How I See ObamaCare

I’m sitting here, right now, watching the Democratic National Convention on BBC Parliament channel.  I’ve sat through Michelle Obama, some General Motors workers, some people I know and some people I have never heard of.  But one thing has stuck with me in the nearly two hours I have been watching.

One of the Democrats said that under ObamaCare, if an insurer does not spend at least 50% of the customer’s premium on the customer (I use the word customer, not them), then they receive a cheque back.  I do not know how much the cheque would be, maybe the remainder of the 50% that should have been spent on them, or the rest of their premium, but on the face of it, I see this as a damn good idea.

However, after a quick think,and a talk with W, we came to the conclusion that this  may not actually be as good as it seems.

See, getting some of your money back is good for YOU, but NOT for business.  Therefore, the companies will want to make sure they do not directly give you any money back.  They would make sure they hit the 50% target, by sending you for regular checkups.  All well and good, we all know that the earlier illnesses are found, the easier they are to treat.  So, say your health insurer sends you for regular checkups, once every two months, to somewhere approved by them.  Maybe, even, OWNED by them.  So they pay themselves.  With your money.

And if something is found, and you do turn out to be ill?  They will raise your premium for the next year, just so they can pay themselves even more of your money, by sending you to an ‘approved’ hospital.  Or, here is a possibility, what if they refuse to renew it next year, citing ‘pre-existing conditions’?

I’ve tried doing some research on this, but to no avail.  I did find this quote though, from

Insurance companies can issue rebate checks or deduct the money from future bills, but employers who provide health benefits to workers will often pocket the money, rather than the employees.

Which is a nice way of keeping money in the system.  Somewhere.  As everyone knows, a credit note is WAY better than a refund.


Can someone help me with some of these questions?

1. If you are found to be ill, can they increase your premium, and by how much?

2. How does the 50% rebate work, do you get all of the money back, or is it 50% minus the amount spent?

3. Can they refuse to renew it if you were receiving treatment for something and they actually HAD to provide you a service?


I’m SO glad we have the NHS.




2 thoughts on “How I See ObamaCare

  1. 1) If you have private insurance, i.e. not through your employer, this is very possible. But by how much or when that increase would hit, I don’t know. It varies with each insurance company.
    2) No idea on this. I’d never even heard of this rebate thing. I don’t see any individual getting this money. It’ll all be kept by the employers.
    3) They can refuse to deny you coverage any old time they want – and they do – no matter what your insurance is supposed to cover. There are loopholes big enough to drive a truck though in medical insurance policies. They can tell you after you’ve had a procedure that they won’t cover it, and you’ll be stuck with the bill. They can stop your policy whenever they want. They can make it so you can’t renew it.

    A few years ago, I needed surgery – but the insurance company refused to pay for the one that my surgeon (who was a top surgeon and a professor of surgery at a highly respected university) recommended. I had to fight them for over a year, including getting a lawyer, to force them to pay for me to have the correct type of surgery… and I still had to pay 5% of the total bills for the surgeon and the hospital out of pocket, which of course were far from cheap.

    In general – but not always – you are always better off when you have coverage via an employer. Those plans are set so they can’t deny you coverage based on pre-existing conditions, they often have fewer restrictions, and you pay less out-of-pocket all because your employer wants you to be healthy so you can work. It’s ultimately a win-win. But that doesn’t mean that the insurance companies won’t try to fight you, even if you’re on an employer plan. Every company is different in terms of how much of the premium they pay vs. what the employee pays, but it’s usually some percentage – and if you’re paying for an entire family it’s MUCH higher.

    Private insurance is full of pitfalls. You have to give a medical history and tell all about any pre-existing conditions, and they will deny you outright for many things OR offer your insurance that costs so much there’s no way anyone but a multi-millionaire can afford it. I have a few things pre-existing and I’ve never even tried to get private insurance, not during any of the times I was laid off and had no coverage. I know they would have denied me immediately.

    Access to Medicaid is very strict and you have to be below the poverty line. Each state and county has their own options for free or cheaper care – some places, like Texas, have good options via the county. Other places, like here in California, do not. When I was trying to find somewhere to see a doctor here in the last few months, the rules for the private free clinics were odd… like they would only serve homeless people. It has to do with the grant money and donations they receive, but ultimately I couldn’t find anywhere that would help me. LA County has nothing, really.

    That’s why I ended up going to the ER once – they HAVE to treat you at the ER by law, even if it’s not really a life and death emergency. You also don’t have to pay then, so you can get care when you absolutely need it… you’re just screwed because they WILL bill you. As it happened when I went, I qualified for an indigent program the hospital had, and I didn’t get charged for the visit, the shot they gave me or the prescription that was filled. But I went there because I was desperate and fully expected to get stuck with a bill of at least $1000. I got very lucky that day.

    I hope this helped to answer some of your questions. It’s a ridiculously complicated thing, and frankly, I don’t know how Obamacare will work. It sounds positive in theory, but the entire medical care system in this country will have to be overhauled – and that’s a frightening prospect.

    • Private healthcare in the UK can be a bit of a joke too, with the pre-existing conditions thing. Sometimes they crop up on programmes, and someone with asthma was turned down for health cover, someone else didn’t disclose something silly like a broken toe they had when they were six, and cause they had cancer in their forties, when the company found out, they terminated the contract. But this is all in addition to the NHS. It’s an option. The idea that i’d HAVE to pay for it, direct, out of pocket, is scary.

      I thought Medicaid covered everyone who didn’t have insurance, but as you and others told me on Twitter, I was just dreaming. Hmph.

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