Health Care Bill: What's in it for us?

I explained last week what the time-frame for the bill is. This week I want to try to explain what's in it for us.

As you read on my timeline last week, starting this year (probably around November) insurance companies can no longer deny coverage for pre-existing conditions. This could be a really good thing or a bad thing depending on how you look at it. I will explain in a moment. The insurance companies will no longer be allowed to put lifetime caps on plans. You will be allowed to keep your children on your plan until the age of 26 instead of the age of 21. Insurance carriers will be required to offer preventative care to help catch diseases earlier.

I want to talk about the pre-existing clause for a moment; so, bear with me as I rant about this. If you are someone that has a pre-existing condition there are a couple of things you need to know. First, your rates will still be high due to the fact that the "exchange" you get it from will have mostly "sick" people in it. This is nothing more (in my opinion) than a glorified high risk pool (which most states have, by the way). Second, there are minimums that the health care providers have to offer. These will be very basic plans that have very high deductibles, probably no co-pays, and prescription cards that have separate deductibles on them as well. Now you will be able to "buy" up to a better plan that has lower deductibles. But, you will have to pay huge prices for those things.

Now let me throw out a scenario:

There is a guy that is 25 years old, self-employed, never goes to the doctor, works out, eats right and really does a great job of maintaining his health. One day, he gets really bad cramps in his abdomen and decides he needs to have it checked out. He goes to the doctor, pays out-of-pocket because it's cheaper for him to pay a $300.00 doctor bill twice a year than to pay $300 a month for insurance. The doctor tells him his appendix is about to burst and they need to operate. This will cost him $10,000. The patient says he doesn't have that kind of money available. The doctor tells him not to worry, to go to the exchange and get health insurance. Once the operation is done he can drop it, the doctor says. He agrees, signs up for the best plan available, and has the operation then cancels his policy.

Now, using this scenario you're probably asking yourself, "What about the mandate of having health insurance"? Well, I just read that the IRS has no authority to place liens or seizures for failing to have health insurance. All they can do is take the fines out of your refund check. So, if you're self employed and you have no refund check, you don't have to pay the fine.

If you can't see where I am going with this stay with me. OK, so we have established that the patient can get health insurance through the exchange, have the surgery, then cancel his policy the next month.

This is going to have a domino effect. The insurer just paid out $10,000 for a surgery that someone only paid 2 months worth of premiums for. Now the insurance company won't be able to recoup that cost because they are only going to be able to charge so much on these exchanges. This will then cost the insurance carrier more money, so they have to cut their costs and start laying people off. Once the layoff is done and they have more people taking advantage of the system it will push the carrier out of business. Then, Washington will come in and say "You know what? We can't have all these people without insurance so we need to offer it to them." So now comes into play the whole scenario for universal, government-run health care.

All of this being said, my goal today is to make folks aware of situations that most people don't think about and I really hope I have done that for you today. I will be adding more stuff about this next week so be sure to check back with me. If you have any questions please contact me.

Also, I deal with a variety of insurance companies and it is likely that I can save you money on your current health insurance. If you have been with the same company for more than a year, you really are paying too much. Please contact me to let me see if I can save you money. If I only save you $50.00 a month or more, wouldn't it be worth it? Click here for a free assessment and more information.