Update on proposed Pre-existing Conditions amendment


And what happens if someone…Due to no fault of their own…Gets this “gap” in coverage? Say for instance intense radiation treatment, some major surgery, etc, that makes the person unable to work as part of their recovery process and this results in them losing their job…and thus…Their coverage?

I think the biggest disgrace is that the legislators don’t have to live by the same laws that they pass.

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From InsulinNation:
"Introduced by Representative Tom MacArthur (R-New Jersey), this amendment to the previous bill would give states flexibility for determining:

Whether people with preexisting conditions could be charged more than the average population for coverage
What essential health benefits insurers must cover […]

States would apply for a waiver from federal health insurance standards to make these changes. State officials would have to attest, but not prove, that the changes they make would do one of the following: lower premiums on average, boost enrollment, stabilize the health insurance market in the state, or stabilize the price of premiums for people with preexisting conditions.

If granted a waiver, states could then allow insurers to charge more for those with preexisting conditions who let their coverage lapse, as long as insurers established a way to make sure people with preexisting conditions had access to coverage. They also could determine what benefits insurers need to cover for the conditions, and whether there would be a lifetime cap on benefits. […]

So far this amendment has been panned by JDRF, the American Medical Association, the American Hospital Association, and AARP, among other organizations."

I haven’t had time to read the article yet, but historically cobra has been what covers such gaps in coverage… it was designed to ensure that all people were able to prevent any gaps in coverage… which is what people with preexosting conditions used to have to make sure to avoid

No they are saying if you drop coverage for 60 days, premiums are allowed to spike by double or more… States and insurance providers can decide

Yes, but with cobra there is no reason for anyone to ever allow their coverage to lapse… or at least that’s the design

Assuming one can get cobra. Cobra had qualifications also.

I’ve not heard any talk of one having cobra negating this 60 day gap clause.

There is no gap if you activate cobra, which can be done retroactively to a point. Gaps in insurance are pretty much avoidable as long as you can afford to pay for cobra. Everyone concerned with preexisting conditions should ensure they have enough saved to cover cobra in an emergency

That’s what the COB stands for… continuation of benefits, to allow for hapless insurance coverage when people lose jobs, change employers, whatever the case may be

Let’s say someone had no family, has Diabetes, and they get into a car accident and end up in a comma for six months. How would that work? They can’t enroll in cobra or anything else in a coma. So when they wake up.? Everything is suddenly much more expensive.

Just one example…

I don’t know how that would work, by the same logic they can’t sign a consent to treat at the hospital and receive treatment either…

No consent is necessary for an unconscious patient where no family is known to exist or cannot be located.

That is incorrect, @Sam. COBRA only applies to people who get insurance through their work. There are many tens of millions of people who don’t As far as I know, at least 70M people in the US, possibly more, don’t. Someone may know better than me on this subject.

For instance, most anyone who does not get 40 hours per week is not covered – many employers make sure that they will give their hourly workers just below the max number of hours needed so they don’t have to pay for health insurance.

FYI - I have started several companies. Several of them I bootstrapped, i.e. we didn’t have the income or the money to pay people what they were worth. But I ALWAYS set up health insurance for EVERY employee working for me. Once, I was not able to draw a salary for 2.5 years – but I always paid my employees’ health premiums on time :slight_smile: I have also had several nannies taking care of my kids in the past. I am not quite sure why a bunch of politicians get caught – I have always paid taxes on my nannies AND given them health insurance. I find the custom of not providing health insurance for your employees repulsive. I am sure many of these employers go to church regularly – I don’t really know how they find themselves worthy of any congregation – let alone look at themselves in the mirror. I despise these people, their executive board, and their investors.

But – this is just why I think it is so important to make sure that there is a form of health insurance that EVERYONE can get, regardless of their employer or their employment status. It should not be a privilege to be able to get medicine that will stop you from dying – such as for diabetics. You cannot count on so-called “paternalistic” capitalism to protect employees from sheer greed.

And – I also think that a low-income diabetic should NOT have to pay any more than another person. What makes them able to shoulder a higher burden? For many, just being able to afford health insurance on a low income is extraordinarily difficult. Getting charged two or three times more – how in heaven can they afford it?

Sorry – but that is just WRONG. It is condemning some people to death, or to a life that nobody should be compelled to live – particularly when you have to live a life of marginality, with episodical employment where you cannot choose when you eat and what you eat – something that makes surviving with the “old diabetes technologies” a long-term impossibility – a delayed death sentence.


Also everyone is “advised” to have six months worth of money set aside as a cushion in case of job loss or catastrophic life event, etc… But only a snail percentage has it. A large amount of Americans live paycheck to paycheck. They work longer for less while the 1% continues taking more.

Expecting everyone to have this cushion for cobra is a pipe dream… Not because they’ don’t want to save more… They just don’t have more to save.

Well yes, COBRA is the mechanism that allows the employee to pay the insurance benefits themselves, if their employer stops doing so to prevent a lapse in coverage.

If an individual or family is already paying for their own insurance outside of their employer there is even less reason to ever let coverage lapse… because they’ve been paying the bill all along…

There are always extreme cases like the one above with someone who has no family getting into a six month coma and there should always be safety nets to protect those extreme cases, but we as Americans generally also need to start taking some personal responsibility…

and of course the underlying problem is still that the cost of healthcare is so high that we need someone else to pay for it… solve that problem first and everything else will fall into place

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What if they want to switch insurance companies? What if they just left their parents’ insurance company? What if they were expats in a foreign country? What if they were just in jail? What if they are legal immigrants? I could keep on going with probably 200 or 300 cases that will find the myriads of cracks in your assertion.

COBRA works if:

  • you were employed

  • you are now unemployed and you have money to pay an expensive premium

  • you will find another job which provides you with health care within 18 months.

That is what it is designed for. It works well for that – not for anything else.

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Except that if they lose their job they can’t pay anything… Including healthcare.

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Which are the rules I’ve knowingly had to play by for my entire adult life… I had to stay on my parents insurance until I got my first real job that provided my own. I had to learn the skills to get a good job with insurance, I had to make sacrifices to save enough to have enough savings to pay for coverage myself if I had to (I bet I drive an older car than anyone on this forum)… as long as we know the rules the game doesn’t seem that unfair to me…

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You might be able to follow them because you are in the mainstream, but they can’t be applied by another 70M people who can’t make them work for themselves. I just gave a list of examples where these rules cannot work, and could find many more.

I don’t think you do. I still have a 1991 Acura Integra. Now show these cards of yours :slight_smile:

That’s assuming everyone had the same opportunities and luck that you’ve had. Everyone’s life, opportunities and circumstances are different

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Well you’ve got me beat in age but yours is worth a lot more I bet… 1993 dodge Dakota here

You could probably sell yours and get at least 1 month of Obamacare;). Me, not so much