| > That's my biggest problem with the ACA, actually. I think it's great that insurance providers now have to accept pre-existing conditions, and while I'm against the ACA in general, I see that as the biggest good that it's doing > My dislike for it is that one provision could have been its own separate law that would have been passed easily, with more bipartisan support, and would have fixed much of what ails the system No, it would have destroyed the system. This happened in Washington state in 1994. They passed a law in 1993 that required acceptance of people with pre-existing conditions, prevented charging sick subscribers more, and had an individual mandate to get health insurance. The mandate would start in a few years. In 1994, Republicans got control of the state legislature, and repealed the individual mandate part of the law. The result: people dropped insurance until they got sick, then got insurance. If their condition was not chronic, they would drop insurance after they got treatment. Insurance companies started bleeding money. By 1998, 17 insurance companies that had provided individual health insurance in Washington no longer did so. By 1999, the last two companies that provided individual health insurance in the state stopped. You could essentially no longer buy individual health insurance in Washington. In 2000, they modified the law so that people with pre-existing conditions had to wait nine months before insurance would be effective. I'm not sure why they picked nine months, but my guess is that it has something to do with how long pregnancy lasts in humans, because people buying insurance when they found out they were pregnant and dropping it when they brought the baby home was one of the biggest causes of losses to the insurance companies. |
Guaranteed issue are the words of art for not considering preexisting conditions.
Community rating (https://en.wikipedia.org/wiki/Community_rating), means charging everyone the same amount, although that's often "Adjusted"; for Obamacare, by smoking, and maybe somewhat by age.
Individual Mandate: everyone must be part of the system.
It's the latter two that are politically difficult. Community rating means the healthy young ("young invincibles" is the current phrase) must pay a lot more to cover the less healthy older folk, also men must pay more to cover women. And it's not hidden in taxes like a single payer system.
The mandate of course means you can't escape the game for the sorts of reasons you've noted. And it's political poison, e.g. presidential candidate Obama, unlike Hillary!, was against individual mandates. And as you've noted, it's relatively easy to zap and in due course kill the rest of such a system.
Three guesses what's going to happen in 3 years when the mandate ramps up....
Ah, another critical line of attack: "BAILOUTS FOR INSURERS!!!", the "risk corridors" that will prevent them from going under this year, and the next one or two, due to insufficient signups and more importantly payments.
"Official" enrollment figures for Healthcare.gov were those who've put a plan in their cart, as of a while ago not even those who then hit "sign me up", and the communications between it and insurers are horrible, and I doubt the government even knows who's "signed up" but never paid, or stopped paying, or didn't pay their first huge bill that started to satisfy the huge deductibles of lower grade plans.