Health Insurance Companies Really Hate Your Sick Children

The health insurance industry is generally known for its efficiency, generosity and — of course — for its customer-first attitude. That’s why it comes as such a shock that several of the more beloved insurance institutions like Wellpoint, Aetna, Cigna and United Healthcare have decided to stop selling you insurance policies for your sick children.

These companies say the have opted to put a halt to selling child-only policies rather than comply with a new federal law forbidding them from rejecting coverage for children under the age of 19, even if they have (here’s the sticking point) a pre-existing medical condition.

Insurance companies have seen sales of child-only policies increase in recent years as more employee-based health plans cut coverage of dependents. But now that the insurers won’t be able to say no to kids with costly conditions, many have decided to cease selling new child-only policies.

From the L.A. Times:

Insurers said they were acting because the new federal requirement could create huge and unexpected costs for covering children. They said the rule might prompt parents to buy policies only after their kids became sick, producing a glut of ill youngsters to insure. As a result, they said, many companies would flee the marketplace, leaving behind a handful to shoulder a huge financial burden.

“Unfortunately, this has created an un-level competitive environment,” said a rep for WellPoint’s Anthem Blue Cross, which recently stirred up a hornet’s nest by jacking up rates on individual policy holders in California.

We don’t know why the insurance companies are so worried about having to pay for kids with pre-existing conditions. After all, insurers have had no moral quandaries with practicing recission on policy holders withbreast cancer or HIV.

White House Press Secretary Robert Gibbs responded to the news with expected exasperation: “It’s obviously very unfortunate that insurance companies continue to make decisions on the backs of children and families that need their help.”

Big health insurers to stop selling new child-only policies [L.A. Times]

New healthcare law kicks in today [Houston Chronicle]

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  1. stock2mal says:

    Why don’t we just do away with for-profit insurance companies anyway? ( I know the REAL reason why, but seriously)

    • EarlNowak says:

      Mutual insurance companies have too much incentive to demutualize (Mostly because the board of directors in such a scenario will get stinking filthy rich in the demutualization offering, though they’d argue it allows them to increase capital->increase investments->decrease policy costs- even though that has rarely happened over the years.)

      So a non-profit insurance company that’s not sponsored by an organization that will keep them from demutualizing (professional associations, guilds, state employee plans, union plans) will inevitably go for-profit.

    • DariusC says:

      Probably because profit covers them in case of a horrible downturn or epidemic… You cannot make a profit in a non-profit and claim that it is “savings” for a future problem that you have no idea when is coming. Non-profits must throw everything back into the business or give back to their customers.

      IANAL

      • stock2mal says:

        One needs to look beyond the conventional structure of non-profit and for-profit organizations when you are dealing with this issue. For-profit insurance companies are a conflict of interest for the insured, regulation only causes them to make things more difficult for customers, something needs to change because the profit-driven ones are screwing their clients with regulation and without.

        • diasdiem says:

          I always wondered about that. Most companies make money the more you use their services. Health insurers make more money the less you use their service. And yet we trust them to provide us with this service. It makes no sense.

          • dragonfire81 says:

            When you pay your premiums you are not paying just for your healthcare costs but others as well. If you were just paying for yours alone, they would make more money if you used it but since you have to also pay to cover people who aren’t as profitable it changes the dynamic and business model.

            I come from Canada and I now live in the U.S. I have not been particularly thrilled with my experiences with the U.S. healthcare system nor the costs that come along with it. I know the Canadian system isn’t perfect, I know it costs more in taxes, I know it has issues, but I still argue it is miles ahead of what exists in U.S. now. Did you know Canada has a longer life expectancy than the U.S. and we only spend approximately HALF what the States does per capita in health care and we have single payer!

      • hills says:

        Yeah, but the “profit” is given in bonuses to the execs, instead of sitting in a rainy day fund….

        • VeganPixels says:

          After deregulation, insurance cos. took your premium dollars and bought junk bonds in the ’80s, tech stocks in the ’90s, and CDOs in the ’00s. Any questions?

      • Elcheecho says:

        that’s why there are foundations.

    • kc2idf says:

      We were told we couldn’t go to single-payer because we needed to save the insurance industry. What for? What the hell have they done to make them worth saving?

      • raydee wandered off on a tangent and got lost says:

        Old family legend has it that my great grandpa continued paying his life insurance monthly until the day he dropped dead in his 90’s … but they would not pay out because his coverage “expired” when he reached age 80. As far as I know, the family was unable to get anything out of them. I was very young when I heard the story, so I am fuzzy on the exact details.

        Any industry that can pull off a con like that–and get away with it!–must be preserved. It must be saved. Probably from itself. Or from the mob of pitchfork-waving people storming their offices.

        • strawbabies says:

          Did they at least refund the premium that had been collected since the time his policy supposedly expired?

    • BigDave says:

      FREEDOM!

      • kenj0418 says:

        Even William Wallace would have needed insurance to pay for the testicle reattachment procedure after the English finished torturing him. Oh, they killed him right after that scene — never-mind then.

    • Difdi says:

      An insurance company, ANY insurance company, is a legal form of organized gambling. Not much different from a casino, really.

      You put up money with them, betting that you will be injured. They put money up against yours, betting you will not be. If they win the bet, they get your money and you make a new bet. If you “win”, they pay you. They make a profit by having a lot of bets going at once, and by playing the odds to determine how much money they put up against how much money you put up.

      A pre-existing condition means the bet they make will always be a losing bet for them. If every bet they make loses, they go bankrupt and all the bets they have at the time go unpaid no matter who wins. To an extent, they can support a certain number of sure-loser bets, without it cutting into their profits or ability to pay their employees. But sooner or later, if they’re compelled to accept any bet regardless of how bad a deal it is, there won’t be any insurance companies anymore.

    • grumpygirl says:

      As bad as private insurance companies are, I’d rather deal with them than Medicare.

  2. Loias supports harsher punishments against corporations says:

    Fuel for the fire for why health insurance shouldn’t be profit-driven.

    • nova3930 says:

      Yeah for sure. If people are allowed to make money assuming other people’s risk, there’s no limit to what goods and services people might want to make money providing to those that want them. Hell, next thing you know farmers might start making a profit providing life sustaining food…

      • Loias supports harsher punishments against corporations says:

        Whether I get my corn from Farmer Jon or Farmer Sue doesn’t directly effect how long I live.

        When a company denies citizens coverage, they die. Health care and food are in no way comparable in this context.

      • c!tizen says:

        There you go, compare the insurance industry to the farming industry, that’s a fair comparison. After all, farmers are known to deny hungry families food because of pre-existing eating conditions. Or how about when the farmers needlessly raised the price of bread because the government told them they could no longer gouge people for needing to eat?

        • angelmvm says:

          Yes.. farmers charge what they deem a fair price. Maybe this weekend I’ll go down to my local farmers market and try the same argument. If I can’t afford to pay the $1.00 for the apple I want to buy I’ll explain to the farmer that I am hungry. I have a human right to not be hungry. So he should sell it to me for the much more reasonable price of $0.50. Should it matter that it cost him $0.55 to bring that apple to the market for sale? Nope. After all.. I have rights!

          • Mecharine says:

            Thats called haggling. Which is something everyone should know how to do.

            Of course, you can’t haggle with for-profit health insurance./

          • c!tizen says:

            dude, WTF are you talking about?

          • RTarkenton says:

            @angelmvm The cost to the farmer is completely irrelevant, in a free market. That apple has no inherent value. The apple is worth exactly as much as the buyer is willing to pay for it. If I am the buyer, and I am only willing to pay $.50, then $.50 is the value. The farmer can refuse based on principle, and he can go home and eat his apple, without my $.50.

            Now, if there is another buyer that comes along and is willing to pay $1.00, then THAT is the apple’s value. But the little price tag the farmer puts on the apple is little more than a desire which the farmer expresses, and which many people will honor because of social convention. Haggling is perfectly acceptable.

            An insurance company is not an independent farmer. They don’t haggle. They just let you starve to death, because they want their dollar.

  3. NeverLetMeDown says:

    The coverage on this has been grossly unfair. The new laws prohibit pre-existing condition exclusions. So, it creates an untenable position for carriers: people can (and will) choose to get plans only when their kids get really sick, so there won’t be the steady stream of premiums from people who AREN’T using the insurance, that actually makes the insurance business possible.

    Think of it this way: imagine if you were an auto insurer, and people were able to call in to get coverage _after_ they were in an accident, have you pay to fix their car, and then drop coverage again.

    If we’re going to require insurers to issue policies regardless of risk, the only way it actually works is if we also require consumers to get policies, regardless of risk. Otherwise, you’ve got a classic adverse selection problem. In this case, the adverse selection is even worse, since the population overall is quite healthy (kids don’t have many heart attacks), but has a relatively small subsection which has extremely high health care costs.

    • rbb says:

      +1

    • Tim says:

      Insurance companies want to absolve themselves of any and all risk. They want to take in as much money as possible, then pay out as little as possible. If you can hand-pick who you insure and discriminate for any reason whatsoever, you can pick a group of people who are very cheap to insure. There’s very little risk they’ll get sick, so you just rake in the money, sit back, and don’t pay a penny.

      I’d be fine with an individual mandate, but that’s just me.

      • NeverLetMeDown says:

        Sure, they’d like to only insure healthy people, just as we would like to only be able to buy health insurance when we’re sick. The system only works if both parties are locked in, so that they can’t refuse to pay when we do get sick, but we pay premiums even when we’re not sick. In this case, the law has restricted their ability to discriminate, but hasn’t put in place similar restrictions on consumers, so I agree with you, if we’re going to prohibit pre-existing conditions exclusions, we’re going to need an individual mandate.

      • Guppy06 says:

        The mandate will start in 2014. If Republicans and Blue Dog Democrats had something more constructive to say than “no,” then it might have been sooner.

    • Loias supports harsher punishments against corporations says:

      Solution seems simple. Mandate insurance for all citizens.

      Also, insurance can mandate the length of coverage to be a year, so you can’t get your kid fixed up and then dump coverage. It probably won’t make up for the cost of major issues, but it’s something.

      But really, insurance for all citizens solves these problems carriers keep saying. I think even they support it.

      • jesirose says:

        Uhm, you realize that’s what they did?

        It’ll be cheaper to pay the fine and buy insurance when you need it, than to buy all year round because the law says to.

        I’d love to be able to get insurance right now. No one will cover me. But once it becomes a mandatory thing, you can bet I’ll wait until I need it, and pay a fine, rather than accept being forced to buy a service.

      • GqhnqCTE says:

        Oh yes thats a perfect solution.. Mandate that everyone has to go and buy insurance (that’s what they did). Only that’s not the government’s job and it is NOWHERE in the constitution. If you want it to be, then try to amend it and see how far you get.

        • Loias supports harsher punishments against corporations says:

          People who make the Constitution arguement do so out of ignorance. There are literally thousands of laws and millions of lines of text that is not inthe Constitution and yet are perfectly legal legislature.

          Perhaps you should try not being a GOP automaton.

          • VeganPixels says:

            I’m a lifelong Leftie/Social Democrat in the EU sense and I don’t believe it’s constitutional, either. Nowhere in that document does it mandate that I prop up the share price of any for-profit corporation.

            • Loias supports harsher punishments against corporations says:

              Regarding the constitution arguement, see the other comments, they pretty much have it right.

              It’s not about propping anyone up. It’s about making insurance affordable. And the most effective way to do that is to make everyone participate. When more people participate, more money is thrust into the system. When there is more money, then less is being charged to the insured (states mandate that profits over a certain percentage be refunded to participants in the following plan year). More participants = less cost to run insurance and thus less cost to the insured.

              Right now, the youth of America rarely participate in insurance. And they also don’t use it as much. If they were required to participate, that is a huge revenue stream, which would bring downs costs for everyone. And before you say they shouldn’t buy into it if they don’t need it, remember that no one knows what will happen to them. We, as a group, all need insurance, even if there is always a statistical group that doesn’t use it.

        • c!tizen says:

          Seriously? Where in the Constitution does it say I can’t speed on the highway? Where does is say I can’t run nude down the street? Where does it say I can’t be in a public park after 9pm?

          The Constitution is a set of standards that we use as an unshakable cornerstone to keep our country free and our laws fair. It isn’t the end all be all of law, it serves one extremely important purpose… it protects us from our government.

          • huadpe says:

            Those are all state laws. The US constitution restricts what states can do (i.e. free speech), but outside those restrictions, states can pass any law they want. MA has had an individual mandate for quite some time, for example.

            The US constitution however only allows Congress to act according to various provisions of Article 1 (and amendments). In the history of the US, Congress has only once required people to purchase items from a private purveyor, and that was to buy a musket, bayonet and belt, two spare flints, a cartridge box with 24 bullets, and a knapsack, under the Second Militia Act of 1792, which was permitted under Article 1, Sec. 8’s provision for the raising of an army.

        • ARP says:

          Where in the Constitution does it say that a corporation is a person entitle to free speech rights. Scalia, the consumate originalist (you can only do what’s in the constitution) seemed to have no problem with that.

          My guess is that the Constitutionality argument is a strawman for the fact that you don’t like the law. So, just tell us why you don’t like it.

    • farlo666 says:

      yeah i use this analogy a lot, “would you expect to be able to get auto insurance for your car the day after you total it and expect them to cover the damage that was done previously” health insurance is the same way it is based on risks, if you have many people who are healthy paying in, they counter the sick people using the services.

      more blame should be placed on out of control hospital and doctors costs, instead of it all being thrown at health insurers/

      • indeeme says:

        Except there is no “risk” involved with health insurance. Every insured is going to use it, which isn’t the case with car insurance. (It’s only a matter of how much a person is going to use it, not if they’ll use it.) Health insurance isn’t actually insurance, regardless of what they call it. It’s really just a middle-man between patients and doctors, just like the distributor between the farmer and the grocery store. Sure, lots of people shop ahead of time, others only when they’re hungry. Have I got to let the farmer know in advance that I’m gonna want to eat next year?

        • huadpe says:

          By that logic, all people should pay the same for whole life insurance regardless of age.

          The timing matters. For it to work, the average person must pay in as much in premiums as they get out. If people can hop in and out, only having coverage when they will get out more than the price of premiums, it’s mathematically impossible to make it work.

    • sleze69 says:

      +1

      This is why medicare was created – because the insurance companies weren’t covering the elderly. If the market cannot offer a solution, the government should step in.

    • sleze69 says:

      +1

      This is why medicare was created – because the insurance companies weren’t covering the elderly. If the market cannot offer a solution, the government should step in.

      • GqhnqCTE says:

        The market can offer a solution but the government won’t let them. It’s called competition. If they allowed companies to go across state lines then more companies would offer better coverage for less, and other companies would follow suit, or lose all their customers to the other company. One company would realize that elderly people want to pay them for insurance too and offer coverage and soon after, all companies would have to offer it, or they would lose their customers. It’s pretty simple, leave the government out of it.

        • Sir Winston Thriller says:

          And what coverage laws would the insurance company have to follow? The law of my state or the state where the insurance company does business? If Mega-Insure is in Ohio, but I live in Vermont, which state controls? Ohio, where coverage for diabetes might not be mandated, or Vermont where it is?

          I’ve heard your argument before, and it doesn’t work.

        • indeeme says:

          If they allowed insurance companies to sell across state lines, we’d all end up with a single standard policy determined by the laws of the state most willing to make concessions to the industry. I don’t want some other state defining my health insurance policy any more than I want Texas setting the standard for my kid’s textbooks or South Dakota outlining my credit card agreement.

          By the way WE are the government, you and I. So, we should leave the government out of it? Tell me, how does the government get in? ‘Cause I sure could use some health insurance.

        • Phineas says:

          Or (the more likely scenario), they would pull companies out of some states and do what the credit card companies did: move to the states with the most pro-business/anti-consumer laws. With policies across state lines, everyone will move their company to Delaware or South Dakota. Some state lawmakers will purposely get bills passed to make their state more attractive to insurance companies moving their tax revenue to their district. Then, some other state will want the companies to move there and will write an even MORE draconian set of laws bad for the public. And down the line, some other state will make it even worse, and so on.
          So, if you want “competition” to work, it won’t go in the direction you think.

        • OutPastPluto says:

          Nonsense. All that inter-state insurance would do is eliminate whatever effective regulations remain in place for insurance companies in some jursidictions. Insurance companies would still continue to raise premiums and make up excuses to deny claims.

          For-profit insurance is just a big con. Some insurance companies are just more obvious con artists.

    • c!tizen says:

      I may be mistaken about this, but isn’t part of the new healthcare plan a mandate that all citizens must have health insurance? There is no getting it when you need it, I thought it was you have to have it. Again, I might be wrong… I’m sure someone will correct me if I am.

      • huadpe says:

        The mandate doesn’t kick in til 2014, this kicked in a couple days ago, so for 3 years, not at all.

        As for after 2014, I’m not sure if it will include kids or not, since they don’t exactly file tax returns, or have income, to be accounted for by the mandate system (which is run through the tax code).

  4. Hi_Hello says:

    i say get rid of health insurance. if doctors are at fault, remove their license and throw them in jail. as for the patient that has a problem, free medical stuff for the rest of thier life.

    I don’t see how given something millions of dollar because of a doctor’s fault will make them better…

    • hypochondriac says:

      How do you prove the doctor was at fault? You know you can sue the doctor till the kid turns 18.

    • NeverLetMeDown says:

      You’re confusing health insurance and malpractice insurance.

      • Hi_Hello says:

        nope. that’s another mess up insurance all created because this country is sue happy.

        ppl pay for insurance, insurance pay hospital.
        doctor pay for insurance.

        ppl sue doctor. doctor’s insurance pays. doctor’s rates go up. hopsital rates goes up. ppl’s insurance pay hospital.

        endless cycle.

        • coren says:

          What you just said in your op has nothing to do with why HEALTH insurance exists, and has everything to do with malpractice insurance

  5. tackhouse1 says:

    I’m torn on this, while I think its unfortunate that the Insurance companies took this action, at the end of the day they are for profit businesses. If they can’t make money on a certain type of insurance, then they owe it to their stock owners to not be in that line of business.

    • Loias supports harsher punishments against corporations says:

      You’re right. Human health should not be a money-maker. Choosing (or not choosing) to provide health coverage should not be based on the possibility of profit. People shouldn’t die because it’s more profitable to let them.

      • nova3930 says:

        Sorry but the ability to contractually assign your risk to someone else, is not something ANYBODY is entitled to. In fact, forcible foisting off your risk on someone else is the exact opposite of a right, its a form of subjugation of the other individual(s).

      • macruadhi says:

        And if I can’t make money from treating your various maladies, why should I invest 8 years of MY life educating myself? Should YOU be able to enjoy free or nearly free healthcare at the cost of my livelihood? Oh, and can you provide references to these people who have died due to being refused treatment?

        • Loias supports harsher punishments against corporations says:

          Why are you using a doctor as your argument? A doctor doesn’t deny you coverage, a health provider does. Doctor’s want to help you. Insurance carriers just want you to be profitable. Come back with something better.

        • Munchie says:

          A another bit of mis information. You costs and education costs would not be so high if we handled medical education with subsidies like most other nations. Without the same education costs and malpractice insurance costs it would not be necessary to pay doctors so much.

          • jesirose says:

            Because food subsidies have worked out real well, right? We only get healthy good wholesome food for cheap, right?

            Right?

  6. shibblegritz says:

    Not even a non-profit insurance company would be able to withstand the enormous losses of being required to pay for coverage for customers who don’t bother to pay premiums until they or their children get sick.

    But, by all means, let’s pile on the insurance companies because we know that while they shouldn’t get a free ride, or even be able to buy a reasonably priced lunch, we all should get to hop on the back of the flatbed and ride that sucker to Gravy City.

    • stock2mal says:

      Starting in 2014 you will be required to purchase coverage, so your point is useless.

      • NeverLetMeDown says:

        I wouldn’t count on it. It’s no coincidence that the “insurance companies must do X” part came now, and the “consumers must do Y” part was pushed off four years. A true reform would have had the two kick in at the same time.

      • nova3930 says:

        Not hardly. All the O-bots are going to be exceedingly sad when the Supreme Court tells them to GTFO with the stupid idea that the gov’t has the power to force people to buy something they don’t want.

        And oh, by the way, the Democrats, stupid as ever, were in such a hurry to shove this BS down our throats, that they forgot to include a severability clause in the bill. In other words, WHEN SCOTUS strikes down the individual mandate, the entire law is gone.

        • crashfrog says:

          Not likely. There’s no Constitutional challenge – the US Constitution gives Congress sole authority to set rates of taxation. Rates like, “pay an extra $500 if you weren’t covered by health insurance this year.”

          The lack of an explicit severability clause in the ACA doesn’t mean what you think it means. Sarbanes-Oxley has no severability clause, either; the Supreme Court recently struck down a portion of the law but the rest of it is nonetheless still in effect.

          • huadpe says:

            No, actually, the 5th amendment restricts Congress’ taxation power to the methods listed in the constitution, these are:

            Excise taxes (a fixed tax per unit sold of an item, such as cigarettes, gasoline, or alcohol)
            Tariffs
            Income taxes (which are a proportion of income, not a fixed amount)
            Capitation (fixed per person) taxes, in accordance with the population of each state. (this one is stupid and hasn’t been used in a long time, and the healthcare law doesn’t use it).

            The penalty as described in the law is not one of the allowed taxes, therefore it is a 5th amendment taking, and is not allowed without just compensation (i.e. a full refund to anyone who asks).

            They could easily solve this by lowering the kick-in of the 25% bracket by about $4100 and giving everyone who does by health insurance a $650 credit (which has the same monetary effect), but it wouldn’t feel like a mandate, so people wouldn’t do it.

      • pinkbunnyslippers says:

        Let’s see. If I have the choice of paying $3,600/year for insurance (if I’m a freelancer and don’t have employer-coverage, let’s say) or pay $500/year to the government for NOT having insurance, and know in an emergency I can still go to the hospital and get taken care of without $$ from my pocket, I think I’ll take the latter. The very people the government needs to pay into this and make this plan worthwhile (i.e. young and/or healthy people) are the same people who don’t want to buy something they don’t need. I’m an advocate of always having it, but not everyone feels the same.

        Quite honestly, how the government didn’t see this kinda move from insurance companies coming from a mile away after they pushed through this “reform” makes me even less inclined to entrust them with things like my health.

        • shibblegritz says:

          They did see it coming! It seems patently obvious that the bill was designed to encourage people to go without coverage, consequently reducing their revenue even as the legislation requires more and more spending on their part (full preventative care “for free,” no lifetime limits, etc).

          It’s about forcing private insurers out of the game so as to open the door to universal coverage single payer system, the liberal wet dream that will turn into a nightmare for all of us.

          If they were serious about the coverage mandate, they would have set the penalty at an annually adjusted rate equal to that of the cheapest available basic plan insurers are required to offer, and they did include that as one of the options. But they also included several other things including percentage of income standards and an “applicable dollar amount” standard, which is $695 after the two-year phase in during which it is even less, so the penalty, by default, will be $695 a year. Whoopee.

          Given that average individual premiums are something like $2,600 a year, it doesn’t take a PhD in economics to understand the value in not buying insurance until you get sick. Of course this doesn’t include accidental injury, but many auto policies include some measure of medical benefit for injury and lots of people will choose to take the risk, just as they try to do with auto insurance.

        • stock2mal says:

          Then you increase the amount of the penalty to where it does not make financial sense to go without insurance. Most people don’t want to deal with an SR22, so most people pay for auto insurance.

        • Thorzdad says:

          Where the hell can you get coverage for $3,600/year???? We pay almost a third of that each *month*.

      • shibblegritz says:

        You’ll be required to purchase coverage or pay a fine that is less than what that coverage will cost you, which will likely, if not in the first year, very shortly afterwards, be taken out of your withholding. As such most of the ignorant masses in this country won’t even know they’re paying a fine. They’ll just hear from their buddies that they don’t have to buy insurance till they get sick ‘cuz the government made a law or sumthin.

        Maybe you don’t believe it now, but you will in a few years when you see how many people choose to go without coverage until they need to have it, further taxing a system already strained to near the breaking point. They’ll have to put limits on care.

        And what limits will they put on? They won’t tell you you can’t go to the doctor for the sniffles, because there are too many people who think it’s their God-given (oh, no there’s no God, that’s right) … Obama-given right to go to the doctor they love and have him or her give them useless antibiotics for a cold and that might make all those people mad and they’ll vote for someone else. No, they’ll just take really expensive medicines and treatments away from the very small group of people who have rare, untreatable or extremely advanced diseases and who won’t be around to vote during the next election. Big bucks, small pool of affected people = electoral indifference! Yay! Welcome to the new paradigm in health care! No longer will insurance companies marginalize and redline patient categories … your government will!

        I believe this is part of the plan … force private insurers into an untenable financial predicament and have government welcomingly, lovingly embrace those poor, poor souls left uncovered when each private insurer fails.

        Single payer through the back door, baby. Nothing like shoving something up our asses and telling us its “choice.”

  7. Tim says:

    Yay capitalism!

  8. balthisar says:

    I’m fairly impressed that the preceding comments aren’t full of vitriol against the insurance companies.

    For profit-making enterprises, this seems like a perfectly sensible decision. As was mentioned above, ex post facto insurance just can’t work.

    • theyoungandthebetrayed says:

      The same thought occurred to me two comments up. Looks like I’m going to have to spend all morning investigating these usernames for corporate shills as this surely isn’t normal for Consumerist readers.

  9. daveinva says:

    “That’s why it comes as such a shock…”

    Only to the fools who believed that compelling insurers to cover more expensive pre-existing conditions without charging higher costs was physically possible.

    Gee, it’s not like you all weren’t *warned* about this during the healthcare debate. Wishful thinking is no substitute for a grasp of basic economics.

    Healthcare must be reformed. No one disagrees with this conjecture. But the way we did it fixed nothing; indeed, as is now apparent, only made matters worse than before.

    • humphrmi says:

      Yeah, I’m starting to agree with you. Unfortunately it was hard during the debate to weed out the shrills from the real analysis. I didn’t support or oppose health care reform, but now I’m starting to think that some groups have it right – repeal it, start over, do it right.

      • Spike3185 says:

        Here’s the problem with that, though. We’d be giving it back to the same committees and people who never wanted to see the reform in the first place and making it so they can screw the whole thing again. I think anyone who still calls this whole thing “Obamacare” needs a smack upside the head because it’s not as if the original plan was bad, it just got worse with every committee it went through. I don’t see anything different happening if we let them start over. It’ll go thru the same committees and come out the other end just as bullshit as what we’re getting now. End of Life care would have been a great thing to have but it got turned into Death Panels and thrown out the window. I’m trying REALLY hard not to make this political but…well…y’all were there. The Republicans WILL fuck it up again or just can the whole thing alltogether if we repeal and start over.

    • zandar says:

      ironically, what should have passed instead of all these other rules was that hot potato no one wanted to touch: a public option.

      • GqhnqCTE says:

        Well then figure out a way to pay for it and I’m all ears. Oh yeah, and there is this thing you probably never heard of, called the constitution, that doesn’t mention health care for all. I (and the majority of americans) don’t want to be taxed more to pay for your health insurance.

        • Pork Chops of Rage says:

          I’m sure we could find the money somewhere in the 674 billion we currently spend on the military.

        • JulesNoctambule says:

          The Constitution doesn’t mention a lot of things, and yet we still have them. It’s interesting

          • DeepHurting says:

            I don’t think you don’t understand. The Constitution is like a buffet; you choose what bits you like and ignore the rest.

        • dolemite says:

          You pay for it by not having 3 trillion dollar wars (Thanks G.W.), and by raising taxes. Let’s say we raised taxes 15-20% to have healthcare for all. Many people currently pay $15-25% of their paycheck to health insurance companies. Where I work, if you have a family of 4, you are going to be paying 50% of your paycheck for insurance. And then you have the $2,000 yearly deductable, per person.

  10. Gulliver says:

    More proof that the only situation that will improve the lives of most people is a SINGLE PAYER FEDERALLY FUNDED health care provider,. The highest rated health care organization in the country is the most socialized THE VA. Surveys consistently show the VA ranks higher than ANY health care provider. Why shouldn’t every American have access to similar care?
    Oh thats right, it is better to allow rich right wing nut jobs make money off of peoples illnesses.

    • daveinva says:

      “If you like your plan, you can keep your plan.”

      • angelmvm says:

        +1

      • Torgonius wants an edit button says:

        you can keep your plan, until the company that offers that plan is forced to weaken that plan to compensate for all the losses they are incurring; or no longer offers that plan it because just offering a watered down version of it is no longer profitable; or goes out of business entirely.

    • jessjj347 says:

      You do realize that if there is “one” public option, that there will still be a multitude of private options? The rich will get better care regardless of any health care reform in the US.

      Look to the UK for this issue. There are actually “private” sections of hospitals.

    • RosevilleWgn says:

      Don’t forget TriCare. That’s certainly a model as well.

    • shibblegritz says:

      You assume that the quality of care will scale from the, at most, 24 million people eligible for VA care today, to a system in which more than 300 million people would have to be covered. And unlike the VA scenario, where many of the patients will have Tri-Care, Medicare and possibly private insurance from a second career, many of the patients in a single-payer system wouldn’t have two nickels to rub together.

      It’s like saying you’ll get the same service and quality you get at a boutique bistro that you’d get at McDonalds. It’s just not going to happen.

    • hansolo247 says:

      Then you have the real “public option”: Medicaid. A total failure.

      It has the most expensive patients per capita by far, getting every drug they see on TV on demand. The docs are more than happy to do it because it’s the only way they can make a living with Medicaid patients.

      The only way a “public option” will work is if both provider and consumer have a motivation to keep costs down…they both have to have skin in the game. Medicaid patients get it all free, and abuse the crap out of it (not all of them, but many of them). EVERY TIME YOU CONSUME A SERVICE, YOU SHOULD PAY *SOMETHING*. Veterans have already paid that cost, IMO.

      It should start with health care costs being 100% tax CREDITS, not deductions. Insurance, copays, prescriptions, all of it. Obama’s health care plan REDUCED THE DEDUCTIONS for people who spend large sums of money on health costs…the very sick. I still can’t see how any legislation that does that is written by someone with a conscience (I know, I know, they didn’t read it). And they will remove deductions entirely for insurance…THE WRONG DIRECTION!

      And before you call me a right wing nut…I’m libertarian. You’ll want to read what that really means. I have no problem with a public option, as I think it is one of the few good uses of government money, but when you open it up to the Medicaid crowd, it isn’t going to work if it is free to them.

  11. ParingKnife ("That's a kniwfe.") says:

    If only there was an alternative “option” available to the “public”…

  12. H3ion says:

    Maybe the government should borrow a page from the auto insurance industry and create an assigned risk pool. As a condition of being licensed to sell insurance, you must take high risk insureds at a government limited (but higher than general underwriting rates) premium cost. That way, if an insurer doesn’t want to continue in business, it need not accept high risk customers but if it wants to keep its license, it must take all comers under this program. Just a thought.

    • ARP says:

      Yes, Texas did that an instituted torr reform. Guess what happened? Prices went up at the same rate as other states, but now the insurance companies have more profit.

  13. rubicthecube says:

    Why do we even need health insurance companies? They’re nothing but a middleman whose only purpose is to give my money to the doctor and deny me coverage. I see both sides of the coin on this whole health care thing. We need health care reform, but I also dont want to pay for the guy who’s been eating nothing but cheeseburgers and smokes a pack a day without exercising a lick.

    • Foxtrot-Yankee says:

      They are not just middlemen who give your money to your doctor. The fact that people don’t understand the nature of insurance is what’s making this issue so muddy.

      Insurance companies aggregate risk. They take money from large groups of people and pay their doctors. If what they pay your doctor exceeds what you paid them, you don’t owe any more (up to some large agreed-upon maximum). If they do their job properly, what they take in will exceed what they pay out by a few percent.

      If you think all they do is take your money and pay your doctor and you don’t need them because of this, drop your insurance and pay your medical bills directly.

      • richcreamerybutter says:

        Why should I have to “understand” something that’s completely unnecessary to begin with?

        Help me understand why, in the case of some prescriptions, insurance companies feel the need to subject the prescription to their own third party approval process? Somehow I don’t recall ever having a face-to-face exam with my insurance company, yet they feel qualified to “approve” an actual doctor’s prescription based upon a diagnosis?

        • NeverLetMeDown says:

          It’s not completely unnecessary. Someone has to make decisions about what will be paid for and what won’t. This is true in any system, be it public, private, single payer, whatever. There are drugs and procedures for which Medicare won’t pay, there are drugs and procedures for which the UK National Health Service won’t pay, etc.

          For example, what if drug A works 1% better than drug B, but costs 50x as much. It’s a perfectly reasonable position for any paying entity (public, private, whatever) to say “we’re not going to pay for drug A, only for drug B.” Doctors can’t be the ones to make that decision, since they have the core responsibility to make the best decisions for their patients, not the most cost-effective ones.

    • Foxtrot-Yankee says:

      They are not just middlemen who give your money to your doctor. The fact that people don’t understand the nature of insurance is what’s making this issue so muddy.

      Insurance companies aggregate risk. They take money from large groups of people and pay their doctors. If what they pay your doctor exceeds what you paid them, you don’t owe any more (up to some large agreed-upon maximum). If they do their job properly, what they take in will exceed what they pay out by a few percent.

      If you think all they do is take your money and pay your doctor and you don’t need them because of this, drop your insurance and pay your medical bills directly.

      • rubicthecube says:

        Thanks for clearing that up. I had no idea what I was thinking posting on a thread about insurance and not knowing the basics. Damn my feeble mind. See that? That’s called sarcasm. What I did earlier was called simplifying.

      • PunditGuy says:

        The question still stands — why do we need private insurance companies? The federal government can aggregate health risk in a pool of over 300 million people.

  14. Foxtrot-Yankee says:

    Suppose you’re a casino. You run fair games and do not cheat (like with loaded dice or unfairly-dealt cards). Some people lose money in your casino and some people walk out winners. But all the players playing, when taken as a group, lose three and a half percent more than they win. That’s your margin.

    The government comes along and changes the rules of one of the games you offer. The new rules make it so the players will probably win more than they’ll lose. In fact, one of the new rules lets the players look at their cards before they even decide to bet!

    The government says that if you want to deal this game in your casino, you must play by these rules and you know that will destroy your casino’s overall 3.5% margin.

    Or, you can stop dealing the game.

    What do you do?

    The insurance business *is* legalized gambling and the government just changed the rules on one of their games, forcing them to accept really bad bets. Why should they be forced to deal a game that they will lose? Their 2009 margin was 3.4% (Morningstar). Why should that margin get thinner?

    People are mad when they raise rates on risky groups. People are mad when they shut down a product line. What other choice do they have?

    You can save all of your emotional “think of the children” arguments. Emotional appeals aside, is there an objective reason why a business should continue a product where they are exposed to losses like this?

    • ParingKnife ("That's a kniwfe.") says:

      Is there an objective reason a business should be permitted to exist in the first place?

    • Ben says:

      Except you forget the part about mandating that all people must buy health insurance. I’m sure casinos would love it if EVERYONE that visited Las Vegas was REQUIRED to play blackjack for 10 minutes every day.

      • jesirose says:

        Not if they were going to win…?

      • Foxtrot-Yankee says:

        Except you forget the part where the the requirement to buy insurance doesn’t go into effect until 2014. It’s 2010 today Ben. Starting today (in 2010), there’s a law that says that insurance companies may not exclude anyone under 19 years old on a pre-existing condition. There is no requirement today (not until 2014) to buy health insurance for everyone under 19.

        Try to pay attention. The story at the top is about insurance companies dropping plans for children and that’s because of the law that takes effect today. My analogy is apt and I didn’t forget the part where people are mandated to buy insurance because that doesn’t happen until 2014.

      • hansolo247 says:

        But it doesn’t require them to buy it.

        There is the option to pay the nominal fee…and if you don’t, they have said they won’t take any action for nonpayment.

        So it’s a tax, but it’s not.

    • drrictus says:

      Shouldn’t you be “Foxtrot-Uniform”???

      • Foxtrot-Yankee says:

        No. The word “you” starts with a “Y”. That makes it “yankee” in spite of the fact that it’s pronounced the same as “U”.

    • varro says:

      Using the Las Vegas analogy, the new rule does not mean that people can cheat; the new rule means that the casino can’t put previous winners into the Black Book just because they won the last time they were in.

  15. H3ion says:

    Why is the health insurance industry like a Nevada brothel?

    They’re both legal ways of getting screwed.

  16. BoredOOMM says:

    You did not chime in that in California starting today you can add your children to your existing health plan. This is a part of the March 2010 health bill passed and is the first steps in Obamacare.

  17. Hi_Hello says:

    can someone explain this to me.
    when I go to the dentist and don’t use my insurance. they charge me..let say 70 bucks.
    if I use my insurance, the dentist charge the insurance 130 bucks. insurance only cover 20 bucks, I have to pay the remainning 110.

    Also
    http://getbetterhealth.com/the-cost-of-healthcare-with-health-insurance-and-without/2010.02.26

    how can hospital give you 2 difference prices for the same thing??

    • pb5000 says:

      It’s a group discount for those that provide a heavy amount of volume. The doctors set a price they feel is within the market value (in theory), then the insurance company asks for a discount since xx% of this docs overall business is from ABC Insurance, the doc agrees.

      There have been a few times I’ve had short lapses in medical insurance, one of those times my wife was pregnant and requiring multiple doctors visits. We explained our situation to the doctor and said we’d just pay his per visit cost for the two visits required before our new insurance kicked in. We had our previous statements with us and asked if he would accept the amount the insurance gave him for our previous visits, paid on the date of service. He gladly agreed and said that with insurance, he usually doesn’t get paid from them for 4-6 weeks, so getting his reduced fee on the date of service was a deal to him. Your dentist probably has a similar deal, you have crappy insurance and for him it’s better to collect $70 on the date of service rather than $110 + $20 later.

      • Hi_Hello says:

        thank you!

        • ReverendTed says:

          If your dentist charges less for “cash” payments than he charges you for using your insurance, then he’s probably in violation of the terms of his insurance agreement.
          In most cases, the “cash” fee is higher (a market rate for the service), while the dentist agrees to a lower negotiated rate from the insurance company in exchange for being listed on their network.
          Most insurance agreements specifically prohibit charging insurance companies (and their patients) a higher fee for a given service than the provider’s “usual and customary” fee.

          For instance, at our office, a gold crown is approximately $900. This fee is charged to cash patients (and patients for whom we are “out of network” for their insurance).
          One insurance plan we participate in (being “in-network”) caps that fee at $650, of which the insurance will usually pay around half, with the patient paying the rest.
          For those “out of network” patients, sometimes their insurance will pay half of the $900, or they might pay half of some other arbitrary cap, with the patient paying the rest.

  18. nova3930 says:

    I will never understand why people have this stupid idea that groups they’re not terribly fond of will suddenly stop acting in their own best interest as soon as the gov’t passes some new law or regulation

  19. Awesome McAwesomeness says:

    Honestly, I have no issue with insurance companies waiting a year to cover a pre-existing condition, which has already been formally diagnosed (already diagnosed is the operative phrase here–so they can’t come back later and say that a bladder infection means you knew you had breast cancer.)

    Why should people just be able to call up and get an insurance company to pay for their child’s cancer treatments they know could run into the hundreds of thousands of dollars? If that were the case, no one would get insurance until they got sick/injured and insurance companies would go under.

  20. gtrgod01 says:

    Does anyone have statistics on how many “child only” policies even exist? It’s possible the number could be very small and this is just a way for the insurance companies to fear monger. I know the article says “as many as 500,000 nationwide” could be affected, but how many policies DO they actually have that ARE child only? Saying a half million “could” be affected doesn’t translate into a half million “being” affected. For all we know those half million would never get a stand alone policy anyway as it would be to expensive in the first place….

    oh and i love how “child” in the eyes of an insurance company includes 18 and 19 yr olds…..you know the “children” that can go fight a war but can’t get health insurance from these companies on their own.

    • billbillbillbill says:

      I have a child only policy since the “family” rate from my employer is so much higher than the “couple” rate. It is cheaper for me to use the couple rate and then pay for my 1 child. Now, once baby #2 comes along, that will change.

      Not sure how popular it is but it has been a good program for us. I have heard nothing of ending it in my insurance company but I wouldn’t be surprised.

      • billbillbillbill says:

        Great, just checked the website of my insurer and they stopped offering kids only plans last week so I guess this is not an option any more. Thanks Obamacare

        • PunditGuy says:

          Relax, you’re grandfathered in. They can’t yank your policy. You just can’t take out a new policy on kid #2.

  21. Consumeristing says:

    Nice cover there for the administration Consumerist. Here’s what Obama promised that his plan would do: ” If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. “

    He lied.

    • crashfrog says:

      No, he didn’t. They’re not taking away health insurance for children that they’ve already sold, they’re just not selling any more of these individual child plans.

      So, yeah. If you like your health insurance, or your child’s, you get to keep it. If you liked someone else’s child’s health insurance, sorry, you can’t have it, but Obama never promised you could.

      Learn to read articles, Teatard.

    • Evil_Otto would rather pay taxes than make someone else rich says:

      Who’s taking away a doctor or a plan in this case? This article is about insurers refusing to issue NEW plans.

      Oh wait, it was a (marginal) chance to pile on the Obama administration. Never mind. Reading comprehension is obviously optional in this case.

    • Consumeristing says:

      I see the Obama dickriders are spinning just as fast as they spin on his dick. Sorry, but presidential protein is not substitute for health care. The article states that as much as 500,000 children nationwide would be affected and not get the same benefits as they would previously enjoy from insurance companies due to this law.

      Of course, the Obamabot solution to all of this: Force children to buy health insurance.

      • Mecharine says:

        Someones got pent up homosexual tendencies, I see…

        See what I did there? I acted like a jackass, it aint so cool is it?

  22. Awesome McAwesomeness says:

    I wonder what would happen if no one had any insurance. Doctors could get rid of insurance billers and accept cash up front. Maybe they would charge less to cut out the middle men. People might start using less expensive nurse practitioners to treat mild illnesses. We might think twice about that MRI for a few mild headaches ( you can get cash pay MRI’s for $400–which is less per month than my premiums.) People would be in charge of where their own health care dollars go. Hospitals could charge less and have payment plans–receiving a steady stream of predictable income.

    • pb5000 says:

      I would like to see this happen, but with high deductible insurance plans for a potential serious issue.

      • billbillbillbill says:

        Bingo, I don’t call my auto insurance when I need my oil changed. They are there for the major stuff. I wish Health insurance was similar. I can handle the office visit to tell me I have strep throat. When I am hit by a truck and need to be life flighted to the hospital, that is when I need insurance. The insurance business would be much better if they got out of the minor office visit business.

      • Simon Barsinister says:

        Let me tell you this is EXACTLY what I have and it is fantastic.
        I pay less than half of what I used to pay in monthly premiums. I pay for most routine things out of pocket (I still submit them to the insurance company so I can get the plan discount and so they can keep track of my deductible). If I or my family gets very sick the deductible is reached and the plan pays 100%.

        In a good year I will pay less than half what I used to pay. In a bad year I will pay slightly less than what I used to pay.

        Of course, the new health care bill, written by the insurance companies for the lazy for-sale congressmen, forbids my plan. I am looking forward to my health care bills more than doubling.

    • hypnotik_jello says:

      I don’t think the insurance companies or doctors would go for that idea..doctors peddle unnecessary procedures as sort of a CYA.

    • indeeme says:

      My doctor’s office charges $40 for a general office visit without insurance, $25 if I pay upfront and they don’t have to bill me later. As opposed to $1000 a month with a $3000 deductible for insurance that I might use three times a year and wouldn’t cover anything if I did. My last yearly bloodwork was $150 out of pocket. At the time, the hospital gave me their price list for out-of-pocket labs and mine was the most expensive on it. My generic meds are $10 a month.

      Has anyone actually asked their doctor how much a visit would cost if they didn’t have insurance? If my doctor’s prices are typical, then if everyone gave up cable t.v. we could all see the doctor once a month.

    • balthisar says:

      That’s kind of how it is in Mexico… it’s a cash business. Except for the people on the government plans.

  23. DJ Charlie says:

    Here’s one for you. I’m “locked in” on my prescription coverage until November (dropping that FAST soon as Nov 1 hits, too). Over the last few months, every time my doctor puts me on a new medication, the insurance pays 80%. But then less than a week later, I get a letter from the insurance company saying “Effective (today’s date) we no longer cover this medication.” How can that be legal?

  24. Sarcastico says:

    Aetna hates my entire state [Alabama] as they recently informed me they were no longer writing individual policies in my state.

  25. pot_roast says:

    Yup… good ol’ Obama sure fixed up health care and protected the innocent children alright…

    As if they didn’t see this coming. They should have, especially since the head honchos at WellPoint basically wrote the health care bill.

    Here’s a very Democrat/liberal blog noticing the same thing: http://fdlaction.firedoglake.com/2010/03/29/baucus-thanks-wellpoint-vp-liz-fowler-for-writing-health-care-bill/

    We got snowed so bad.

  26. axiomatic says:

    If my employers insurance drops my kids. Right at that point I stop using my employers insurance and get my own insurance. I flat out refuse to pay in to anything that is not inclusive of my kids. I have a feeling my employer counts on me dedicating part of my paycheck to their insurance costs. When enough employees pull out of the corporate insurance (scam) the corporations will force the insurance companies to start covering the kids again.

    • shibblegritz says:

      Um, no, the corporations will just stop offering insurance. They’re going to anyway. It’s going to be cheaper for a lot of corporations to just pay the “fine” for not offering insurance. The competitive advantage of having insurance dies the moment people can get portable insurance on the exchanges, and corporations will quickly start dropping coverage for employees. Within five to 10 years, I predict there won’t be a major corporation in America offering health benefits.

      If you think corporations are somehow getting fat off of health insurance premiums, you might want to spend some time talking to a benefits manager. I think most executives would love to be rid of the albatross of administering insurance benefits so they could focus their efforts more closely on their core business.

  27. Ichabod says:

    Another reason why vigilantism is not such a bad word.

  28. Liam Kinkaid says:

    If you ever thought discourse on The Consumerist was uncivil, you should check out the comments on this and other Chron.com stories. That being said, I comment on there quite a bit, trying to bring sanity back to these rootin-tootin cowboys that learned how to work a computer. Here’s one of my comments on this article (apologies for wall-o-text):

    The reason healthcare is so expensive is because of health insurance. They are purely profit driven. The two ways to increase profit are to increase revenue and decrease costs.

    The way they increase revenue is by obtaining more customers. If healthcare was priced as a normal good, no one would need insurance. So, insurance companies negotiate with doctors (and hospitals, etc.). The deal they make is this: Dr. So-and-so, you want to target $70 from each visit, right? Well, we’re only going to reimburse you 35% after you collect the co-pay of $30. So, if you want to make up that $40, you have to set your billing at $145. The doctor sets his visit price at $145 and submits the bill. He’s already collected $30, and the insurance reimburses 35% of $115, or ~$40, so the doctor has his $70 and he’s happy.

    With insurance, your doctor charges $145, instead of $70. With this increase, you think “wow, I better get insurance to help with the skyrocketing cost of healthcare!” Of course, the insurance company is only paying out $40, when you visit the doctor. They’re collecting many, many times that every pay period from you. Hospitals work much the same way, as do pharmacy plans. Don’t buy into the baloney that “research and development costs” or “FDA approval costs” are why drugs are so expensive. The pharma companies can make the EXACT same drugs in Canada and in European countries, which has as strict approval processes and sell it for 10% of the cost. The drugs are made on the same machinery as they are here and are made with the same chemical ingredients and are made to the exact same tolerances. The reason the drugs are so expensive here is because, again, the insurance companies. They backroom wheel and deal so the pharma companies have outrageous non-insurance prices so you feel you have no choice but to have insurance because you might not be able to afford the drugs if you happen to get sick.

    The other way to increase profits is to decrease costs. Of course, they could do this by lowering executives’ salaries, but that’s not gonna happen! What they do is analyze claims that come in to try to find any chance of denying that claim. Wellpoint recently targeted breast cancer sufferers for policy cancellation shortly after their diagnoses. Why? Because breast cancer is costly to treat. Even though these women kept their part of the bargain and paid their premiums, Wellpoint figured that they didn’t have to keep up their end.

    In short, insurance companies are scummy, scummy entities. They bought and paid for Congress in order to stay alive so they can keep up their practices. They make money hand over fist by exploiting US and they will continue to do so.

    • Consumeristing says:

      Obamacare institutionalizes the existence of insurance companies by forcing us to buy their products.

      • Liam Kinkaid says:

        Of course. The whole healthcare “reform” was derailed and corrupted by Big Insurance lobbyists. Of course, it didn’t hurt that there were Congresspersons (on both sides of the aisle) absolutely itching to be corrupted.

      • dolemite says:

        Correct…should have abolished health insurance and gone with universal care, just like every other industrialized country in the world.

  29. macruadhi says:

    A question and a solution. Why is this whole thing referred to as “Healthcare reform”? Isn’t is actually “How you finance your healthcare reform”? I mean there is NOTHING wrong with our healthcare system. Folks with terrible diseases are cured or suitably treated every day. If we want to talk about reforming healthcare, look at Canada, they actually have people crossing the border seeking proper treatment of their illnesses, or, since Canadians can’t legally pay for their own treatment, obtained from human medical professionals, have gone to veterinarians for diagnostic treatment.

    And now, for the solution. No coverage for chronic lifestyle related illness. You’re fat, diabetic, etc, and the illness you present to the doctor can be related to your lifestyle, you pay 100% of your bill. If your an alcoholic or drug addict, you get one chance, no more. You smoke and present with COPD, asthma, or have a lung trying to escape your chest, no coverage for any of these maladies.

    Coverage, however, will be extended to those who are physically or mentally disabled. Treatment due to accidents related to lifestyle will be covered, until it is seen that there is a trend forming. Like injuries related to “adventurous living”, racing, skydiving, extreme sports, etc.

    • dolemite says:

      I think you’ve been listening to Rush too much. Canadians are not flocking to America for “proper” coverage. Most of them are happy with their coverage. There are some procedures that have wait lists, same as in the US. And if you have missed it, there actually ARE thousands of Americans flocking to other countries for procedures, because insurance won’t cover it, and/or it costs 10x more here. And the majority of the procedures go off without a hitch. Now, there are some horror stories of something like back alley botched liposuction or something, but of course the media will focus on those instead of the inexpensive drugs/care many countries offer.

      Make no mistake, our healthcare costs more than any other country, but our system is far from the best. In fact, it was rated #37 out of all of the healthcare systems in the world by the World Healthcare Organization, years ago.

  30. SteakNeggs says:

    I knew someone that would only sign up for insurance when his wife was pregnant. They would pay a couple hundred dollars in fees for a couple months but the insurance company was on the hook for tens of thousands of dollars for the delivery and post care of the baby. After about 6 months they would drop the insurance.

    I know a lot of people hate people who make money, especially consumerist readers, but c’on, it’s a two way street, there are citizens who abuse situations like this. Why wouldn’t someone sign up their children for insurance once they became sick then drop when they are done? If they are allowed to do this, who is going to pay for it?

  31. SteakNeggs says:

    I knew someone that would only sign up for insurance when his wife was pregnant. They would pay a couple hundred dollars in fees for a couple months but the insurance company was on the hook for tens of thousands of dollars for the delivery and post care of the baby. After about 6 months they would drop the insurance.

    I know a lot of people hate people who make money, especially consumerist readers, but c’on, it’s a two way street, there are citizens who abuse situations like this. Why wouldn’t someone sign up their children for insurance once they became sick then drop when they are done? If they are allowed to do this, who is going to pay for it?

  32. Consumeristing says:

    BTW, I didn’t see this story on another Obamacare-induced cuts on health insurance coverage offered by colleges.

    “WASHINGTON — Colleges and universities say that some rules in the new health law could keep them from offering low-cost, limited-benefit student insurance policies, and they’re seeking federal authority to continue offering them.

    Without a number of changes, it may be impossible to continue to offer student health plans, says a letter that the American Council on Education sent Aug. 12 to Health and Human Services Secretary Kathleen Sebelius, signed by 12 other trade associations that represent colleges.

    Additionally, the colleges say that some provisions of the law don’t apply to their policies, including those that require insurers to spend at least 80 percent of their revenue on medical care and that bar them from setting annual coverage caps.

    More than half of colleges nationwide offer student insurance plans, according to a March 2008 study by the Government Accountability Office. While 80 percent of college students were insured, often through their parents’ coverage, only 7 percent bought their own policies or purchased school-based plans, according to the GAO.

    Starting in 2014, the new health law bars annual caps such as those in student health plans. Starting this year, insurers must offer at least $750,000 in coverage per year, although insurers or employers can apply for waivers from that restriction.

    Colleges say their plans don’t fall under the annual cap requirement because they’re considered “limited duration” policies, meaning they expire after a certain number of months, generally the school year.

    Read more: http://www.mcclatchydc.com/2010/08/23/99550/colleges-say-new-health-law-may.html#ixzz10MzbbULG

  33. Consumeristing says:

    And who didn’t see this coming?

    “Health law could ban low-cost plans

    Part of the health care overhaul due to kick in this September could strip more than 1 million people of their insurance coverage, violating a key goal of President Barack Obama’s reforms.

    Under the provision, insurance companies will no longer be able to apply broad annual caps on the amount of money they pay out on health policies. Employer groups say the ban could essentially wipe out a niche insurance market that many part-time workers and retail and restaurant employees have come to rely on.

    This market’s limited-benefit plans, also called mini-med plans, are priced low because they can, among other things, restrict the number of covered doctor visits or impose a maximum on insurance payouts in a year. The plans are commonly offered by retail or restaurant companies to low-wage workers who cannot afford more expensive, comprehensive coverage.”

    http://dyn.politico.com/printstory.cfm?uuid=142CBE3B-18FE-70B2-A82B15071E682918

  34. dolemite says:

    “on the backs of children and families that need their help”. To me, this is the “exasperating” thing. When are people going to learn…these companies are in it to make money. Not “help people”. Not just good profits, not great profits, but obscene profits. They gladly let thousands of people die just so their profit margins are nice Letting corporations run our healthcare system was probably the worst mistake we’ve made as a country. Rates/deductables are going to continue going up every year, indefinitely. It doesn’t take a math wiz to realize that if it keeps increasing at a rate that is double inflation/the cost of living, it won’t be too long before the majority of companies/people can’t afford it at all. You might get a 1-2% cost of living raise per year (if you are lucky), but insurance is climbing about 5-6% per year (more depending on how you look at it).

    And the “health care reform” is merely going to make this all worse. Congress had the chance to really make a difference with true universal care, but they flopped and now we merely have insurance companies can’t deny coverage, so they just won’t offer coverage.

    • Mike says:

      “Congress had the chance to really make a difference with true universal care”

      SHHHHHH, Glenn Beck’s chalkboard told me that this is a socialist idea, therefore it is terrible.

  35. DanRydell says:

    “We don’t know why the insurance companies are so worried about having to pay for kids with pre-existing conditions. After all, insurers have had no moral quandaries with practicing recission on policy holders withbreast cancer or HIV.”

    Do you even understand what you’re writing about?

  36. BettyCrocker says:

    Access to health care should be available to everyone regardless of income. The rich are no more deserving of life than the poor.

    Could you bear the thought of your mother, child or spouse being denied access to the very procedure or medication that could save their life? And why? Because you don’t make as much money as someone else does?

    Why don’t you think about telling your child that they will die because you can’t afford for them to live?

    Think about losing everything you own in an effort to keep them alive… only to be denied treatment when the money from the sale of your house, your wedding rings, your car etc runs out. And then you’re out of money and they are out of time.

    No one understands until they no longer have health insurance. You question everything… you don’t let your kids do things because if they get hurt falling off a bike and break their arm, it’s going to be paying for that or groceries/rent.

    If you’ve never been without insurance, you will not understand.

    When they pulled the public option out of the health care bill, they should have scrapped the entire thing. It’s worthless without it. Affordable health care should be a right – not a priveledge.

    • NeverLetMeDown says:

      All right, what health care? Everything for everybody? Who says “that’s too expensive, you’re not getting it?” In every system worldwide, regardless of how good, there are some things that won’t be paid for. Health care provision isn’t free, and some method of rationing has to be delivered.

      Think of it this way: if there were a procedure that cost $100k, but could extend the life of a comatose patient by two days, should the health care system (however funded) pay for that?

      • crashfrog says:

        Maybe we could have a government panel that would assess the effectiveness of medical procedures, as a guide to which ones were effective treatments and which were effective boondoggles. And maybe we could have doctors advise terminal patients on when it made more sense for them to get hospice care than ruin the quality of their last days of life on an expensive wild goose chase.

        ..you know, all those things that were in the ACA bill before Sarah Palin told the teatards about “death panels.”

        • NeverLetMeDown says:

          I 100% agree with you. The UK does this right with QALYs (Quality Adjusted Life Years), which allow for a reasonable conversation about what to spend on, and what not to.

    • shibblegritz says:

      Single payer systems deny care too. You’re fooling yourself if you think single payer is a panacea.

      • shibblegritz says:

        For instance … a case in Great Britain where a man with a wife and a four-year-old girl, I think it was, was denied coverage for a potetially life-saving cancer treatment because the government system concluded it cost too much and would likely only extend his life a little bit.

        Government plans are as cold and calculating as private plans. In fact probably more so because the private insurers have to respond to public relations pressure, while the government can just misdirect you for a few months until you forget about it and vote the bums back in.

  37. Dallas_shopper says:

    I don’t want any passive-aggressive chest-thumping out of DC politicians when they won’t support a national single-payer system. Fuck all of them.

  38. momtimestwo says:

    I just want what they have in Europe, Australia, Canada, etc. It may not be perfect, but at least everyone is covered.

  39. TuxthePenguin says:

    Let me say something and be perfectly clear.

    If you child is already sick and you go to get insurance, you’re not really trying to get insurance. You’re trying to get someone else to pay for things.

    Insurance is a hedge against risk. You foresee a risk in the future of a 100k liability, but maybe it’ll only happen 1% of the time. You would be willing to pay 1k now to someone to hedge against that uncertainty. That person will want a premium on that amount to make it worth their while (after all, they’d just go to someone asking for $1 to hedge against their thousand dollar risk). That’s all insurance is.

    Our medical insurance, whether its through the government, for-profit or non-profit sources, is being treated more as a prepaid medical expense than insurance. I’ve argued that before, but lets argue it again. The concept behind insurance is for rare, catastrophic events. The more common something is, the cheaper it is (*usually*). The more common something is, the more you’ll have to pay someone to hedge the risk for you. Its just the way hedging risk goes, whether it is health, default, auto accidents or loss.

  40. Mike says:

    I lived in Canada for four years. Sure taxes were a bit higher, but when I got back to the states and saw how much health insurance was I realized it was MUCH cheaper to pay taxes into universal health care than it was to buy private insurance.

  41. tom___ says:

    Here is the problem. The insurance company is working for their shareholders. I want my health insurer working for me, and currently the only entity who works for me is the US Gov’t. Hopefully someday we will have a public health insurance.

    • Mike says:

      YOU SOCIALIST!

      You expect everyone to contribute to one health system through taxes so we can pool risk into one big pool across the entire country?!?!? In your system both healthy AND sick people will be chipping into the system. Sick people are NOT profitable. How will health insurance CEOs be able to buy yachts when our health care is no longer about making money? You are all about class warfare aren’t you? You must hate rich people because you want health care for all.

      As someone told me once on consumerist: Go to Cuba.

  42. mannyvel says:

    This was a pretty obvious consequence of the health law. Insurance companies offset sick people with healthy people. If you’re insuring a child, that generally indicates that the child is chronic and will be a huge money loser, from an insurance perspective. Why would you bet on a loser, financially speaking?

    Remember, the whole point of insurance is simple: money spent on claims has to be less than the money paid in premiums. Nobody except the government can spend infinite amounts of money. The Obama administration deliberately ignored this basic idea, or thought that insurance companies wouldn’t act in their own self-interest.

    And yes, I wrote both of my senators pointing this out. It’s not that hard. Once more of the act kicks in the smaller companies will start to fold, once they realize that the insurance business isn’t a viable business anymore.

  43. tz says:

    And you wonder why people like me were pointing out the bill was a gift to big insurance?

    Isn’t wonderful – the kid will be thrown in jail by the IRS for not having insurance which is too expensive for anyone but Gates or Buffet to purchase.

  44. Sys Admn says:

    If you can’t be denied for having a pre-existing condition, who the heck is going to buy the insurance until they need it? And if they don’t, where is the insurance company supposed to get the money to pay the claims? Doesn’t anyone understand how insurance works? Spreading risk over wider pools? Like most politicians (Republicrat or Democan), Obama apparently thought economic laws would bend to his wishes.

  45. Gregg Araki Rocks My World says:

    Companies are so concerned about enriching their shareholders that they forget that their decision affect peoples lives in serious ways. Abolish them.

  46. ReverendTed says:

    Imagine if it was legislated that banks could not deny mortgages to people based on their prior credit history.
    (Un)Fortunately for us, the banks ran that experiment on themselves already.
    It should come as no surprise that a preponderance of high-risk investments results in a preponderance of financial failures.

    I understand that the idea is requiring everyone have insurance will dictate the healthy (who used to find other things to do with their money) fund coverage for the ill, but the “require everyone to have coverage” part hasn’t gone into effect yet.

  47. Endgame says:

    They cry poor from there beautiful, plush Mansions

  48. Puddy Tat says:

    I agree with stock2mal lets close the doors on WellPoint’s Anthem, Blue Cross, Cigna and all these others and just open up Kaisers offices country wide.

    When I go to my doctors office at Kaiser I get taken care of promptly without any of the run around and Bullsh*t that comes along with the Hellpointes Anthem! I believe their policy is run them around enough and they won’t come and SEE THE DOCTOR.

    The system is broke and there is no fixing it!!!

  49. grumpygirl says:

    What’s bizarre is that some people didn’t realize this would happen when the health care bill was signed into law.

    When discussing this with people who supported Obamacare, I was told that I was a racist because I would not support the bill on account of consequences such as this.

    As badly as I feel for the kids who won’t be getting any health insurance, it’s true that voting Americans get the government that they deserve. I hope all my fellow Americans who thought I was a racist (and who never hesitated to say it to my face) for opposing this healthcare law choke on it.