Pre-existing Conditions

This is a hot button, I understand that, but read and keep an open mind.

I have some family members who are not employed where they get healthcare coverage. They have tried to seek private insurance, willing to pay the premiums themselves, and they have been denied because of certain chronic health factors. At the same time they don’t qualify for state assistance. This means when they go to the doctor they have to negotiate a price and pay out of their own pocket. That’s not too bad, but a trip to the ER ends up costing them huge and there just isn’t much they can do about it.

In this case it seems only right to say that insurance companies cannot deny someone coverage because of a pre-existing condition.

I hope that this exact scenario is the reason for Section 111, of HR3200, which across the board prohibits insurance companies from denying coverage because of a pre-existing condition. I hope. But sometimes things that are put in place for good reasons have ‘unintended’ bad consequences.

Now, let’s think for a minute. Say Jane is in her thirties. She’s self employed and relatively healthy and only goes to the doctor every couple of years, so when it comes to insurance she decides to pass and pocket the money. One morning, Jane finds a lump. She goes to the doctor and finds out that she has an aggressive form of breast cancer. Facing huge medical costs as well as the personal and emotional trauma of the situation she goes and applies for insurance, which they cannot deny. She gets her coverage and begins treating her cancer. She has a mastectomy, but finds a lump in the other breast resulting in another mastectomy. She goes through chemo and radiation and is in remission. Things are improving. The insurance company is also required to cover breast reconstructive surgery after a mastectomy, so she decides to have that as well. She’s finally recovered from this personal struggle and she finally hears the words from the doctor that she has been waiting for, a clean bill of health. Fantastic! But, it’s been two years of struggle and she wants to do some things to have fun, go on vacation, buy a new car, live life again. So, she looks at her expenses and decides to drop her medical insurance since she really doesn’t need it anymore.

The insurance company has just fit the bill for two years of treatments, including multiple surgeries, very expensive treatments and medications, and has collected a tiny fraction of that money back in premiums. They are literally tens of thousands of dollars in the red for just one case. They are a company, with stockholders and investors, they have to show a profit, so they increase premiums across the board. Naturally that causes other people who aren’t in the midst of a personal tragedy to drop their insurance, knowing they can pick it up again should a tragedy occur.

Realistically speaking, how can the insurance company stay in business? Insurance companies don’t really make money off of sick people, they make money off of healthy people.

So then do we start bailing out insurance companies?

Undoubtedly you suddenly have people being dropped as insurance companies go out of business. Amid the national outcry to help the average family that is suddenly without coverage, the government steps in with a plan to help those who have been hit hard by this unfortunate turn of events.

Hmmm…

Public option or no public option, this bill has some good intentions with some very negative possible consequences.