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Repeal of ACA and T1D (pre existing conditions)

Discussion in 'Parents of Children with Type 1' started by njswede, Jan 12, 2017.

  1. njswede

    njswede Approved members

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    I don't want to get political, but how will the repeal of the ACA and it's protection of pre existing conditions affect the T1D community? Will my son ever be able to get on a health plan when he grows up? Assuming things will get back to what they were before the ACA, what was it like back then?
     
  2. Theo's dad Joe

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    You mean if he wasn't a full time student or had an employer with a group plan? That is a good question. Keep in mind though that US healthcare prices are driven by collusion (in the descriptive sense not the legal one) between lawmakers, drug companies and insurance companies. You can buy many of the exact same products in Europe for literally pennies on the dollar.
     
  3. sparty87

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    Even with an employer plan, unless you can demonstrate continuous coverage, I recall exclusionary periods for pre-existing conditions. I don't know what law/laws governed this or what it means when ACA is repealed.

    Lots of focus on slicing and dicing of risk groups, but as Theo's dad pointed out, little on the cost side. I'm convinced America subsidize world pharmaceutical costs. The Canadian and western European health system depends on us paying a disproportional share of drug development costs and profits. The reason you can buy that $75 dollar box of 5 lantus pen in France is because Americans are paying $450.
     
  4. Theo's dad Joe

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    With most large group plans, are either covered immediately, or there is a period where you are excluded from coverage for pre-existing conditions, but you are not permanently excluded. As an example, I just checked on Kaiser group insurance for various nearby school district employees, and the plans cover pre-existing conditions immediately upon employment. Also, same goes for children and spouses of district employees.

    Regarding $75 Lantus boxes: they can make a profit at $75 because the bulk of the company's overhead/employee salaries etc is covered by our/our insurance payments of $450. They could make a profit on the next box at $75, but only because there large fixed costs are already covered. It is an interesting question though, if suddenly everyone was paying for D-supplies out of pocket or from some kind of savings account, what would that do to prices. Hospitals charge on paper far more than they need to run and make a profit because it gets paid out by insurance. Insurance companies encourage high pre-negotiated pricing to force the consumer to buy insurance, but most of the overhead for health insurance is in the salaries of the insurance company workers (not the corporate profit), so we basically pay people to process insurance, the insurance companies give favored status to hospitals or certain drugs etc. The end result is overhead. One year that I was a public school teacher and had to have my wife and kids on my plan, I and my district paid in about $25,000 to pay for all of my insurance. That is a lot of money. I wonder how much a year of D-supplies really cost, or how much a year of medical bills would really cost most families with competitive pricing. I think most people could pay their family's medical bills for a year AND by a catastrophic coverage plan for $25K a year with competitive pricing-and probably even earn some interest. I don't know the exact numbers but I don't think that a typical family with a child with T1D is actually racking up 25K a year in competitively priced medical expenses.
     
  5. Sarah Maddie's Mom

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    I anticipating that my soon to be 19 year old will remain covered by my husband's (very expensive) employer plan until she graduates from college. I figure we have three safe years and then she'll need to find a job with coverage. If she wants to work for herself or as a contract worker she'll be screwed.
     
  6. Theo's dad Joe

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    By the way, it is still possible that a replacement plan will prohibit denial of coverage for PEC's. Personally, I have wondered from a legal standpoint why someone with T1D could not argue that an insurance company is discriminating on the basis of disability if they deny coverage or even ask someone if they have a disability prior to coverage. I would propose a law that prohibits insurance companies from asking about sex or disability in an approval questionnaire (or age). The net result is the same. Everyone pays a little more to cover some with higher risk.
     
    Last edited: Jan 13, 2017
  7. Snowflake

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    And the same goes for us parents who might want to change jobs or strike out on our own. My family currently enjoys excellent group coverage through my employer, and changing jobs at the moment sounds unimaginably risky. Maybe we'll have more clarity in a few months, but it's really hard to imagine the path forward right now.
     
  8. samson

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    Disability law is also under threat

    The Americans with Disability Act and similar protections are also potentially under threat with a slightly different Supreme Court. Currently the supreme court is hearing a case about what IDEA requires for providing a fair and adequate public education for students with disabilities. I can imagine scenarios where ADA is gutted, or made even more toothless than it is, in which case trying to create new precedent for preventing discrimination in our healthcare system is pretty unlikely.
     
  9. Theo's dad Joe

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    That is likely, but if congress wanted to avoid people being excluded, they could restrict the questions that insurance companies are allowed to ask (by law).
     
  10. Snowflake

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    But I'm not sure that's the goal for a lot of congresspeople! :) The only way that the insurance lobbyists got on board with ending PECs was because that regulation came in tandem with the individual mandate. I imagine that the insurance industry would lobby hard against any similar restriction if the regulation were not part of a package deal that also allowed them to make up the additional expense.

    Assuming the repealers can figure out a way to repeal and also assuming they don't find some way to protect people with PECs (both huge question marks), then I think the non-employer market looks really challenging for people with T1D.

    To the original question, here's a report from late 2010 on how PEC restrictions were applied back in the day, including specifically mentioning diabetes as a condition typically used to deny coverage:
    https://www.propublica.org/blog/ite...e-to-1-in-7-people-citing-pre-existing-condit

    And here's an explanation of one policy alternative, high-risk pooling, for people who couldn't obtain non-group coverage before the ACA passed -- at least it was something, but it sounds like it was expensive for the insured and often dependent on public subsidy to boot:
    http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/
     
  11. Theo's dad Joe

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    The drug companies certainly don't want people with T1D to be excluded so there is going to be pressure on both sides. It also seems that it would put a downward pressure on prices of certain items considering that they sell for a profit at 20% of the price in Europe.

    FWIW, the president elect said that people with pre-existing conditions will still not be denied coverage on that basis and that children would still be able to stay on until age 26 on their parent's plan. On Tuesday, he said that he would only sign a repeal virtually simultaneously with a replacement plan-no "repeal and stall". The current voting going on only affects parts of ACA that require government funding. The senate rule to allow filabuster block by a simple majority only blocks Senate filabusters on budget reconciliation issues, so it would take 60% of the senate to repeal the components of the ACA that are not budgetary. http://time.com/money/4632898/obama...t-repeal-what-happens-preexisting-conditions/ and this would not include the restriction on denying coverage based on a pre-existing condition. In other words, that part stays law without 60% of the senate so it looks like to get a replacement plan through, it will basically have to include those non-budgetary components of the ACA.

    On the other hand, we got this: https://theintercept.com/2017/01/12...asure-to-import-cheaper-medicine-from-canada/
     
    Last edited: Jan 13, 2017
  12. susanlindstrom16

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    I think the part that is unclear right now is how will the insurance companies be on board with covering pre existing conditions and a lot of the non budgetary aspects of the ACA, without some way of guaranteeing that the more healthy people participate, through mandates and subsidies. I'm glad to see this discussion here, its something I'm concerned about too. Its going to be hard to wait and see how this all shakes out.
     
  13. Snowflake

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  14. rgcainmd

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    Thanks for this link, Snowflake!
     

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