Obamacare is eliminating all those crappy individual policies, so it's really okay, right?

Great Debates
1

This talking point comes out in virtually all the talking head debates. Typically, I’ve seen it in the form of weasel words against some unstated definition.

“Many of these policies were terrible anyway!” “Lots of people had policies that weren’t worth the paper they were printed on. There were almost worthless.” Etc., etc.

“Many” and “lots” are weasel words. And this whole “substandard” argument begs the question. I have not seen much that (1) defines “crappy,” (2) explains why this definition is self-evidently bad and not just a matter of personal choice, and (3) provides details that show that a material number of people are in this category. I realize this would still have an element of subjectivity. But I reject out of hand the constant chorus of “Obamacare is finally addressing all this substandard coverage” with regard to all the recently cancelled individual health policies unless someone can substantiate it. There’s too much dishonesty that has already been demonstrated in this debate, so we all need to be skeptical.

If someone asserts that anything that doesn’t possess all the minimun Obamacare standards…

[quote]
The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures that health plans offered in the individual and small group markets, both inside and outside of Affordable Insurance Exchanges (Exchanges), offer a core package of items and services, known as “essential health benefits.” EHB must include items and services within at least the following 10 categories:[ul] [li]Ambulatory patient services[]Emergency services[]Hospitalization[]Maternity and newborn care[]Mental health and substance use disorder services, including behavioral health treatment[]Prescription drugs[]Rehabilitative and habilitative services and devices[]Laboratory services[]Preventive and wellness services and chronic disease management[*]Pediatric services, including oral and vision care[/ul][/li][/quote]
…is substandard, for everyone, every instance, I reject that as nonsensical. A single man, for example, could well decide that a contract that doesn’t provide maternity care is fine, and he’d prefer not to pay for it. But perhaps you have a different opinion. If you assert any contract that doesn’t possess ALL of these is a “crappy” policy, I will think it a silly position, but at least I’ll know where you stand. I haven’t heard even the most partisan talking heads take this stance, however.

In any event, my purpose for the debate is not to discuss the philosophy of “good care,” it’s to ask for the factual basis for the assertion that “Obamacare is remedying the large number of crappy individual policies out there” in response to the shit-storm over all the cancelled policies. No anecdotes, please. What defines “crappy”? How many of the cancelled contracts fit into this category as you (or some expert) define it? Details, please. I am really interested.

2

Overpaying for services you don’t need subsidizes insurance for people who otherwise would be too costly to insure. In that respect, a barebones policy is crappy for somebody’s purposes, just not necessarily yours.

3

I think that’s it right there. I would never voluntarily sign up for maternity care or even mental health care, but if you want it to be relatively inexpensive for the people who do need it, then you have to subsidize it.

But it’s more than just the list the OP gave. Obamacare requires that there be no lifetime caps and no screening out of people with pre-existing conditions (for example). If your policy has those, it’s probably cheaper. But then, those are things the legislations is trying to get rid of.

4

I don’t have a prostate or testicles, can I get out of paying for testicular and prostate cancer? I’m not going to be impotent any time soon, can I get out of paying for Viagra. My kids are neurotypical, can we not have any coverage for autism, ADD, ADHD in our policy? I’m still fairly young, I shouldn’t need to pay for any geratric services. I don’t have diabetes and am not likely to get it for another ten years, can I pick up the coverage then?

If we want a cafeteria plan where you only pick up coverage on the things you need coverage for, you are getting towards fee for service, not insurance. And signing up for insurance would be a nightmare of check boxes (glaucoma, no - mental health care, yes - mammograms, yes - obesity treatment, no, about ninety pages of it).

5

Especially when you consider that having a prostate could be considered a “pre-existing condition” and you get billed more. Just kidding! They only did that to women!

6

A friend of mine’s doctor said “all men, if they live long enough, will get prostate cancer. For most who get it though, they’ll be so old when it arrives and it will move so slow that it won’t be what kills them.”

He’s exaggerating. But I’m not sure by how much.

7

Men have always paid more for auto and life insurance. I don’t see anyone screaming “discrimination” about that.

The insurance plans that pay for Viagra, et. al. (and Medicaid and Medicare Part D(isaster) are not among them and haven’t been since 2006) have limits on how many you can get, usually 6 doses per month, and some plans have age limits unless a man has a documented condition that can cause impotence, like diabetes or spinal cord injury. That age is generally 50. You’d be surprised at how many women use these drugs for their own sexual dysfunction. If someone is using it for primary pulmonary hypertension or BPH, insurance will (and should) pay.

8

Thanks for the responses, but I already understand why Obamacare needs the healthy guys paying more premiums, and why permitting people the option of buying only the minimal coverage they’d prefer fouls up Obamacare. What I’m questioning is the prevalent talking point regarding the individual contracts being cancelled that is a variation of, “Well, yeah, but many of those contracts were crappy, worthless policies anyway.” IOW, this makes the sting of the cancellations less, because, gee, we’re just eliminating crappy policies.

Something like this might substantiate such a claim: “Studies have shown that 60% of the cancelled contracts lacked coverage for A, B and C,” where “A, B and C” constitutes someone’s definition of bare minimum coverage to avoid being a crappy policy.

Is there any detail to support the contention that some material number of the cancelled policies were substandard? Some definition of substandard? I might disagree with it, but at least it would be something. As opposed to what were currently have: a shapeless assertion.

9

Kinda avoids the more fundamental question: should it be legal to sell substandard insurance?

Ever see any of those ads on TV? Usually on the less popular channels of cable, the one’s that show re-runs of Matlock and Golden Girls, you see these ads from the Totally Benevolent Health Insurance Company, the one that doesn’t really care about profit, just doing its very best to help on out folks who are in their later youth.

You look at them, you wonder why we need any health insurance reform at all, when you see this marvelous product, that ensures a senior citizen that they will have total coverage with no deductions, no health examination required, just pay your modest premium and sign up and you never have to worry if you are the victim of an elephant stampede in a snowstorm on the 4th of July. Not that you ever did, but you never will need to!

I’m just guessing here, but I’m gonna take a wild stab at it and suggest that we both agree that such a load of crap is “substandard insurance”. Or if not so defined, then “a load of crap” that ought to be defined as substandard insurance.

If you can talk somebody into buying that load of crap, and they do so willingly, does that make the transaction legitimate? Do we approve of such behavior, do we condone and encourage that sort of thing? We won’t let someone beat you up and take your money because they are bigger and stronger than you, why do we let people steal money because they are smarter?

You’ve heard the stories, I’m fairly sure. How somebody pays through the nose for rock solid health insurance, totally covered for even the most grievous health issue. And then it happens and they ask for the money they are due and somebody tells them “Sorry, but you broke your toe when you were fifteen and you didn’t tell us about that precondition, so you’re boned. Here, have a calender and a ball point pen.” Well, if you’ve been badly done by, you can hire a lawyer and sue them! If you have any money left. You’ll have to shop for a lawyer of course, and they already have them. Experienced lawyers in the fine points of fine print.

As far as I’m concerned, that qualifies as “substandard”, being “beneath contempt” and “criminally greedy”. How about you, have we an agreement that “substandard insurance” is an actual thing, and is actually being sold, and that the people who buy that might best be regarded as victims?

The question to ponder then isn’t so much whether or not it is a legitimate concern of the state to declare such policies “substandard” and forbid insurance companies from selling them, the question is why we let them get away with this shit for so long.

10

Pre-ACA, you effectively did get out of paying for coverage for testicular cancer through underwriting. Sure, your policy technically covered testicular cancer, but as a woman, the underwriter would have charged you near $0 for that particular coverage. Similar to a man and maternity benefits.

Now, the new rules prevent ANY type of underwriting except age and sex. That’s it. If I have stage 4 testicular cancer, you pay the same premium as me. That’s why the OP is correct: many of the old plans weren’t “crappy” or substandard; they simply didn’t meet the administration’s social policy.

11

Except I didn’t, because I’ve always gotten insurance through my job, where I was offered something a lot like “Bronze” “Silver” or “Gold” plans that had the same premiums regardless of if I was male or female, young or old, an obese smoker, or marathon runner. Now, Bronze didn’t cover maternity care, chemical dependency or mental health, but it didn’t cover it for men or for women. And within the past five years, there was a “discount” if you were a non smoker, and another “discount” if you belonged to a health club. So, maybe thirty years of paying for insurance this way has formed an acceptance of something that is unfair, or maybe, since this is the way its been for millions of Americans getting healthcare for decades, this isn’t that unfair at all.

12

You’re talking about “group plans”. But you’re responding to a post about “individual insurance”. “Group”. “Individual”. See the difference?

13

Many of them weren’t “crappy and substandard”? Which ones? And the others, the ones that really *were *crappy and substandard, is it “social policy” to get rid of those? Nanny-state?

How long do you figure we have put up with that shit already, and how much longer do you suggest we continue?

14

Yes, but as part of a group, I have been paying for my non-existent prostate all along, so I fail to see what the big deal is. We’ve simply made everyone a member of the group - which is what insurance is supposed to be.

15

Because you were in a “group” policy. You chose to be in a group policy instead of an individual one, because it made sense for you (mostly because your employer was paying for it).

Whether they wanted to be or not. Cuz we know what’s good for them.

16

Typical that gender reassignment should be an essential part of collectivism. Connect the dot, people!

17

Yes, that’s my question, basically, though asked a different way. What is the definition of substandard and what percentage of the cancelled individual policies were in that category?

This has not been answered, and that’s the essence of the OP. If 60% of the cancelled policies met some “reasonable man” standard of crappiness, for example, the public might react differently than if it’s half of 1%. Asserting that there are crappy policies out there, some number that’s not zero, is a “no shit” conclusion. We could conclude that about any market for any product anywhere. I’m asking what we consider substandard and how prevalent it is in the individual contracts cancelled, since this is routinely offered as something that mitigates the broken promise that people could keep their contracts. “Well, yeah, but many of them were just crap anyway.” Okay. How many, and what does “crappy” mean? Otherwise, this is meaningless.

18

By asking [del]how on earth could everyone possibly keep their policies[/del] what constitutes a “crappy” policy that should be done away with, you’re essentially querying what particular grievance might have brought war between Oceania and [del]Eurasia[/del] Eastasia. Why worry your pretty little head with such details? Obama will tell you as much truth as he believes you can handle.

In other news, four legs good, two legs bad.

19

I am with the OP, I’d like to see some numbers. The fact that I haven’t, despite looking and following the issue pretty closely, suggests the numbers probably don’t exist. They wouldn’t be that easy to compile, and it would probably take a long time to do so, it’s possible the numbers don’t exist as of yet.

With cancellations though there are three distinct types that I can see:

1. Bad policies, that genuinely suck - I’m not sure what the term for these are, but many of them were the type of policies very low income employers (McDonald’s for example) would “offer” for their employees. They also existed on the individual insurance market. These policies had very low lifetime limits, around $50,000 or so. They had moderately high deductibles (a couple thousand), and were not accepted by many doctors. They tended to still cost more than you’d expect, for not much coverage.

They were really akin to a really low coverage car insurance or something of that nature. It covered you for a “medium or small disaster” but any serious medical issue you were fucked. (Just like how the low coverage, minimum auto insurance policies can leave you significantly exposed if you seriously injure/kill someone in a car accident.)

These policies were genuinely bad and probably needed to be cancelled and no longer offered.

2. Policies that provided great options to the customers who chose to utilize them, but don’t fit Obamacare’s social engineering guidelines.

These are fairly good PPO type plans, many that previously had $1.5m or higher lifetime coverage limits (more than enough for most people prior to age 65, when Medicare kicks in.) They didn’t offer things like maternity care for male customers or mental health care to people that probably didn’t need it. (The most serious mental health issues typically manifest before age 30, and thus if you’re older than that and have not needed mental health services your chances of needing them prior to being old enough to utilize Medicare are minimal.)

These plans are the result of people making an informed choice. The PPACA took away this choice for social engineering goals. Whether those goals are worthy or not really is 100% outside the bounds of this thread. It is worth mentioning this is the type of cancellation the Obama Administration wants to minimize and barely concede exists, because they don’t want to openly tell Americans “we’ve made decisions about what you should pay for, even if it’s not good for your personally, because we have larger social engineering goals. That may mean you pay more, but we think it’s good for society as a whole so tough titty.”

3. Plans Cancelled due to State Economic Factors The famous Edie Sundby plan cancellation in California was not a bad plan by any measure. In fact, this individual insure plan from UnitedHealth had paid out over $1.2m over 7 years to help her fight Gallbladder cancer. It allowed her to have a primary oncologist at Stanford, a primary care team at UC San Diego, and allowed her to travel to Houston’s MD Anderson Cancer Center for additional treatment. She was receiving the Cadillac treatment of American medicine, the kind of care some rich people come from overseas to receive here.

Unfortunately for her, UnitedHealth only had 8,000 people in the individual market in California. As part of setting up the exchanges, State insurance commissioners wanted to keep the options below a certain number. If the exchanges offered 250 possible plans, the fear was it would dilute the risk pools too much and they would all be unprofitable. So smaller plans typically were not approved to be on the exchanges by State insurance commissioners. That is what happened to Edie Sundby’s plan, her insurer was not picked to be one of the 13 insurers that could offer plans on the exchange. UnitedHealth then made a business decision, that without access to the exchange customers they could not profitably continue to offer individual insurance in California, so they exited the market.

Her options on the exchange are far worse. She can at best get a plan that covers her visits to UC San Diego, since Stanford is in a different county, the best plans offered by Covered California will not cover treatments at both Stanford and UC San Diego. Coverage for trips to MD Anderson are 100% unavailable to her through any plan offered by Covered California. The only option she can get that covers visit to UCSD is an EPO option, which means UCSD would basically be her provider for almost all medical care. Any trips outside the UCSD network would only be covered at all if it was for emergency services.

Stanford accepts a PPO plan, but under Covered California the PPO plan Stanford accepts is not something residents of San Diego can enroll in. [So you literally have a crap shoot based on which county you live in.] I suppose one option for her would be to move to the same county as Stanford so she could get PPO coverage there and decent out-of-network coverage for treatment at UCSD. But that would still most likely be more expensive than her existing coverage and closes off options to visit MD Anderson in Houston.

These cancellations are probably rare, but still in the tens of thousands per state, and they are probably the least desirable/defensible cancellations because these are high quality plans that are simply being excluded from the exchanges because State insurance commissioners want to keep the risk pools small.

If say, 95% of the cancellations are Type 1 plans, then we probably don’t have a problem. But if a large portion fall under Type 2 and Type 3 then it’s undeniable: Obamacare is taking away good, high quality insurance from people who already have it and pushing them into inferior/more expensive exchange coverage.

20

http://thinkprogress.org/health/2013/11/07/2906471/cancer-patient-wall-street-journal-buy-cheaper-obamacare-policy/

An alternative view of the “famous Edie Sundby” case is herein offered. This view should be approached with caution, as it does not have the endorsement of Fox News, the WSJ. or Rush Limbaugh.