About: Insurability, Accessibility, Portability and Pre-existing Conditions.
We don’t need a Federal Government-run health care system. What we do need is a National Insurance Mandate to impose smart regulations concerning issues related to insurability, accessibility and pre-existing conditions clauses. These issues are addressed below:
I. We need to eliminate the difference the difference between commercial coverage and individual coverage.
II. Insurability & Portability:
a. Commercial Coverage ("GI GR"): In most states health care through your employer is guaranteed issue, at guaranteed rate ("GI GR"). However many businesses do not offer health care and many people try to secure an individual policy. Individual policies are not guaranteed issue at guaranteed rate ("GI GR"). If a single health care company were to immediately open the door and provide "GI GR" to individuals, that company would be flooded with new business. The newly insured’s often consist of:
1. Persons who were denied coverage due to existing health conditions.
2. Persons who could not afford rated policies and forgo health services due to cost.
The result would be that the health care provider would experience tremendous health care cost and would go out of business. This is not speculation. This has already happened and on numerous occasions in numerous states to numerous commercial carriers. Kaiser Permanente completely withdrew from doing any business in the State of
Connecticut in 1999 for exactly this reason. All of Kaiser’s Connecticut customers were required to find new health care providers; Kaiser Permanente did assist its’ insured’s in securing new coverage.
The solution is a national mandate that specifies all providers of individual policies in all States must provide a guaranteed issue at guaranteed rate ("GI GR"), to all applicants (as is the practice in NY). "GI GR” would not have a tremendous effect on the current cost of health care.
The uninsured are currently getting free health care and the cost of this health care is passed on to employers and employees who purchased fully insured plans. Employers with less than 50 employees are the purchasers of fully insured health care programs.
IV. Pre-existing condition clauses: A pre-ex clause states that the insurance company will not pay for a health care concern that existed before you became insured. Pre-ex clauses are often permanent and need to vanish after a reasonable period of time. Pre-ex clauses are necessary.
a. Waiving Pre-ex clauses:
Commercial Carriers offer a “takeover” provision, which simply states that if coverage is being replaced (a business is changing providers and replacing Aetna
with Blue Cross) then the new carrier will recognize the exchange and accepts all risks, meaning that no individual will be subject to repeating a Pre-ex clause; the key being “continuity of Coverage.”
The exclusion would be for the individual who walks around with out health care coverage and then one day discovers that he has a serious and expensive health condition. It would not make sense if we all paid for insurance and this person just purchases the policy after they have been diagnosed with an expensive medical condition? The solution is:
One year pre-ex clause for those young adults, ages 18 thru 21,
Three year Pre-ex clause for adults
No Pre-ex clause for children!
In summary, Regarding Portability, If a “takeover” provision is mandated on a “GI GR” basis, then portability is no longer an issue because everyone would now have the ability to buy a policy anywhere, anytime, without penalty due to medical conditions.