Preexisting Conditions

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I have heard it said that before Obamacare, insurance companies calculated that being a woman in itself was a preexisting condition.

Why is this so?

Why was this practice adopted and who and what was responsible for this?

Not to mention that most of the CEOs of these major insurance companies were probably men or woman who were generously paid to look the other way while other women were denied affordable healthcare.

Are breasts and a womb a preexisting condition? What about male colon, prostate and testicular cancers? Do not women have to pay for these if the insurance is some sort of pool system?

This is a discussion that is aimed at getting to the root of this issue that rich unscrupulous republican men are trying to control woman's heath issues.

Men who find rape okay and forcing a woman to carry a rapist's baby to term while denying them affordable healthcare. Men who find it absurd that they are expected to actually raise and support the children they have fathered.

While, the only serious preexisting condition that many woman have is the deadbeat fathers of their children...

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@TheCobbler,

Quote:

I have heard it said that before Obamacare, insurance companies calculated that being a woman in itself was a preexisting condition.

This is a ridiculous statement. And it is untrue.

1 Reply

A healthy body with a healthy immune system is a pre-existing condition that aides in natural healing.

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@maxdancona,

Actually max, it was true.

www.chicagobusiness.com/article/20131003/OPINION/131009919/under-obamacare-being-a-woman-no-longer-a-pre-existing-condition

https://nwlc.org/blog/worst-tbt-ever-when-being-a-woman-was-a-pre-existing-condition/

Many times, women were not covered for pregnancy if they had not yet been insured for a full year with a policy.

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@livinglava,

The term "pre-existing condition" is a legal term defined by the insurance industry. It refers to conditions such as AIDS or cancer or diabetes that are very expensive to treat (and thus costly to the insurance companies business). A person with a pre-existing condition would be unable to get insurance. Insurance companies did not exclude member simply because they were women.

If being a woman was a pre-existing condition, then zero women would have insurance.

This is a silly thread.

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@Sturgis,

Sturgis, after reading this piece of political propaganda... I checked the actual data.

Take a guess.... which gender do you think is more likely to be uninsured... men or women?

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@Sturgis,

A pre-existing condition means a serious illness. The issue is that once people have such an illness... no insurance company in their right mind is going to cover them (knowing that they will lose money). People with real pre-existing conditions (such as cancer, or diabetes) are unable to get coverage.

This has nothing to do with pregnancy. I might agree with the politics... I am far to the left of Obamacare (I want true single payer).

But changing the meaning of words to score cheap political points is ridiculous.

1 Reply

@maxdancona,

maxdancona wrote:

The term "pre-existing condition" is a legal term defined by the insurance industry. It refers to conditions such as AIDS or cancer or diabetes that are very expensive to treat (and thus costly to the insurance companies business). A person with a pre-existing condition would be unable to get insurance. Insurance companies did not exclude member simply because they were women.

If being a woman was a pre-existing condition, then zero women would have insurance.

This is a silly thread.

Yes, but instead of taking the bait and getting into an argument about birth-control coverage or lack thereof as a form of misogyny, I decided to focus on the bright side of positive 'pre-existing conditions' like having a healthy body that heals itself for free instead of requiring expensive medical procedures.

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@maxdancona,

Don't you consider that profit driven insurance companies tried to railroad women because no one in their right mind would insure someone who might get pregnant and become "two people" (knowing they will lose money)...

Your logic turns around on itself and disproves your point.

In the same way I am sure gays were also denied coverage on the false presumption that they would all catch AIDS and need costly treatment.

I am a 55 year old gay man with no STDS (not a single one)...

There are many men who father numerous children with woman and many women who choose to have no children.

We all pay for one another in a good socialized medicine system.

We pay for one another so that on the chance that we ourselves get sick the money will be there for us also...

The insurance companies under the republicans broke the system and left sick people and those needing care out in the cold so they could pocket the profits...

Now they are pissed that people with a conscience took away their cash cow that was killing people.

While the republicans also fought abortion rights which forced women to come up with the money regardless of their circumstances.

This is egregious and corrupt!

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@TheCobbler,

There is something called facts.

- Can you name a single insurance company that has refused to cover healthy women? (Sturgis' article claims that there was a 1 year exemption on covering pregnancy, but that is the worst it gets... and that isn't "pre-existing")

- Can you name a single insurance company in the past 50 years that has refused to cover healthy gay men (without another health concern)?

- Do you realize that women are more likely to be insured then men are?

I probably agree with you on policy. But you can't make up facts.

The fact is that there aren't any insurance companies that consider being a woman to be a pre-existing condition. This is just political propaganda.

Facts matter.

1 Reply

@maxdancona,

Can you name one insurance company that is not profit driven?

Yea, facts do matter...

Expecting? Expect to Be Denied Insurance Coverage Through 2014
https://www.aclu-wa.org/blog/expecting-expect-be-denied-insurance-coverage-through-2014

(1) Pregnant women are frequently unable to obtain health insurance in the individual market. The four largest for-profit health insurance companies each list pregnancy as a medical condition that results in an automatic denial of individual health insurance coverage; put differently, if a pregnant woman applies for insurance coverage in the individual market, insurers generally consider her pregnancy to constitute a preexisting medical condition and deny her coverage. The investigation also found that, because the law in some states requires insurers to extend coverage to policyholders’ newborn or adopted children, insurers sometimes deny coverage to expectant fathers and those who are in the process of adopting.

Comment
Are pregnant women considered "not healthy"?

That is like saying that having teeth is a preexisting condition that should disqualify one from obtaining dental insurance.

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@TheCobbler,

If I am looking at this purely from a business perspective (no morals or so forth) ... I can understand why an insurance company would consider pregnancy a pre-existing condition. It is not because a pregnant woman is unhealthy, it is because in the very near future because of her situation she is going to cost the insurance company alot of money - I believe the average cost for a healthy pregnancy runs about $10k.

Looking at if from the perspective of the insurance company -- what if a healthy young person does not have any insurance well because they are generally healthy and is seems to them cost effective to not have it. Then she finds out she is pregnant - well now she will need insurance because it will be too expensive for her otherwise. She has not paid into an insurance company previously so now she decides to do so. If the insurance company picks her up now - it will lose money as in within the next 9 months it is going to cost them $10k.

This is no different than life insurance - they have actuaries that determine how much a life insurance policy will cost depending on the chances of you dying. In this case --- women benefit because they tend to live longer so men typically have to pay more money to be insured. They also look at pre-existing conditions, life style and anything they can legally obtain to determine what would be profitable for them to insure you.

That is why we currently have laws protecting those with pre-existing conditions - because insurance companies are businesses - they are not moral beings. Believe me I have fought over the past several years on things the insurance company states are not medically necessary while my daughter's surgeon (head of Children's Hospital Sports medicine) insists are medically necessary. For the insurance company it is all about the profit.

And this is not comparable to having teeth - your teeth are not necessarily going to cause you problems, have cavities or any other medical issues. You may not ever have an issue with your teeth or you may. It is known that being pregnant will result in the insurance company having to pay out $10 within 9 months.

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@TheCobbler,

TheCobbler wrote:

We all pay for one another in a good socialized medicine system.

We pay for one another so that on the chance that we ourselves get sick the money will be there for us also...

The insurance companies under the republicans broke the system and left sick people and those needing care out in the cold so they could pocket the profits...

Now they are pissed that people with a conscience took away their cash cow that was killing people.

You could look at the history of health insurance generally in this way you are talking about. By pooling their money, employers were able to afford more expensive healthcare, which drove up the cost of healthcare generally and made it so people had to be employed (with benefits) to get healthcare.

People simply sharing costs shouldn't result in prices going up but it does because business people aren't stupid. If they can raise their prices because people are sharing costs, they will and do. The net result of that is excluding the lowest bidders from getting health care. This aspect of capitalism will never change due to socialism because socialism reinforces and stimulates it.

The only way health care costs will go down is if there is more supply than demand so that high quality care-givers will engage in price-competition without compromising quality. That is very difficult to achieve in the highly regulated environment that keeps the costs of everything from medical training to pharmaceuticals to diagnostic equipment high.

Quote:

While the republicans also fought abortion rights which forced women to come up with the money regardless of their circumstances.

That's like saying fighting tobacco sales to minors forces minors to buy cigarettes illegally. No one is forcing anyone to smoke or seek abortions. They just do it because they don't care.

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@livinglava,

To equate minors buying cigarettes to a woman seeking an abortion does not nearly come close at all.

Minors need an adult to help them break the law whereas a woman had a singular, legal right to seek a medical treatment on her own behalf.

1 Reply

@neptuneblue,

neptuneblue wrote:

To equate minors buying cigarettes to a woman seeking an abortion does not nearly come close at all.

Minors need an adult to help them break the law whereas a woman had a singular, legal right to seek a medical treatment on her own behalf.

You don't seem to understand analogies. The comparison wasn't between abortion and cigarette smoking. The comparison was between the choice to smoke and having an abortion and whether or not the law 'forces' people to take illegal action because they're not allowed to take legal action.

In short, the point of the law is to discourage people from the thing prohibited. When liberals insist that prohibitions don't work because people will just do them anyway, that's unacceptable. If something is prohibited, people shouldn't do it.

What if men responded to #metoo by saying it just forces men to sexually harass and assault women illegally? That would be unacceptable because the point is to get them to stop harassing and assaulting women. It is the same with abortion prohibition. The point is to stop abortion, not force women into getting illegal abortions.

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@livinglava,

So what you are saying is that pooling people together into insurance exchanges works but allowing Republicans and their big business cohorts to gouge the exchanges at will doesn't. This is the single most convincing argument for Obamacare regulations I think I have heard to date.

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@TheCobbler,

TheCobbler wrote:

So what you are saying is that pooling people together into insurance exchanges works but allowing Republicans and their big business cohorts to gouge the exchanges at will doesn't. This is the single most convincing argument for Obamacare regulations I think I have heard to date.

No, I said that health insurance never worked because it was just used as a tool for employers to control health care resources and use them as a means of leveraging power over employees.

For health insurance to work, the industries involved would have to restrain their own greed and allow more people to practice medicine for low pay.

What happens under the insurance system (public or private) is that insurance companies drive up prices/costs, which causes medical schools to raise tuitions, the AMA and licensing requirements become stricter to exclude more people from practicing medicine, and they generally force everyone into the choice between expensive insurance-paid health care or nothing.

In fact, it would be best to eliminate insurance altogether so that people only pay for health care out of their individual budgets. That way most people would only be able to afford low cost health care and so the demand for low cost health care providers would increase, which would mean more people would be able to work in health care, including volunteers who would practice medicine pro bono while working other jobs for pay.

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@livinglava,

Quote:

The only way health care costs will go down is if there is more supply than demand so that high quality care-givers will engage in price-competition without compromising quality.

This is actually untrue when it comes to health care costs. When you have a heart attack, you get taken in an ambulance to a hospital where you don't get to negotiate price. You say "yes" to everything and then worry about the cost later.

Add to that the fact is that you have a small chance of needing a very expensive procedure to save your life. So, you make choices now to pay for hypothetical future medical care. The normal principals of market economics don't apply.

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@livinglava,

Quote:

In short, the point of the law is to discourage people from the thing prohibited. When liberals insist that prohibitions don't work because people will just do them anyway, that's unacceptable. If something is prohibited, people shouldn't do it.

You have a point here... but the reverse is also true.

If people are going to do it, then it shouldn't be prohibited. There have been several times when laws were changed because enforcing them did more harm than good (i.e. prohibition). And there are other laws that are widely ignored but kept on the books anyway (i.e. speeding).

1 Reply

@maxdancona,

maxdancona wrote:

Quote:
The only way health care costs will go down is if there is more supply than demand so that high quality care-givers will engage in price-competition without compromising quality.

This is actually untrue when it comes to health care costs. When you have a heart attack, you get taken in an ambulance to a hospital where you don't get to negotiate price. You say "yes" to everything and then worry about the cost later.

Add to that the fact is that you have a small chance of needing a very expensive procedure to save your life. So, you make choices now to pay for hypothetical future medical care. The normal principals of market economics don't apply.

That's just one example. And besides, if employers and other insurance payers weren't pooling their money to fund hospitals, etc. then the cost of procedures would simply have to be lower for people to afford them.

1 Reply

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