HEALTH COACH - What are the pre-existing conditions and what the GOP bill could do?
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HEALTH COACH -
What are the pre-existing conditions and what the GOP bill could do?
A young lawyer who died after a prolonged crisis. A young woman died of cardiac arrest. Patients with diabetes who can not get insulin. Dr. Leana Wen said that cases like these will recur if the new version of the American Health Care Act (AHCA) goes to Congress.
All of these patients had what the insurance industry calls pre - existing conditions - diseases, injuries or conditions that affected a patient before they got a health insurance policy .
"At the present time, the Affordable Care Act protects those with pre-existing conditions," said Wen, who was an emergency room physician before becoming a commissioner. Health of the city of Baltimore. This would change under the AHCA.
"States could allow insurers to set much higher rates for patients who have a pre-existing condition.This is terrifying because patients could, in essence, be evaluated out of coverage," Wen told NBC News.
Related: Here's what you need to know about the health care bill
Pre-Obamacare, health insurers have systematically refused to cover people for such conditions, or have charged extremely high premiums, co-payments and deductibles.
The companies argued that this was the only way to prevent people from buying insurance until they were Already sick. Some AHCA supporters say that it is personal responsibility. After all, why should all clients of a health insurance plan pay for people who are waiting for them to be sick or injured to buy coverage?
But medical groups from the American Medical Association to the Juvenile Diabetes Research Foundation (JDRF) say that health insurers have often made their own definitions of pre-existing conditions. And they often refused coverage to people born with such conditions, or who developed them in childhood.
"For many years the type 1 diabetes community has had to fight with insurers who have been allowed to deny coverage or charge much more to cover people with pre-existing conditions and we want to make sure that Our community does not have the same battles in the future, "JDRF said in a statement.
The Affordable Care Act, 2010 has changed by requiring health insurance companies to accept all those who have applied for coverage. In return, the ACA required that almost all get health insurance or pay a special fee.
The idea is to mix healthy people with the sickest people, with all those paying premiums, so that companies have enough money to pay each other's claims.
Prior to Obamacare, the pre-existing conditions that cost the coverage of people, or led to very high premiums, included:
Infection
Injuries
Injuries
Infections
Cancer
Mental Disorders
Wen said that she saw the fallout on a daily basis.
"I remember seeing a 20-year-old patient who had a seizure disorder," she said. "He should have paid like $ 8,000 a month for health insurance."
The man, a lawyer with young children, was to be without medical coverage, which meant that he could not take medication to control his convulsions. "He ended up in ER a day after taking a crisis for an hour. We could not stop the crisis for another hour," Wen recalls.
He never got out of his coma.
Wen described the case of a young woman with a congenital heart disorder, also in her 20 years, who was refused medical insurance. "She stopped taking her medication and arrived in case of cardiac arrest," said Wen. "This is literally a life or death problem".
The new version of the AHCA does not expressly authorize insurers to refuse coverage. This allows states - which regulate health insurance - to seek authorization to withdraw from the obligation, the Department of Health and Social Services decide who can do so.
It also allows states to set up high-risk pools of insurance, which are policies to cover people with pre-existing conditions who are struggling to get health insurance. And it provides federal money to help the states pay for them.
But experts say that high - risk pools have never worked before.
Related: Medicaid is trendy with the death of GOP Health Bill
"High-risk pools are not a new idea." Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools and were not a panacea for Americans with problems Medical Pre-Existing "American Medical President of the Association (AMA), Mr. Andrew Gurman, said.
"The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in a second-class health care coverage - so they are able to get coverage at all".
Other groups agree.
"High-risk state groups have generated higher premiums, long waiting lists and insufficient coverage," said a coalition of 10 medical groups, including the American Cancer Society Cancer Action Fund, the American Diabetes Association and the National MS Society. A joint statement opposed to the AHCA.
"State high-risk pools have premiums above the standard non-group market rates, with most states covering them at 150% to 200% of standard rates." Many also have high deductibles , About $ 5,000 or more, "the Kaiser non-partial family Foundation said in a statement.
Related: The creators of Obamacare tell GOP You were told
"Almost all high-risk pools have imposed life limits on covered services and certain annual limits imposed," he added. "Some states have limited or closed enrollments." Overall, these high-risk pools lost $ 1.2 billion in 2011.
The Avalere health consulting firm issued an estimate Thursday indicating that the $ 23 billion allocated by the new AHCA to help people with pre-existing conditions would pay only 110,000 of them. "About 2.2 million registered in the individual market today have some form of chronic pre-existing disease," Avalere said in his report.
"Given the amount of funding in the bill, the program can afford only a few small states opt for medical underwriting," said Caroline Pearson, senior vice president of Avalere. "If large states receive a waiver, many chronic sick individuals could be left without access to insurance."
There is another reason why medical groups are opposed to the new AHCA. This would allow States to redefine "essential benefits" - the conditions that must be covered by the plans.
"The Affordable Care Act included emergency services as an essential health benefit and any alternative law must do the same. Patients can not choose where and when they will need emergency care and should not be financially punished for having emergencies, "the American College of Emergency Physicians said in a statement .
Wen said an emergency visit could go bankrupt without this protection.
"These are not people who pay a few dollars more a month," she said. "These are avoidable deaths and I saw them every day in emergencies."
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