I am a retired health insurance underwriter, and for 50 years, I made life and death decisions about prospective insureds. It was actually very simple. If the applicant had a disorder that was likely to cost more than the premium we were likely collect from him, he was declined. If the entire group of employees of an employer had a individual that had a disorder that was likely to cost us more than the premiums we recived, the entire group was turned down. For example, a group of 25 employees and their families, who had an individual who was on a heart tranplant waiting list, would have coverage denied for the entire group. In addition to that, employers knew that Bob's wife, Mary, who needed the transplant, was the reason that he could not buy health insurance for his employees. Therefore, "business conditions" often caused Bob's employer to lay Bob off. Then, after Bob's COBRA ran out, Mr Employer no longer had the curse of the health insurance underwriters hanging over his head, and was free to buy group health insurance.
.....and you guys on the Right think that this is a GOOD system....
BTW, Down's Syndrome was an automatic "decline", so Paliin would never have gotten past me....