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Sun Aug 17, 2014, 01:08 PM

 

Have Insurers Found New Ways To Avoid The Sick?


By RICARDO ALONSO-ZALDIVAR
Associated Press

WASHINGTON (AP) -- Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.

The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.

With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act's anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years.

More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions and may ... violate the (law's) nondiscrimination provisions."

more...

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_DISCRIMINATION?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2014-08-17-10-20-09

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Reply Have Insurers Found New Ways To Avoid The Sick? (Original post)
Purveyor Aug 2014 OP
MisterP Aug 2014 #1
gtar100 Aug 2014 #2
truedelphi Aug 2014 #3
BrotherIvan Aug 2014 #4
LiberalElite Aug 2014 #5
JayhawkSD Aug 2014 #6

Response to Purveyor (Original post)

Sun Aug 17, 2014, 01:29 PM

1. "central AVOWED goal"

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Response to Purveyor (Original post)

Sun Aug 17, 2014, 01:36 PM

2. It is and always will be the natural result of having *for profit* companies

managing the costs of health care. Profit in health care is simply the amount of money taken in by the insurance company *NOT* spent on health care. Operating expenses have to be met regardless so the money going to feed shareholders and excessive salaries and excessive bonuses is money coming straight out of what could and should be spent on actual health care.

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Response to Purveyor (Original post)

Sun Aug 17, 2014, 01:37 PM

3. Sad to read about, lthough I suspected it was happening. n/t

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Response to Purveyor (Original post)

Sun Aug 17, 2014, 02:14 PM

4. Shocked not shocked

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Response to Purveyor (Original post)

Sun Aug 17, 2014, 07:00 PM

5. I've always felt that insurance

for whatever, health, property you-have-it is a crock. Nowhere else in any other business do they try so hard to not give you what you paid for.

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Response to Purveyor (Original post)

Mon Aug 18, 2014, 01:35 AM

6. I read the article several times

 

and I could find nothing but vague generalities. Where are any specific charges which illustrate insurance companies "avoiding the sick?"

Washington state's insurance commissioner, Mike Kreidler, said "there is no question" that discrimination is creeping back.

Well, I could make a charge that the San Diego Chargers are deliberately losing football games, too. Easy to do if I don't have to provide any specifics as to how they are doing it, let alone offer any proof.

The law also takes away some of the motivation insurers have for chasing healthy patients.

Well, one of the major and most controversial aspects of the law is that healthy people have to sign up whether they want to or not and, a minor point, the term "healthy patients" makes no sense.

A few states refuse to enforce any aspect of the law.

Which is a problem that the people of those states need to deal with.

Kreidler said the federal government should establish a basic level of protection that states can build on.

Which the ACA does. Remember the flap about plans being cancelled because they did not meet the minimum standards set by the ACA?

Also worrisome are the narrow networks of hospitals and doctors that insurers are using to keep premiums down.

Actually, no. The insurance companies set payment levels for the plans to keep costs down, just as Medicare does. Medical providers are then invited to participate in the plans and decide for themselves whether or not they want to do so. Many decline because the payment levels are not high enough to suit them. "Narrow networks" are the result of choices by medical providers, not by insurance companies. If your doctor is not in the network it is because he wants to be paid more than that network is paying. Some doctors also refuse to accept Medicare.

Healthy people generally shop for lower premiums,

Which means policies with lower payments to providers and therefor narrower networks. Also higher copays and deductibles. There is no such thing as a free lunch.

while people with health problems look for access to specialists and the best hospitals.

Which means plans that have higher payments to providers and therefor higher premiums. There is no such thing as a free lunch.

Some plans are requiring patients to pay 30 percent or more for drugs that go for several thousand dollars a month.

Or they could raise the premiums paid by the patient to cover that 30% of the medication cost and then pay the entire cost so that the patient thinks he is getting "free medication." The insurance company does not produce the medication out of thin air. It has to buy the medication and pay for it, being reimbursed by the patient in the form of premiums. The patient could, of course, buy the medication direct from the drug company and save the amount that the insurance company charges for overhead and profit, but then he would not be getting "free medication."

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