The Individual Mandate is only a 'pretend' law

[RDD_1210]

Yeah, I'm pretty sure it's still there. I'd have to go look it up again but it was there last time I checked.

Actually, it's not there. And there's a reason for that. Once you start down that road, you're re-creating the same problem they were trying to avoid - the dreaded 'pre-existing' conditions dilemma. Telling someone they can't get health insurance for another year isn't much different than telling them they can't get it at all - especially in the emergency scenarios you're proposing.

But pretending we can legislate away the pre-existing conditions problem is a fantasy. Insurance simply can't work that like that. You wouldn't expect someone to sell you car insurance to retro-actively fix your car after it's been totalled - and we can't expect health insurance to work any differently. What we're trying to do is to create socialized health care and pretend it's something different. But in that senseless denial, we're only enriching the insurance companies willing to play along with our delusion.

Actually, it is there. Did you actually bother to look? Because I did and it's there.

 

[dblack]

Actually, it is there. Did you actually bother to look? Because I did and it's there.

Cite it. I'm perfectly willing to admit it if I'm wrong. But the entire point (supposedly) of the individual mandate was that it would work as a quid pro quo with the insurance companies - they would take all comers, pre-existing conditions or not, whenever they decided to sign on, in exchange for the state forcing us all into their clutches.

I don't think the law as passed includes the stipulations you're saying it does. But I fully expect such additional requirements will be added - just as I fully expect that the individual mandate will wind up putting people in jail because they refused to buy insurance as ordered. It simply won't work any other way.

 

[RDD_1210]

Actually, it is there. Did you actually bother to look? Because I did and it's there.

Cite it. I'm perfectly willing to admit it if I'm wrong. But the entire point (supposedly) of the individual mandate was that it would work as a quid pro quo with the insurance companies - they would take all comers, pre-existing conditions or not, whenever they decided to sign on, in exchange for the state forcing us all into their clutches.

I don't think the law as passed includes the stipulations you're saying it does. But I fully expect such additional requirements will be added - just as I fully expect that the individual mandate will wind up putting people in jail because they refused to buy insurance as ordered. It simply won't work any other way.

http://docs.house.gov/energycommerce/ppacacon.pdf

Page 91

"(6) ENROLLMENT PERIODS.—The Secretary shall require an
Exchange to provide for—
(A) an initial open enrollment, as determined by the
Secretary (such determination to be made not later than
July 1, 2012);
(B) annual open enrollment periods, as determined by
the Secretary for calendar years after the initial enrollment
period;"

 

[dblack]

URL="http://docs.house.gov/energycommerce/ppacacon.pdf"]http://docs.house.gov/energycommerce/ppacacon.pdf[/URL]

Page 91

"(6) ENROLLMENT PERIODS.—The Secretary shall require an
Exchange to provide for—
(A) an initial open enrollment, as determined by the
Secretary (such determination to be made not later than
July 1, 2012);
(B) annual open enrollment periods, as determined by
the Secretary for calendar years after the initial enrollment
period;"

So this says the exchange will have enrollment periods, though we apparently won't know what that means until the Secretary makes a 'determination' in July 2012 (thanks for looking it up, btw) Where does it say that insurance companies can refuse to sell insurance outside those enrollment periods? The law was sold on the claim that no one can be turned down for a pre-existing conditions. If this works as you're suggesting it seems they can turn us down - for up to a year at least.

What I find sort of hilarious about this (assuming it works as you're suggesting and means we can't go buy insurance whenever we want) is that it really represents no difference at all. Most 'pre-existing conditions' exclusions only last for six months to a year - meaning that after you've been with an insurance company for a year, any illness is covered, even if you had it before you signed up. i.e - nothing has changed.

The more I read, and the more is 'revealed' about how this law actually will work, the more it seems clear that it boils down to two significant changes: the mandate and a legal formalization of the insurance cartel via the 'Exchange'. This essentially gives the insurance companies everything they've been looking for. They can now control the market at the federal level (as opposed to dealing with individual states) and they have a captive customer base.

The question remains whether they will be able to enforce the mandate. In many ways, it's a moot question. The regulatory impact of the bill will be to effectively ban any viable alternatives to financing our health care outside of corporate insurance (this was the whole point of the bill, in my opinion). Without such alternatives, most people won't be able to go their own way, and will acquiesce. But they put the mandate in there for a reason, and I expect it will be enforced - likely via the scenario I described earlier, where all your tax payments are first applied to the penalty.

 

[LilOlLady]

And it works so well in Massachusetts, where it is actually illegal to do. The problem is that the fine they impose is less than the cost of the insurance, and the enrollment periods are quarterly. That means that, if worse comes to worse, you only have to hang on for a few weeks before you get coverage.

What makes you think that the open enrollments you think will prevent people from doing this will only be once a year?

So you suffer a heart attack or stroke and your idea is to just tough it out for a couple of weeks? You being serious?

Emergency rooms will stabilize you, unless you are saying the law changes that.

The faster you receive medical care the better you rate of survival. Especiall with strokes, they have medication that stop the damage. Be my guest, stay home and save us money.

 

[Greenbeard]

So this says the exchange will have enrollment periods, though we apparently won't know what that means until the Secretary makes a 'determination' in July 2012 (thanks for looking it up, btw)

We do know what that means, as the preliminary regulations governing the exchanges were released on Monday. They're proposed regulations, which means they're now open for public comment and will be revised at the end of the comment period based on those comments.

In addition to "an initial open enrollment period that allows a qualified individual to enroll in a QHP [qualified health plan] from October 1, 2013 through February 28, 2014" when the exchanges first launch, they're proposing a 7-week enrollment period at the end of every year.

Section 1311(c)(6) of the Affordable Care Act directs the Secretary to establish an initial open enrollment period and an annual open enrollment period. In §155.410, we propose standards for Exchanges related to the initial and annual open enrollment periods. Our proposed timeframes are informed by both the experience implementing Medicare Advantage and the Medicare Prescription Drug Benefit Program, as well as information from FEHBP. [...]

In paragraph (e), we propose an annual open enrollment period from October 15 through December 7 of each year, starting in October 2014 for coverage beginning January 1, 2015. As an alternative annual open enrollment period, we considered November 1 through December 15 of each year to provide a 45-day window close to the end of the year that would be easy to remember. We welcome comments regarding our proposed and alternative approach for the annual open enrollment period.​

Just as with HIPAA-covered plans, there are allowances for special enrollment periods. That means people can buy coverage outside of the open enrollment period if they lose the coverage they already had for some reason.

Examples of loss of coverage include decertification of a QHP that occurs outside of the annual open enrollment period. [...]

Other examples of events that would qualify as loss of coverage include but are not limited to the following: legal separation or divorce ending eligibility of a spouse or step-child enrolled in other minimum essential coverage as a dependent; end of dependent status (such as attaining the maximum age to be eligible as a dependent child under the plan); death of an individual enrolled in minimum essential coverage ending eligibility for covered dependents; termination of employment or reduction in the number of hours of employment necessary to maintain coverage; or relocation outside of the service area of the QHP. Examples of relocation include relocation to the United States (US) in the case of a US citizen, national, or lawfully present individual who was not previously eligible for Exchange participation while residing outside of the US; release from incarceration; moving from the jurisdiction of one Exchange to another; or relocating outside of the individual’s QHP’s service area.

In accordance with section 9801(f) of the Code, we propose that loss of coverage also include: termination of employer contributions for a qualified individual or dependent who has coverage that is not COBRA continuation coverage by any current or former employee, exhaustion of COBRA continuation coverage, reaching a lifetime limit on all benefits in a grandfathered plan, and termination of Medicaid or CHIP. We vary from the Code [i.e. the special enrollment rules established for HIPAA plans] for this first special enrollment period by specifying only loss of minimum essential coverage rather than loss of any coverage because of the requirement in section 5000A of the Affordable Care Act that qualified individuals and their dependents must maintain essential coverage. If otherwise qualified individuals who maintained less than minimum essential coverage were granted a special enrollment period based on termination of such coverage, such individuals might wait until experiencing a significant health care need to enroll in a QHP through the Exchange by using a special enrollment period. Such allowance could create a problem of adverse selection; we solicit comment on this provision.​

I've bolded that last part as it gets right at the point. The purpose of enrollment periods is to deter adverse selection (just as, previously, pre-existing condition exclusions were designed to deter adverse selection). Folks who've acted responsibly but find themselves without coverage outside the annual open enrollment period will not be harmed, as they will have a window (regardless of the time of year) to buy another plan, just as HIPAA allows special enrollment periods for people experiencing certain qualifying events.

Folks who've done what you suggested and simply chosen to free ride (or, under the bolded bit from the proposed rule, done the equivalent by buying substandard insurance) will not be eligible to buy exchange coverage outside of the open enrollment period.

Where does it say that insurance companies can refuse to sell insurance outside those enrollment periods? The law was sold on the claim that no one can be turned down for a pre-existing conditions. If this works as you're suggesting it seems they can turn us down - for up to a year at least.

No one will be turned down for pre-existing conditions. But that doesn't mean you can buy a plan any time of year you like (say, in the ambulance on the way to the hospital).

You've said yourself that given the small value of the mandate penalty: "Clearly, the best strategy for all of us who aren't currently sick is to cancel our insurance as soon as the law takes effect. Take care of yourself out of pocket until you get seriously ill, and then sign up. Anything else would be idiotic. And you can do so without any repercussion. "

Under that scenario you bear all the financial risk for any health-related expenses you incur before your health plan takes effect. Maybe you'll chance it but it's certainly not a risk-less proposition. Which, again, is the point. Adverse selection deterrence.

What I find sort of hilarious about this (assuming it works as you're suggesting and means we can't go buy insurance whenever we want) is that it really represents no difference at all. Most 'pre-existing conditions' exclusions only last for six months to a year - meaning that after you've been with an insurance company for a year, any illness is covered, even if you had it before you signed up. i.e - nothing has changed.

Is it a surprise that the insurance market provisions of the ACA are aimed squarely at the individual market (and, to a lesser extent, the small group market)? Yes, because of HIPAA group plans already enjoy most of the federal consumer protections that are being extended to the individual market for the first time under the ACA. They also enjoy financial supports that have largely been unavailable to folks buying their own coverage outside of a group.

The purpose of the insurance piece of the ACA was always to extend protections where HIPAA did not. Ordering and improving the individual and small group market was the other piece of that and it looks like the SHOP exchanges for small businesses will go a long way toward removing employers as the middle man behind employees and plan offerings.

 

[Zander]

Ever wonder what a clusterfuck is? Now you know. It's Obamacare.

 

[RDD_1210]

Ever wonder what a clusterfuck is? Now you know. It's Obamacare.

And how would you describe our system before "Obamacare"?

 

[dblack]

Ever wonder what a clusterfuck is? Now you know. It's Obamacare.

And how would you describe our system before "Obamacare"?

Disintegrating. Which would have led to something different. The health insurance model we have been using doesn't work - it distorts the health care market, artificially inflating prices. What Obamacare does is freeze things in that state - by tying us to the failed strategy through force of law. This is great for the insurance companies. It keeps them firmly entrenched as middlemen in every health care transaction. It's really nothing more than another corporate bailout.

 

[Spoonman]

Ever wonder what a clusterfuck is? Now you know. It's Obamacare.

And how would you describe our system before "Obamacare"?

bad, but not as bad. obamacare fixed nothing. all the issues obama himself told us were wrong with healthcar still exist. honestly, i'm embarrased for anyone who calls this a win. pretty sad and a great example of how far partisan politics can blind us from reality

 

[RDD_1210]

Ever wonder what a clusterfuck is? Now you know. It's Obamacare.

And how would you describe our system before "Obamacare"?

Disintegrating. Which would have led to something different. The health insurance model we have been using doesn't work - it distorts the health care market, artificially inflating prices. What Obamacare does is freeze things in that state - by tying us to the failed strategy through force of law. This is great for the insurance companies. It keeps them firmly entrenched as middlemen in every health care transaction. It's really nothing more than another corporate bailout.

Right, I agree. This is FAR from an ideal solution. A public option would have been much more productive to actually fixing our issues. Too bad Obama had no backbone and gave up on that way too early.

 

[RDD_1210]

Ever wonder what a clusterfuck is? Now you know. It's Obamacare.

And how would you describe our system before "Obamacare"?

bad, but not as bad. obamacare fixed nothing. all the issues obama himself told us were wrong with healthcar still exist. honestly, i'm embarrased for anyone who calls this a win. pretty sad and a great example of how far partisan politics can blind us from reality

So people no longer being denied due to pre-existing conditions isn't a positive?

 

[Spoonman]

And how would you describe our system before "Obamacare"?

bad, but not as bad. obamacare fixed nothing. all the issues obama himself told us were wrong with healthcar still exist. honestly, i'm embarrased for anyone who calls this a win. pretty sad and a great example of how far partisan politics can blind us from reality

So people no longer being denied due to pre-existing conditions isn't a positive?

It's like finding a kernal of corn in a pile of shit. And what makes this "healthcare reform" even worse is now everybody feels we have healthcare reform and were done. So no one is going to fix the real problems that still exist.

 

[Quantum Windbag]

So you suffer a heart attack or stroke and your idea is to just tough it out for a couple of weeks? You being serious?

Emergency rooms will stabilize you, unless you are saying the law changes that.

The faster you receive medical care the better you rate of survival. Especiall with strokes, they have medication that stop the damage. Be my guest, stay home and save us money.

Which emergency rooms will provide even if you do not have insurance.

 

[dblack]

Right, I agree. This is FAR from an ideal solution.

It's not a solution at all.

 

[Patrick2]

If the need for annual enrollment precludes people from waiting till they get a disease to enroll, then why are the obamanistas fighting tooth and nail over the constitutionality of the requirement in obamacare to buy insurance? Obviously, they know many people, especially the younger and healthier, would opt out, thereby making obamacare financially insolvent.

 

[Spoonman]

If the need for annual enrollment precludes people from waiting till they get a disease to enroll, then why are the obamanistas fighting tooth and nail over the constitutionality of the requirement in obamacare to buy insurance? Obviously, they know many people, especially the younger and healthier, would opt out, thereby making obamacare financially insolvent.

it's basically taxation without calling it taxation

 

[Patrick2]

If the need for annual enrollment precludes people from waiting till they get a disease to enroll, then why are the obamanistas fighting tooth and nail over the constitutionality of the requirement in obamacare to buy insurance? Obviously, they know many people, especially the younger and healthier, would opt out, thereby making obamacare financially insolvent.

it's basically taxation without calling it taxation

Uh, noooooooo...... that's just a gimmick they came up with to try to preserve its constitutionality - a recent federal circuit court wasn't impressed with the idea.