutions acceptable to the citizens of that state, that the federal government shouldn't impose a one-size-fits-all solution on the whole country.
That's called "federalism." I'd think any conservative would be in favor of that.
sitetest
I'd have to go look at my paperwork, but I thought that the rates folks would be offered under COBRA if they left my employ were actually higher than the premiums I'm paying. And the benefits were less generous.
I wonder whether our high-deductible HSA plan complicates the matter.
sitetest
You do realize that everything you’re citing now is after many of the changes that ObamaCare has brought in?
That only NOW are pre-existing conditions covered that were acquired before the person turned 19?
That I’m talking about what we had BEFORE ObamaCare?
That COBRA and high-risk pools are now better federally subsidized AT THIS TIME?
Everything that I’ve been talking about is from the years of desperate research I’ve been doing to better prepare my son for his life as a chronically ill adult.
Long stretches of unemployment and loss of coverage because he’s too sick to work, but it’s not permanent enough to qualify him for disability. Health insurance that makes you wait months or even years before they’ll cover pre-existing conditions. Adults who can’t get insurance because of a birth defect that was corrected or an illness that they beat as a child.
These are the realities.
So you can do all the research you want, but you won’t be addressing the basic question: “Once we repeal ObamaCare, what are we going to do to address these very real problems? What do we put in it’s place?”
And I’m not even getting into the issue of the single adult man who loses his job, has a heart attack and can’t get coverage once he recovers and tries to get back on his feet.
Do NOT think that I’m arguing for ObamaCare. I think that it’s a horrible plan. But there were problems that have been addressed by it.
To give you an idea of how bad it was in Texas, the Texas Health Insurance Risk Pool (for high-risk individuals) has only had 90,000 people enrolled since it’s inception in 1997.
More than 23,000 of those people were added to the rolls IN JUST THE LAST MONTH.
I wonder whether our high-deductible HSA plan complicates the matter.
Under COBRA, someone electing COBRA coverage elects to continue with the group plan and exactly the same plan with the very same benefits, the same deductibles and co-pays, the same provider network, etc. as they had while employed and insured under the group plan. At the time they elect COBRA, they can drop dependents (i.e. if they have EE+spouse coverage, they could elect to take EE only coverage but then the spouse has individual COBRA election rights). Employers and insurers cannot reduce benefits to COBRA participants unless they make changes to the group plan as a whole at renewal and those changes effects all members covered under the group plan. Employers, if they self administer COBRA or third party COBRA administrators if the employer outsources, are allowed to charge a maximum of 2% of the monthly premium as an administrative fee but they cannot charge COBRA participants any more than that – premium + 2%.
For employers who are “self insured” the premium charged to the COBRA participant is the “COBRA equivalent rate” which could be higher than what the employer actually pays per month in admin fees and stop gap insurance but when factoring in claims history, it usually ends up pretty close to what one would pay for the same coverage under COBRA as with a fully insured plan.
Unlike an HRA (which is a whole other ball of wax), when an employee with an HSA terminates, there is no right to COBRA on the HSA. The money in the HSA fund at the time of termination however belongs to the employee. An employee with a HSA can pay COBRA premiums with their HSA funds but this has no bearing on the cost of premiums or on the employer.
“You do realize that everything you’re citing now is after many of the changes that ObamaCare has brought in?”
No, wrong. Texas’ high risk pool has been in business since the late 1990s. HIPAA (which started the ball rolling toward portability of coverage) was passed in 1996. HIPAA provided that anyone with continuous coverage (or with a break of 63 days or less) could not be excluded for pre-existing conditions, or subject to a waiting period.
“That COBRA and high-risk pools are now better federally subsidized AT THIS TIME?”
I don't think COBRA is federally-subsidized. State-run high risk pools have generally been subsidized, either by in-state insurance companies, or directly by the state government. That's part and parcel of the high risk pools. Part of the original concept.
I understand your difficulties and am sympathetic, but frankly, most of what you're posting just isn't true, or is badly distorted.
COBRA has been around for decades, HIPAA (which is first and foremost about health insurance policy portability - that's what the "P" in HIPAA stands for) for nearly 20 years, and subsidized high risk pools since at least the ‘90s.
Even WITH HIPAA, it's been tough for folks who aren't continuously employed, that's true.
However, if you would ACTUALLY READ Gov. Romney's website, greater insurance policy portability is ALSO addressed by Gov. Romney's proposals. He has a number of policy points that play into this issue, but two key ones are:
“- End tax discrimination against the individual purchase of insurance
“- Allow consumers to purchase insurance across state lines”
Sen. McCain also proposed these in 2008. The Kenyan anti-Christ badly, knowingly lied about the first point, and Sen. McCain didn't respond adequately to all the lies. But it is truly key in separating out employment from health insurance, and permitting true portability of health insurance.
Frankly, having had to follow this issue fairly closely for nearly 30 years, and having someone in my family who would generally be “uninsurable,” I'm fairly pleased Gov. Romney's health care proposals. As any conservative would be, who took the time to actually read his website’s page on the issue.
sitetest
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