[chimeracoder]

> once that expires, through the public exchanges that are guaranteed to cover their existing condition. Thanks ACA.

The ACA just states that insurers can't refuse a customer who wants to purchase a plan just because they have a preexisting condition. It doesn't actually require that the plan cover treatment for said condition.

In many states - including wealthier deep blue states - the marketplace plan options are actually quite terrible.

[rcme]

The HHS disagrees with you: https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co...

> Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.

[chimeracoder]

No, you are misreading it. They cannot limit benefits due to your condition, but that doesn't mean that they have to cover treatment for your condition.

If you have a disease or syndrome, the treatments for that condition (whether pharmaceutical, outpatient, or inpatient) may simply not be on the list of benefits provided by the insurance plans offered.

It's legally distinct from, but analogous to, a nodiscrimination clause. They can't refuse to cover your mammogram (which they cover for everyone else) just because your initial diagnosis for Vamipiric Brain Syndrome occurred before your plan went into effect. But they can choose to say they they don't cover Nosferatudone for anyone (when Nosferatudone happens to be the only effective treatment for Vamipiric Brain Syndrome).

(There are, separately, certain treatments that all insurance plans must cover by law, although that's separate from the ACA, and it's a very limited set).

[giaour]

The ACA has "minimum value" requirements and defines what constitute "essential health benefits" that plans must include to satisfy the ACA's coverage requirements and be eligible for sale on healthcare.gov or state-level marketplaces: https://www.healthinsurance.org/obamacare/essential-health-b...

[chimeracoder]

> The ACA has "minimum value" requirements and defines what constitute "essential health benefits" that plans must include to satisfy the ACA's coverage requirements and be eligible for sale on healthcare.gov or state-level marketplaces

Yes, I'm well aware of that, and those requirements are incredibly bare-bones. Nearly any insurance provided by employers far exceeds those requirements, whereas the same cannot be said for insurance provided on the marketplace.

This post is about people who are losing employer-provided insurance, and there's almost no universe in which the non-COBRA options available to most of those people aren't markedly worse than what they're losing, even if we ignore the increased cost of self-purchased insurance.

[rcme]

Yes, you're always able to buy a bad health insurance plan. But you're also able to buy a good health insurance plan, and your pre-existing condition won't impact the price of the good insurance plan.

[chimeracoder]

> Yes, you're always able to buy a bad health insurance plan. But you're also able to buy a good health insurance plan,

If one exists, and as I stated in the original post, in many states, even the best plans available on the marketplace are quite terrible. And that's a problem that's actually gotten worse in recent years, not better, as plans have left the exchange (and providers have dropped marketplace plans from their networks).

> and your pre-existing condition won't impact the price of the good insurance plan.

Your "pre-existing condition" won't impact the price of the insurance plan relative to others who are purchasing that same plan, but you quite likely will be in a situation where the "good" (eg, gold) plans are the only ones which will provide the coverage that you need, and those are the most expensive ones. This satisfies the letter of the law, but in practice it still means that often people with chronic health condition either are are forced to pay more for coverage or are literally unable to get coverage for their conditions at all (because none of the marketplace plans will cover it).

The protections provided by the ACA are much more narrow than you're portraying them as, which is understandable because it's a common misconception about how the ACA operates, but it's unfortunately a very important distinction.

[rcme]

Do you have any evidence that the plans aren't sufficient? Others in the thread have mentioned they have gotten nearly identical plans to their old employer plans. People I know who buy their own health insurance have totally adequate coverage, and this is in a "blue northeast state" that, according to you, has inadequate options.

[chimeracoder]

> Others in the thread have mentioned they have gotten nearly identical plans to their old employer plans.

One person said this, without mentioning either their state or any details of their previous plan.

> a "blue northeast state" that, according to you, has inadequate options.

I did not say that every "blue, northeast state" has "inadequate options". I said that many states have terrible options, and that, contrary to the stereotype of ACA issues being limited to poorer red states that refused to expand Medicare, this set includes wealthier blue states.

> Do you have any evidence that the plans aren't sufficient?

You stated that "public exchanges are guaranteed to cover their existing condition", an assertion of universality. This is completely false, for reasons that I have explained. The federal statues guaranteeing coverage for individual conditions are incredibly narrow and exclude both the most expensive conditions for patients, as well as almost all expenses for chronic conditions.

Furthermore, it's very easy to disprove this assertion of universality, because it's incredibly easy to find counterexamples - the ACA has been around for a decade, and there are tons of forum posts all over the past ten years from people struggling to find non-COBRA coverage that continues to match their needs after losing a job. A marketplace plan cannot deny you an insurance plan for a preexisting condition, but that doesn't mean that there exists a marketplace plan that will cover it.

The fact that you happen to know people who are satisfied with their coverage for themselves is neither here nor there, because it does not contradict the main point: the ACA is no guarantee that people losing their jobs will actually have any non-COBRA options to address their health needs (and given that Microsoft has pretty comprehensive insurance and employs people in nearly every state, it's all but certain that the marketplace options will be appreciably worse for many of those people than the status quo).

[foogazi]

> But they can choose to say they they don't cover Nosferatudone for anyone

Does private employer insurance not have the same limitations?

[chimeracoder]

> Does private employer insurance not have the same limitations?

Yes, but insurance sold to private employers is a completely different market, and it is almost universally better than the insurance plans available on the exchanges.

[notch656c]

Doesn't this create a huge incentive for people to buy rolling "temporary" insurance plans which can consider pre-existing conditions, and then switch to subsidizing off the healthy once they actually get a condition and buy the regular ACA plans?

[vikingerik]

Yes, and that's one reason why costs have ballooned so much, the need to subsidize people who didn't pay while they didn't have a condition and now do. The temporary plans aren't even necessary, if you can wait until the next regular enrollment period.

The ACA originally tried to hide that vulnerability by making insurance mandatory, then it appeared when that forcible mandate was repealed.

Edit to reply to the reply: Right, it's not insurance. Insurance is pooling risk. If you wait until the risk event has already happened, it's not insurance, it's just paying your own costs with extra steps.

[notch656c]

... so we have the worst of both worlds. Insurers are forced to take pre-existing conditions, but you can wait until you have a condition before buying it.

I don't think that's even "insurance" at that point....

America may quite possible have the absolute dumbest system humanly possible.

[willcipriano]

The best part? The US spends more per captia than any other OECD nation on socialized medicine. The United Kingdom's NHS costs around half, per capita and delivers universal coverage.

[notch656c]

Yeah. As a a pretty hardcore ancap who hates socialized anything, I'll still take NHS over our current system. Anything is better than our current bastardized system.

[rcme]

You can only switch plans during the open enrollment window or in cases of specific life events. You can't arbitrarily change plans whenever you want.

[notch656c]

"Temporary" plans are 1-12 months so you can buy ones that last until the next open enrollment, and if you're healthy you buy another (12 month) temporary plan. If you develop a condition you buy the regular plan.