Author Topic: Impending repeal of Obamacare--what to do?  (Read 42924 times)

KaizenSoze

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Re: Impending repeal of Obamacare--what to do?
« Reply #200 on: November 14, 2016, 11:40:54 AM »
I have a hard time understand how Ryan is going to get this past the senior citizen lobby groups.

Any change to Medicare or Society Security generally causes a lot of push back.

Of course, I was wrong on Trump getting elected. So, what do I know.

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #201 on: November 14, 2016, 11:49:33 AM »
2.  We have very few protections against malpractice lawsuits.  Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.

In Texas, tort reform didn't make health care less expensive. While malpractice insurance premiums did go down substantially, the difference didn't make it to the consumer's wallet. It just increased the provider's income.

obstinate

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Re: Impending repeal of Obamacare--what to do?
« Reply #202 on: November 14, 2016, 11:57:08 AM »
The main reasons it's expensive:

  • No national drug pricing board, nor any other low-granularity pricing agent. This gives drug companies more market power to demand higher prices.
  • We train doctors later and require them to take on more risk. Therefore, they demand higher compensation.
  • We allow a guild (the AMA) to control the flow of new healthcare professionals into the labor market.

Most of the difference in cost comes from differences in physician compensation, medical device and drug costs, and hospital costs. The first comes from the fact that our doctors don't even start medical training until after university, have to mostly pay their own way (with average debt of $150k after graduating), and they as a group control the flow of new physicians. The latter two are higher because there's no low-granularity negotiator of prices with market power.
« Last Edit: November 14, 2016, 12:01:51 PM by obstinate »

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #203 on: November 14, 2016, 12:01:00 PM »
    • We allow a guild (the AMA) to control the flow of new healthcare professionals into the labor market.

    Aka, The "strongest trade union in the United States."*


    * Milton Friedman

    wenchsenior

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #204 on: November 14, 2016, 12:16:34 PM »
    I have a hard time understand how Ryan is going to get this past the senior citizen lobby groups.

    Any change to Medicare or Society Security generally causes a lot of push back.

    Of course, I was wrong on Trump getting elected. So, what do I know.

    I would expect this to be political suicide as well, but I think the plan is to grandfather in all the people currently on the plan I think, so nothing would be directly taken from most active voting block. So will older voters want to take this program away from their kids and grandkids? And will the younger voters think they are better off without it? Last year we had a discussion on a different thread about whether or not the giant Millennial voting block was liberal or libertarian. This piece of legislation is a going to be a good test of that.

    deadlymonkey

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #205 on: November 14, 2016, 12:25:06 PM »
    I have a hard time understand how Ryan is going to get this past the senior citizen lobby groups.

    Any change to Medicare or Society Security generally causes a lot of push back.

    Of course, I was wrong on Trump getting elected. So, what do I know.

    I would expect this to be political suicide as well, but I think the plan is to grandfather in all the people currently on the plan I think, so nothing would be directly taken from most active voting block. So will older voters want to take this program away from their kids and grandkids? And will the younger voters think they are better off without it? Last year we had a discussion on a different thread about whether or not the giant Millennial voting block was liberal or libertarian. This piece of legislation is a going to be a good test of that.

    Yes Ryan's plan is to sever Medicare so people currently on it get to keep it but no new enrollees.  However, after being severed off from funding (people working not currently on it) how long it lasts is anyone's guess.  It will become an orphan entitlement and ripe for raiding.

    Jrr85

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #206 on: November 14, 2016, 02:01:42 PM »
    For those saying a pre-existing ban cannot work without the individual mandate, could we have a pre-existing ban (no expulsion, no price change) for those who always maintained continuous coverage? This way, people who want to opt in health insurance (likely 50%+ of people) will all be in a single risk pool, but people could also completely opt out if they choose (for life).

    What about people who opt out at age 21 because they feel invincible, and then get cancer at 35?  We just let them die?

    The whole idea here is for society to find a way to take care of it's least fortunate members.  If lady luck fucks you, America is supposed to have your back.

    It's not politically on the table to let people die.  People who did not maintain continuous health insurance coverage would essentially be put in high risk pools that allowed them to get care with no subsidies until a significant portion of their assets and income are used.  It's a pretty small needle to thread.  The "penalty" for needing healthcare after not paying for insurance would have to be big enough that it's never or almost never looks like a good deal to just forego insurance and rely on the government, but it also has to be small enough to be politically viable, and it also has to be small enough that when the person has no assets (and realistically, a lot of the people that choose to go this route will have personalities that ensure they have no assets) they are not completely disincentivised from continuing to work. 

    And that's not even addressing the technical difficulties in making markets work where you can't risk rate people that want to change policies and where there is not a big time potential to game the system (e.g., use poor but cheap insurance in your twenties, jump to better insurance in your thirties when you're having kids, jump back to cheaper insurance in your 40's after it's clear your kids are healthy, and then go back to more expensive insurance). 

    It's a difficult nut to crack when you are committed to protecting people from the consequences of their decisions.  I'm not sure that somethign along the singapore model isn't the best model for developed countries.  Huge mandatory savings that can only be used for healthcare or retirement.  Even in retirement have some minimum that must be retained for healthcare.  Decent safety net after your savings are used.  Extremely paternalistic, but at least gives an incentive to minimize costs on the consumer side and is affordable and helps address retirement security also.   

    Scandium

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #207 on: November 14, 2016, 02:43:08 PM »
    There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.

    I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?

    Scandium

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #208 on: November 14, 2016, 02:48:16 PM »
    The "penalty" for needing healthcare after not paying for insurance would have to be big enough that it's never or almost never looks like a good deal to just forego insurance and rely on the government, but it also has to be small enough to be politically viable, and it also has to be small enough that when the person has no assets (and realistically, a lot of the people that choose to go this route will have personalities that ensure they have no assets) they are not completely disincentivised from continuing to work. 

    Yes, because incentivizing arrogant, hormone-driven, immature young people away from stupid behavior through appealing to the potential bad long-term consequences of their actions always works so well.

    Jrr85

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #209 on: November 14, 2016, 03:33:21 PM »
    The "penalty" for needing healthcare after not paying for insurance would have to be big enough that it's never or almost never looks like a good deal to just forego insurance and rely on the government, but it also has to be small enough to be politically viable, and it also has to be small enough that when the person has no assets (and realistically, a lot of the people that choose to go this route will have personalities that ensure they have no assets) they are not completely disincentivised from continuing to work. 

    Yes, because incentivizing arrogant, hormone-driven, immature young people away from stupid behavior through appealing to the potential bad long-term consequences of their actions always works so well.

    As opposed to using the threat of force to keep anybody from making decisions the government views as too risky? 

    But in this instance, you've actually got it backwards.  It's not incentivizing people away from stupid behavior.  The incentive is naturally there and would be very strong for most people.  It's just avoiding reducing the incentive too much. 

    sol

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #210 on: November 14, 2016, 04:13:11 PM »
    As opposed to using the threat of force to keep anybody from making decisions the government views as too risky? 

    I don't think it's "using the threat of force" to offer people free healthcare.  A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation.  How is that threatening?

    If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.

    FireLane

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #211 on: November 14, 2016, 06:36:37 PM »
    If Medicare goes away, we'll all screwed. It's the one thing keeping the old/dying out of our insurance pools. If we have to pay for the 65+ crowd, expect prices to rise very quickly. This would be a true "death panel" situation.

    I actually woke up at 3 a.m. and had a full on anxiety attack about this scenario. Couldn't sleep for hours, had to get up and distract myself with work.

    Not to be a noodge, but I really hope that everyone who's afraid of this (and I count myself among them) contacts their congressional representatives to tell them so. That goes double if you live in a purple or red state.

    For years I've figured, "no way would the GOP ACTUALLY mess with Medicare in any serious way...that program has more than 75% approval ratings with the public." But I have been consistently wrong the past few years, so I no longer believe myself.

    The American public also overwhelmingly approves of higher taxes on the rich and many other policy ideas that never get passed. Public opinion as a whole means very little to politicians. They care more about the opinions of their base voters and, especially, their funders. And the kind of people who fund Paul Ryan's campaigns have wanted to slash Social Security and Medicare for a very long time. They call it "starving the beast."

    Metric Mouse

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #212 on: November 14, 2016, 07:00:37 PM »
    As opposed to using the threat of force to keep anybody from making decisions the government views as too risky? 

    I don't think it's "using the threat of force" to offer people free healthcare.  A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation.  How is that threatening?

    If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.

    Well, perhaps after the Trump/Ryan care fails, maybe we will move in that direction.  Bandaging the mess that we have now is not really the most positive or efficient change we could be making.
    Give me one fine day of plain sailing weather and I can mess up anything.

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    jim555

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #213 on: November 14, 2016, 07:10:42 PM »
    As opposed to using the threat of force to keep anybody from making decisions the government views as too risky? 

    I don't think it's "using the threat of force" to offer people free healthcare.  A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation.  How is that threatening?

    If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.

    Well, perhaps after the Trump/Ryan care fails, maybe we will move in that direction.  Bandaging the mess that we have now is not really the most positive or efficient change we could be making.
    But they want it to fail, it is not a bug it is a feature of Trump/Ryan care.  They purposefully make sure things can't work and then say, look it doesn't work we must get rid of it.

    ketchup

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #214 on: November 14, 2016, 08:29:40 PM »
    2.  We have very few protections against malpractice lawsuits.  Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.
    This is absolutely a big part of it.  My uncle was a neurosurgeon (recently retired) and I don't know the details but I'm pretty sure his malpractice insurance was six figures annually (granted, I'm sure he was making bank above and beyond that in his specialty, but still).

    gerardc

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #215 on: November 14, 2016, 09:51:50 PM »
    This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!
    Yes, the fact that grocery stores put things on sale is evidence that they have an incentive to keep costs low.  I agree. What of it?

    Both grocery stores and insurance companies have 2 incentives: keep prices low compared to competition AND keep prices high in an absolute sense. I'd say insurance companies have an interest in keeping health care costs high in general, because those costs are applied to all payers/insurers, so they get better profits but no significantly changes in market share. This is really a form of price fixing.

    waltworks

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #216 on: November 14, 2016, 09:54:41 PM »
    Might be worth (if I ran the circus) leaving things alone but adding some tort reform/malpractice caps and the whole "selling across state lines" thing (which is, AFAIK, a bit of a non-issue since the insurers contract with hospitals, not states, but what do I know). See how that goes for a year or two, then decide if you want to blow it up.

    But Trump's mandate, if such a word is appropriate, seems to be mostly to give a big middle finger to the establishment so who knows what he (or the folks who voted for him) want the healthcare system to look like. My assumption is that he doesn't really know and plans to just sign off on whatever congress decides.

    -W

    obstinate

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #217 on: November 14, 2016, 11:15:07 PM »
    Mandate is definitely not an appropriate word to use on a candidate that lost the popular vote. He's president, yeah, but a mandate he has not.

    Metric Mouse

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #218 on: November 15, 2016, 04:03:47 AM »
    But they want it to fail, it is not a bug it is a feature of Trump/Ryan care.  They purposefully make sure things can't work and then say, look it doesn't work we must get rid of it.

    Setting up something to fail to get something better is not always a bad thing in my mind.
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    Re: Impending repeal of Obamacare--what to do?
    « Reply #219 on: November 15, 2016, 05:44:53 AM »
    But they want it to fail, it is not a bug it is a feature of Trump/Ryan care.  They purposefully make sure things can't work and then say, look it doesn't work we must get rid of it.

    Setting up something to fail to get something better is not always a bad thing in my mind.
    Yes, that's the view of revolutionaries through the ages.  Pity about all the people who get hurt in the meantime.
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    OurTown

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #220 on: November 15, 2016, 07:23:50 AM »
    Has anyone run the numbers on affordability of HDHP & HSA? 

    Gin1984

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #221 on: November 15, 2016, 10:04:24 AM »
    Has anyone run the numbers on affordability of HDHP & HSA?
    Which HDHP?  My current one would COBRA at $1600/month for my family.

    sol

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #222 on: November 15, 2016, 10:31:52 AM »
    Has anyone run the numbers on affordability of HDHP & HSA?

    It's going to completely depend on your situation, your tax rate, your family, your employer contribution, and what insurance plans you have available.  They typically cost you less per month, and provide little or no reimbursement for your healthcare costs before you reach a certain limit.

    For my relatively healthy family, it made financial sense to choose one of the existing HDHP plans available to federal employees.  The HSA is an effective (if tiny) retirement vehicle and a portion of my premiums pass through directly as insurer contributions.  It is significantly more cost effective for my family in a normal year of three kids and two adults doing regular doctor visits for routine stuff, but it would suck if we had major hospitalizations or cancer treatments or something.  In that case, we would take the next open enrollment window to switch back to more traditional comprehensive insurance.

    But we also have abundant cashflow which we could use to cover $12-15k out of pocket up front to get care.  HDHPs, like many ideologically conservative proposals, work less well for poor people than they do for rich ones.

    Axecleaver

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #223 on: November 15, 2016, 10:50:49 AM »
    It depends entirely on your specific insurance market. Here in NY, HDHP's are almost always lower cost. Even if you're a high-utilizer, the premiums + deductible is about the same as non-HDHP premiums for the year, without a deductible.

    NY has a very unusual insurance market, in part because age discrimination is not permitted. That means younger folks subsidize insurance premiums for older folks. This also reduces the levers insurance companies have to make rates affordable for people earlier in their careers. A large percentage of our insurance policies are "platinum" plans (18% vs. 2% nationally), which are often better deals for people with expensive health conditions.

    http://www.politico.com/states/new-york/albany/story/2016/10/why-new-yorks-health-insurance-market-stands-out-106875

    Telecaster

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #224 on: November 15, 2016, 11:50:26 AM »
    2.  We have very few protections against malpractice lawsuits.  Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.
    This is absolutely a big part of it.  My uncle was a neurosurgeon (recently retired) and I don't know the details but I'm pretty sure his malpractice insurance was six figures annually (granted, I'm sure he was making bank above and beyond that in his specialty, but still).

    My professional liability insurance is about 3% of my gross.   I understand that professional liability insurance for doctors is pretty close to that number, so insurance cost doesn't seem crazy out of whack compared to other industries.

    But you can also see why tort reform does almost nothing to control costs.   If insurance suddenly became one third or even two thirds cheaper,  that's only a 1 or 2% cost reduction.   Just not much there.   

    Jrr85

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #225 on: November 15, 2016, 11:52:28 AM »
    As opposed to using the threat of force to keep anybody from making decisions the government views as too risky? 

    I don't think it's "using the threat of force" to offer people free healthcare.  A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation.  How is that threatening?

    If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.

    The alternatives being discussed were Obamacare and guaranteed issue with no risk rating for people that maintained continuous coverage.  But regardless, yes, you are using teh threat of force.  Doesn't have anything to do with whether taxes are theft.  The Obamacare model is a little more specific threat of force as compared to single payer, but you shouldn't kid yourself as to what you are doing.  Pretty much all of the systems politically viable rely on a healthy dose of the threat of force.  That's why it's so hard to get anything workable.  People don't like the idea of people having to rely on charitable care, but they are also squeamish about the coerciveness/force necessary to make most other systems work.

    Malum Prohibitum

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #226 on: November 16, 2016, 09:57:38 AM »
    Has anyone run the numbers on affordability of HDHP & HSA?

    It's going to completely depend on your situation, your tax rate, your family, your employer contribution, and what insurance plans you have available.  They typically cost you less per month, and provide little or no reimbursement for your healthcare costs before you reach a certain limit.

    For my relatively healthy family, it made financial sense to choose one of the existing HDHP plans available to federal employees.  The HSA is an effective (if tiny) retirement vehicle and a portion of my premiums pass through directly as insurer contributions.  It is significantly more cost effective for my family in a normal year of three kids and two adults doing regular doctor visits for routine stuff, but it would suck if we had major hospitalizations or cancer treatments or something.  In that case, we would take the next open enrollment window to switch back to more traditional comprehensive insurance.

    But we also have abundant cashflow which we could use to cover $12-15k out of pocket up front to get care.  HDHPs, like many ideologically conservative proposals, work less well for poor people than they do for rich ones.

    We maxed out the deductible in 2016 and do not even have enough left (because of the contribution limit) to pay several thousand dollars in costs, so we will have to do that with after tax dollars.

    It's a gamble, for sure.  Sometimes it's cheaper.  Sometimes it's not.

    And the damn thing is over a thousand dollars  a month in premiums and will not be available come January.

    NoStacheOhio

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #227 on: December 07, 2016, 10:20:06 AM »
    Looks like there is momentum in congress to pass a reconciliation bill that repeals Obamacare but delays it, giving the geniouses in congress enough time to craft a replacement bill.  And the democrats are claiming they won't vote for the replacement bill no matter what.  So, looks like Obamacare and perhaps our entire health market is dead.  Interestingly, this story claims that more people will end up without health insurance than before Obamacare!  30 million would lose health care in 2019.

    https://www.washingtonpost.com/opinions/repealing-obamacare-without-replacing-it-would-be-a-disaster/2016/12/06/74ce1fc2-bbf5-11e6-91ee-1adddfe36cbe_story.html?hpid=hp_no-name_opinion-card-d%3Ahomepage%2Fstory&utm_term=.42c4e60bfe28#comments

    The one silver lining is that at least this will allow those who have not FIREd yet to get better visibility into whether Early Retirement that is dependent on Obamacare is feasible after a change in administration.

    Probably related to people whose employers provided plans before ACA, but sent their people to the exchanges after.
    The first step is acknowledging you have a problem, right?

    https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

    waltworks

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #228 on: December 07, 2016, 11:45:51 AM »
    You know what would be awesome? If they repealed the preferential tax treatment employers get for providing benefits.

    Now *that* would be a useful shakeup of the system. Having health care tied to employment is retarded.

    -W

    TheOldestYoungMan

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #229 on: December 07, 2016, 12:58:23 PM »
    There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.

    I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?

    Yup.  50-100k would probably do me.  I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash.  I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer.  My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession.  Paying cash that would have been around $175,000.00 which would still have been a donkey punch.

    I think part of the conversation is that people are insuring the wrong thing.  You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die.  This is what life insurance is for.  Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.

    When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up.  Also stop over utilizing healthcare.  If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like.  You are going to die.  It likely isn't going to be all that great an experience.  No amount of health insurance, government subsidized or otherwise, is going to improve that for you.
    Notice is turned in! 35 days until FIRE!  I am excited and at the same time terrified!

    Gin1984

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #230 on: December 07, 2016, 01:40:55 PM »
    There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.

    I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?

    Yup.  50-100k would probably do me.  I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash.  I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer.  My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession.  Paying cash that would have been around $175,000.00 which would still have been a donkey punch.

    I think part of the conversation is that people are insuring the wrong thing.  You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die.  This is what life insurance is for.  Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.

    When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up.  Also stop over utilizing healthcare.  If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like.  You are going to die.  It likely isn't going to be all that great an experience.  No amount of health insurance, government subsidized or otherwise, is going to improve that for you.
    And here we have a person with little to no medical knowledge or experience deciding he can just hand wave away medical issue.  Guess what, in the real world, that does not work.  I worked my way through college as a server.  I hurt my back doing so at 23.  I am 32 and still have major back issues.  I use two different medications just to be able to work and not be incapacitated.  I had PT, and injection into my traps for over year and still did not have full range of motion.  I use a medical device now every work day to get through.  I get sport massages to break my muscle up and get injects every 4 weeks.  People get hurt, especially when they have to work 10 hours a day or work a manual labor job.  That is not solved by eating vegetables.
    « Last Edit: December 07, 2016, 06:49:43 PM by Gin1984 »

    Scandium

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #231 on: December 07, 2016, 01:41:49 PM »
    There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.

    I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?

    Yup.  50-100k would probably do me.  I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash.  I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer.  My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession.  Paying cash that would have been around $175,000.00 which would still have been a donkey punch.

    I think part of the conversation is that people are insuring the wrong thing.  You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die.  This is what life insurance is for.  Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.

    When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up.  Also stop over utilizing healthcare.  If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like.  You are going to die.  It likely isn't going to be all that great an experience.  No amount of health insurance, government subsidized or otherwise, is going to improve that for you.

    Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?

    geekette

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #232 on: December 07, 2016, 05:53:15 PM »
    There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.

    I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?

    Yup.  50-100k would probably do me.  I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash.  I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer.  My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession.  Paying cash that would have been around $175,000.00 which would still have been a donkey punch.

    I think part of the conversation is that people are insuring the wrong thing.  You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die.  This is what life insurance is for.  Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.

    When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up.  Also stop over utilizing healthcare.  If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like.  You are going to die.  It likely isn't going to be all that great an experience.  No amount of health insurance, government subsidized or otherwise, is going to improve that for you.

    Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
    Oh, he thinks he can wave that away with a few lettuce leaves...

    Metric Mouse

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #233 on: December 08, 2016, 08:14:52 AM »
    Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?

    Wouldn't most diseases that run that expensive fall under the category of catastrophic?

    And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.
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    geekette

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #234 on: December 08, 2016, 10:56:08 AM »
    Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?

    Wouldn't most diseases that run that expensive fall under the category of catastrophic?

    And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.

    Actually, I've seen the idea floated that pre-ex would only be waived for a new policy if you'd had continuous coverage for x amount of time.

    wenchsenior

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #235 on: December 08, 2016, 11:19:09 AM »
    Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?

    Wouldn't most diseases that run that expensive fall under the category of catastrophic?

    And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.

    Actually, I've seen the idea floated that pre-ex would only be waived for a new policy if you'd had continuous coverage for x amount of time.

    Exactly, so again, very poor people or those with temporary severe financial crunches who dropped insurance at some point would be screwed. 

    sol

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #236 on: December 08, 2016, 11:28:00 AM »
    Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?

    Wouldn't most diseases that run that expensive fall under the category of catastrophic?

    And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.

    Actually, I've seen the idea floated that pre-ex would only be waived for a new policy if you'd had continuous coverage for x amount of time.

    Exactly.  They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage.  What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions?  The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.

    It's just like the 1100 manufacturing jobs at that carrier plant that Trump said he saved.  It doesn't matter that he didn't really save them, people want to hear that he did so he publicly claims that he did.

    It's just like all those times he said "I'm the least racist person you've ever met."  It doesn't matter that he banned black people from his clubs and discriminated against black tenants in his buildings, people want to believe that he's not racist so he says he's not racist.

    This is the Trump MO.  He's a people pleaser, and he'll say anything regardless of the truth if it's what peoples want to hear.  He's going to throw Clinton in jail.  Immigrants ruined the economy.  You can grab them by the pussy, but it was just locker room talk.  Mexico will pay for the wall.  He's going to bring back all the jobs.  Climate change is a Chinese hoax.

    I don't even blame him for being so ridiculous, honestly, it's standard celebrity policy.  I blame the rest of us for eating that shit up, because we apparently WANT to be lied to.  Trump is just the sycophant symptom of the underlying problem, rising to exploit our fundamental weaknesses.

    Weakness that is now being turned into official policy decisions, like the repeal of the ACA and the loss of health insurance for 10% of the country.  Is this really making America great again?  Because from where I'm standing, we're fucking ourselves pretty badly.
    « Last Edit: December 08, 2016, 11:33:33 AM by sol »

    Kris

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #237 on: December 08, 2016, 11:38:10 AM »
    You know what would be awesome? If they repealed the preferential tax treatment employers get for providing benefits.

    Now *that* would be a useful shakeup of the system. Having health care tied to employment is retarded.

    -W


    Agreed. The fact that this is how health insurance evolved in our country -- and the fact that people actually think this is normal -- is a huge source of the problem in the first place.
    Please note: Libertarian4321 did not vote for either Hillary or Trump. He voted for Gary Johnson, who was the Libertarian candidate.

    Scandium

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #238 on: December 08, 2016, 11:39:17 AM »
    Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?

    Wouldn't most diseases that run that expensive fall under the category of catastrophic?

    And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.

    The person I replied to said he wanted only "catastrophic coverage" with a $50-100k annual deductible. I was just wondering if he'd also be ok paying this every year, not just once.

    And presumably one of the reasons the plans he wants are gone is exactly because of the mandate to cover everyone, even with preexisting conditions. They can't afford to have people on cheap plans then suddenly switch to a low deductible one when (or before..) something happens.

    NoStacheOhio

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #239 on: December 08, 2016, 01:04:57 PM »
    I agree with how I don't like that the government is giving a loophole to insurance companies.  So you can't be denied for pre-existing conditions as long as you had continuous coverage your whole life.  So make sure to keep your records from 1982 of your insurance coverage or else we aren't paying this $100,000 cancer bill.

    I've never had a lapse in coverage in my life, but couldn't prove it under any circumstances. I don't even think I'd be able to prove it beyond my five-year tenure with my current employer.
    The first step is acknowledging you have a problem, right?

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    Metric Mouse

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #240 on: December 08, 2016, 01:16:24 PM »
    I agree with how I don't like that the government is giving a loophole to insurance companies.  So you can't be denied for pre-existing conditions as long as you had continuous coverage your whole life.  So make sure to keep your records from 1982 of your insurance coverage or else we aren't paying this $100,000 cancer bill.

    I've never had a lapse in coverage in my life, but couldn't prove it under any circumstances. I don't even think I'd be able to prove it beyond my five-year tenure with my current employer.

    I don't think that is what the issue is. The issue would be if you left your job, went without coverage for several years, and then re-applied. The fact that you have coverage now makes you 'previously insured' - you don't have to prove that you've always had insurance, only that you had insurance coverage immediately prior to the date that you're applying for new coverage.
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    Gin1984

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #241 on: December 08, 2016, 01:33:03 PM »
    I agree with how I don't like that the government is giving a loophole to insurance companies.  So you can't be denied for pre-existing conditions as long as you had continuous coverage your whole life.  So make sure to keep your records from 1982 of your insurance coverage or else we aren't paying this $100,000 cancer bill.

    I've never had a lapse in coverage in my life, but couldn't prove it under any circumstances. I don't even think I'd be able to prove it beyond my five-year tenure with my current employer.

    I don't think that is what the issue is. The issue would be if you left your job, went without coverage for several years, and then re-applied. The fact that you have coverage now makes you 'previously insured' - you don't have to prove that you've always had insurance, only that you had insurance coverage immediately prior to the date that you're applying for new coverage.
    But that was not how it was used prior, when losing coverage even for a day could allow the insurance to not cover your issue because it was pre-existing.  Hell, an MD friend on mine had a case where they did a fetal ultrasound, found issues, treated while in-utero and then the insurance tried to deny the claim for the child after he was born because his condition was pre-existing to his insurance. 

    Metric Mouse

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #242 on: December 08, 2016, 02:38:47 PM »
    how it was used prior, when losing coverage even for a day could allow the insurance to not cover your issue because it was pre-existing.  Hell, an MD friend on mine had a case where they did a fetal ultrasound, found issues, treated while in-utero and then the insurance tried to deny the claim for the child after he was born because his condition was pre-existing to his insurance.

    Ugh. That's pretty low. I can't wait until we can do away with insurance companies all together.
    Give me one fine day of plain sailing weather and I can mess up anything.

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    Kris

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #243 on: December 08, 2016, 02:52:05 PM »
    how it was used prior, when losing coverage even for a day could allow the insurance to not cover your issue because it was pre-existing.  Hell, an MD friend on mine had a case where they did a fetal ultrasound, found issues, treated while in-utero and then the insurance tried to deny the claim for the child after he was born because his condition was pre-existing to his insurance.

    Ugh. That's pretty low. I can't wait until we can do away with insurance companies all together.

    Yes. This was one of the reasons Obama worked so hard to put the ACA in place: stories like this were legion.

    Unfortunately, now that it's probably going to be repealed, we're likely to go right back to where we were before.
    Please note: Libertarian4321 did not vote for either Hillary or Trump. He voted for Gary Johnson, who was the Libertarian candidate.

    iris lily

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #244 on: December 08, 2016, 05:15:20 PM »
    We've had an ACA policy for a few weeks now. We received a letter from our insurer saying that they would not be mailong insurance cards because it was too close to the end of the year. If we have  to have them we could go online to our account and print them.

    So, ok, they mailed a letter telling me they would not be mailing a letter.wtf.

     Then yesterday, they followed up with another letter to remind me they would not be mailing that card, dammit!

    I dont blame this on the ACA, but I gotta say, wtf.

    gerardc

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #245 on: December 08, 2016, 07:58:33 PM »
    Exactly.  They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage.  What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions?  The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.

    No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!

    With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.

    projekt

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #246 on: December 08, 2016, 08:00:11 PM »
    2.  We have very few protections against malpractice lawsuits.  Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.
    This is absolutely a big part of it.  My uncle was a neurosurgeon (recently retired) and I don't know the details but I'm pretty sure his malpractice insurance was six figures annually (granted, I'm sure he was making bank above and beyond that in his specialty, but still).
    Sorry for resurrecting your comment from a month ago, but this is highly unlikely. Malpractice premium for a single doctor is rarely more than $30,000 per year and for most surgeons it is less than $20,000 per year. http://truecostofhealthcare.net/malpractice/

    Quidnon?

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #247 on: December 08, 2016, 09:48:32 PM »
    . Having health care tied to employment is retarded.

    -W


    Agreed. The fact that this is how health insurance evolved in our country -- and the fact that people actually think this is normal -- is a huge source of the problem in the first place.

    There is some interesting history that led up to this being a "normal" employment benefit in the US.  Mostly due to wage freezes during WW2, resulting in businesses turning towards benefit packages to attract dedicated & experienced labor; which in that time, if you weren't in the army, likely implied that you were an older professional with a family.  So sponsorship of a family health insurance plan was a big part of the new benefit packages.  Following the war, the dominance of such benefit packages were ensured due to preferential corporate tax treatment that major manufacturers lobbied congress for, and got.  Prior to WW2, health insurance, if any, was not a normal employment benefit.  That was something that upper middle class or wealthy families would get in the same way people get automobile insurance today, by contacting an insurance agent and seeking it out.  The majority of middle class and lower didn't get health care via health insurance, they got it through mutual benefit societies or charities.  I'm undecided about whether or not health insurance is a necessary part of health care for a single, young adult; but I am of the opinion that children should be granted special consideration.  If a 20 year old with no dependents chooses to forego insurance, I say let'em.  But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.
    "When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
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    Kris

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #248 on: December 09, 2016, 09:21:06 AM »
    . Having health care tied to employment is retarded.

    -W


    Agreed. The fact that this is how health insurance evolved in our country -- and the fact that people actually think this is normal -- is a huge source of the problem in the first place.

    There is some interesting history that led up to this being a "normal" employment benefit in the US.  Mostly due to wage freezes during WW2, resulting in businesses turning towards benefit packages to attract dedicated & experienced labor; which in that time, if you weren't in the army, likely implied that you were an older professional with a family.  So sponsorship of a family health insurance plan was a big part of the new benefit packages.  Following the war, the dominance of such benefit packages were ensured due to preferential corporate tax treatment that major manufacturers lobbied congress for, and got.  Prior to WW2, health insurance, if any, was not a normal employment benefit.  That was something that upper middle class or wealthy families would get in the same way people get automobile insurance today, by contacting an insurance agent and seeking it out.  The majority of middle class and lower didn't get health care via health insurance, they got it through mutual benefit societies or charities. I'm undecided about whether or not health insurance is a necessary part of health care for a single, young adult; but I am of the opinion that children should be granted special consideration.  If a 20 year old with no dependents chooses to forego insurance, I say let'em.  But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.

    Yes, I knew this, but was too lazy to type it out as part of my response above.

    The problem is the way things have played out since WW2, and the ways in which having insurance tied to employment has evolved in terms of attitudes and cultural norms, not to mention its intersection with the for-profit insurance industry.

    That is a much larger subject. And that is what I was talking about when I said it is complete f'ed up that we think of it all as "normal."
    Please note: Libertarian4321 did not vote for either Hillary or Trump. He voted for Gary Johnson, who was the Libertarian candidate.

    sol

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    Re: Impending repeal of Obamacare--what to do?
    « Reply #249 on: December 09, 2016, 09:29:59 AM »
    then in practice the health insurers will make your life miserable.

    My experience is that people most need their health insurance when they are already miserable.  After a major accident, a debilitating illness, a sick child.  Then the insurance company comes along and does everything possible to pay as little as possible.  Hiring a minimum wage claims worker to send you fifty rejection letters for payment is heck of a lot cheaper than paying a $65,000 medical bill from a car accident.

    In my case, my insurance company paid a lawyer to deny my coverage was valid, for months, because that was cheaper than just paying the bills.  I absolutely had legal insurance (through my university) but they had zero qualms about trying to retroactively deactivate my policy.  Any why would they?  They're a for-profit corporation with stockholders who want to see their income maximized and their expenses minimized, and the easiest way to accomplish that is to continue collecting premiums and then refuse to pay as many claims as possible.  The financial incentives for for-profit insurance companies are exactly backwards.  They make money by screwing with you in your must vulnerable state. 

    I was in ICU when my insurance company started breaking their own rules, and then a nursing home after that, and I had to fight them on it while I was unable to use a telephone due to my injuries.  Evil, predatory companies.  It still makes me angry just thinking about it, all these years later.