As a follow up question, are American insurance companies refusing to pay for Covid treatments by saying it was avoidable or a force majeure (Act of God)?
No. I’ve never heard of that for any disease.
I don’t think you could really apply or justify a force majeure clause to health care coverage in general (although there are major medical policies that will specifically refuse coverage in the case of injuries as a result of risky non-occupational behavior) but there is a lot of speculation that force majeure exceptions may be called out to exempt insurers from paying out on business and mortgage insurance. Since this is pretty much an unprecedented event in terms of scale in a modern economy where this kind of insurance is available, who knows how it will pan out but someone is going to take it in the shorts.
The National Law Review: “COVID-19: Force Majeure Event?“
Stranger
This isn’t a force majeur; it’s a disease, not an asteroid strike or nuclear bomb.
But financially speaking, it might as well be either of those. This is something that’s not getting attention now but it will as this continues: the healthcare providers aren’t the only ones who didn’t factor coronavirus into their 2020 healthcare plans; insurance companies didn’t either, and that’s a problem. Anthem, Blue Cross, et al might well be the next AIG.
The optics of this, politically, are going to be explosive: health insurers asking for handouts at a time when ordinary people without jobs and without insurance are in massive debt.
Many force majeure clauses explicitly include epidemics and government-enforced quarantines as “acts of God”.
Stranger
Of course Americans realize that healthy people can get sick at any time. That’s why every American has a chance to fulfill their duty to society and buy insurance on the ACA at open enrollment time if they don’t have insurance through the government or their job.
The current pandemic will not break the business model. The people losing their jobs now are predominantly part time service workers that aren’t insured right now anyway. Those that are losing their insurance with their job have COBRA or the ACA. Meanwhile insurance companies have figured out that things might cause an increase in claims, that’s why they have investments and reinsurance, and since groups renew throughout the year they can start increasing premiums immediately. Meanwhile there’s a drop in expensive elective surgeries.
Finally, costs are going to be limited by the number of hospital beds available and people with Coronvirus either get better (or occasionally die), they don’t last in that state for months and months and years and year filing claims like cancer or congestive heart failure patients. Something like the sickest 5% already take up 50% of U.S. healthcare spending so above average so coronavirus isn’t as big of blip as you might think.
After I lost a job at the end of 2017 I tried to sign up for ACA insurance. I even went to a navigator for help.
My only income was UI which lasts for 6 months.
They told me I made too much each month to quality for medicaid (I was making more than 133% of FPL due to my UI payments) but I made too little on an annual basis to quality for private coverage subsidies since UI runs out after 6 months.
So my choice was to spend $400 a month on garbage insurance (pay the full price) or be uninsured. I picked the second option.
Its pathetic this is the best we could do with 60 senate democrats. In a working UHC system, the uninsured should be auto enrolled in medicare or medicaid.
There are more than just waiters and bartenders out of work due to the COVID-19 epidemic; essentially anyone in or servicing a service-oriented industry will be impacted, and many cannot afford to pay the total premium to maintain COBRA coverage. No actuarial model accounts for 100% of ICU beds being occupied across the entire country at once. The “drop in expensive elective surgeries” is a drop in the bucket, especially compared to the costs for maintaining a patient in ICU for weeks on end.
Stranger
Democrats had 60 seats for only a few months, and congress was in recess for most of that time.
This is true if you’re in one of the “good” states with the medicaid expansion. If you’re not, you’re SOL. See my previous post #12, 2nd paragraph, about people not so fortunate.
What’s needed is a cultural shift. You need more than just 60+ senators; you need 60 senators who fear their constituents if they don’t get universal healthcare done. The last financial crisis was a credit freeze and jobs crisis; this feels different. I said it on another thread and I don’t apologize for it: **I hope this breaks the entire goddamn system. **
One MAJOR reason the pandemic has gotten this damn bad in the US is because our health system doesn’t give people uniform access to the health system and doesn’t provide uniform results across the system. The GOP mantra of letting the free market and states become mini-laboratories for market innovation and democracies have failed to deliver.
Indeed.
That Democrats got Obamacare passed and into effect at all was a major achievement. This is what I’m referring to on the politics threads when I point out the difference between select a platform based on nothing more than ideals and one that aims for the ideal but knows opportunities when they seem them and seizes on them.
Obama knew that right in the middle of a jobs crisis, when people are unemployed long enough to consider life without employer-sponsored health insurance for a few months, is a good time to pitch expanding healthcare options, but not necessarily a good time to go full-on Bolshevik and promise permanent revolution .
This election and the aftermath of this year will provide new opportunities. We need to seize them and know when to cut a deal. I hope that the opportunity that we’re offered is a beleaguered health system in which right-thinking people agree that profit-driven health providers are no match for a pandemic, and that this is dangerous to public health, to our economy, and even to national security.
Who is asking for permanent revolution? A plan like medicare extra for all would’ve been nice.
The democrats win in a landslide, and they pass a tepid reform full of loopholes strategically designed to not offend the rich and powerful.
While the ACA is better than what we had before, it is in no way affordable. Since I purchased insurance from the exchanges, I can give a direct example. As a nonsmoker in my 50s, the absolute cheapest policy available (the one where you pay the first $7500) was over $800 a month. Back before the Medicaid expansion was passed, you started qualifying for subsidies at about $22,000 yearly. If you earned less than $22,000 yearly, you needed to pay the full amount (now that we have the Medicaid expansion, you get free Medicaid under that amount).Yes, it is a crappy loophole, but the ACA was designed to cover those people and the designers didn’t think that states would turn down 90% of the costs of covering low-income people, essentially screwing them over.
Now, if you qualify for a subsidy, it is capped at 16% of your income. If you earn $22,000 a year, you have to pay approximately $300 a month for insurance. That is the absolute cheapest you can possibly pay in Virginia. There is no way to get insurance in my area for $40 a month.
It wasn’t a landslide. If they had won a landslide, they would have had the votes to pass a friggin public option - they couldn’t even do that. It would’ve been great if Joe Lieberman and Max Baucus had been liberal democrats, but they weren’t - we’re not living in imagination land.
I agree it could be more affordable and it the premiums go up every year b/c ACA ultimately still trusted the insurance companies to act with some good faith - that little delusion was nice while it lasted.
I think the only way we’ll ever change the system is to have it collapse. This might do the trick. I hope it does. I know it’s cruel in the moment to want such a thing, but the reason we’re in this mess is b/c people never think about health insurance and how fucked up the system is, and will even defend it out of sheer ignorance because they’ve never had to use it for something serious. Maybe this is a game changer, but I won’t hold my breath. The current system needs to completely implode.
Well how are they going to pay a premium through the ACA when their income is $0? And if they’re in states without the Medicaid expansion, they’re even more screwed.
Plenty of people in this country don’t seem to understand how important health insurance is for everyone or even how it works, or else they are lying that they don’t. Americans seem to buy the argument that the uninsured can just go to the emergency room if they need care. They conveniently forget that an ER bill will be crazy expensive and someone with an ongoing chronic condition can’t get followup care there.
Actually that “drop in expensive elective surgeries” is causing some of the layoffs.
There’s also this report: