CommunityMy FDL

Pre-existing Condition Discrimination?

There a burgeoning issue that I think you all should pay more attention to. With Wendell Potter’s appearance on MSNBC last night, renewed attention has been paid to the pre-existing condition regulations in the bill. He made a general claim that under the bill, we can be charged up to 50% more for having certain “health status factors.” He didn’t give any details at the time, but an examination of this issue is starting to flesh out the details – and it does not look good. All info points toward the wellness provisions in the bill creating a loophole enabling price discrimination based on pre-existing conditions (i.e. health status factors). McJoan at DKos has a post following up on the Wendell Potter claim that the bill allows for up to 50% penalties for health factors. Basically they are arguing that the wellness promotion provisions in the bill allow for incentives of 30% of the premium cost if the insured individual complies with certain simple wellness goals such as joining a gym but also more pernicious wellness programs that are actually related to health conditions that the person may have (such as a diabetic keeping insulin under control, etc.). The bill explicitly allows for both kinds of wellness provisions and simply limits the latter by saying that you can only alter premiums by 30%. However, they allow for the HHS Secretary to expand that to 50% at their discretion.

‘‘(A) The reward for the wellness program,
15 together with the reward for other wellness pro16
grams with respect to the plan that requires
17 satisfaction of a standard related to a health
18 status factor, shall not exceed 30 percent of the
19 cost of employee-only coverage under the plan.
20 If, in addition to employees or individuals, any
21 class of dependents (such as spouses or spouses
22 and dependent children) may participate fully
23 in the wellness program, such reward shall not
24 exceed 30 percent of the cost of the coverage in
25 which an employee or individual and any de88
O:\BAI\BAI09M01.xml [file 1 of 9] S.L.C.
1 pendents are enrolled. For purposes of this
2 paragraph, the cost of coverage shall be deter3
mined based on the total amount of employer
4 and employee contributions for the benefit
5 package under which the employee is (or the
6 employee and any dependents are) receiving
7 coverage. A reward may be in the form of a dis8
count or rebate of a premium or contribution,
9 a waiver of all or part of a cost-sharing mecha10
nism (such as deductibles, copayments, or coin11
surance), the absence of a surcharge, or the
12 value of a benefit that would otherwise not be
13 provided under the plan. The Secretaries of
14 Labor, Health and Human Services, and the
15 Treasury may increase the reward available
16 under this subparagraph to up to 50 percent of
17 the cost of coverage if the Secretaries determine
18 that such an increase is appropriate.

The bill does temper this by allowing individuals to get certification from a doctor that it is inadvisable for them to participate in the wellness program due to their medical condition. I generally sympathize with the potential benefits of incentivizing good health so I can see why this stuff is in there. But if you read this WaPost article you can see how this could be seriously abused. An employer can tell his employee to meet weight loss goals or suffer a 30% increase in his health insurance premiums or cost sharing. And unless his doctor can give certification that there is some medical reason for him not to lose the weight he is screwed. In addition to seeming unfair on its face, this does smack of immense intrusion of government into the private lives of citizens. A way to really control private behavior. I can understand getting a discount on my premiums if I regularly see a nutritionist or join a gym, but if I have risk factors for serious disease I can’t imagine being forced by the government to have my blood pressure not only regularly monitored but required to be under control in order to maintain affordable health insurance. Please take a look at this issue as it has the potential to be an explosive one similar to the revelation that Harry Reid snuck in the provision removing lifetime caps.

CommunitySeminal

Pre-existing Condition Discrimination?

There a burgeoning issue that I think you all should pay more attention to. With Wendell Potter’s appearance on MSNBC last night, renewed attention has been paid to the pre-existing condition regulations in the bill. He made a general claim that under the bill, we can be charged up to 50% more for having certain “health status factors.” He didn’t give any details at the time, but an examination of this issue is starting to flesh out the details – and it does not look good. All info points toward the wellness provisions in the bill creating a loophole enabling price discrimination based on pre-existing conditions (i.e. health status factors). McJoan at DKos has a post following up on the Wendell Potter claim that the bill allows for up to 50% penalties for health factors. Basically they are arguing that the wellness promotion provisions in the bill allow for incentives of 30% of the premium cost if the insured individual complies with certain simple wellness goals such as joining a gym but also more pernicious wellness programs that are actually related to health conditions that the person may have (such as a diabetic keeping insulin under control, etc.). The bill explicitly allows for both kinds of wellness provisions and simply limits the latter by saying that you can only alter premiums by 30%. However, they allow for the HHS Secretary to expand that to 50% at their discretion.

‘‘(A) The reward for the wellness program,
15 together with the reward for other wellness pro16
grams with respect to the plan that requires
17 satisfaction of a standard related to a health
18 status factor, shall not exceed 30 percent of the
19 cost of employee-only coverage under the plan.
20 If, in addition to employees or individuals, any
21 class of dependents (such as spouses or spouses
22 and dependent children) may participate fully
23 in the wellness program, such reward shall not
24 exceed 30 percent of the cost of the coverage in
25 which an employee or individual and any de88
O:\BAI\BAI09M01.xml [file 1 of 9] S.L.C.
1 pendents are enrolled. For purposes of this
2 paragraph, the cost of coverage shall be deter3
mined based on the total amount of employer
4 and employee contributions for the benefit
5 package under which the employee is (or the
6 employee and any dependents are) receiving
7 coverage. A reward may be in the form of a dis8
count or rebate of a premium or contribution,
9 a waiver of all or part of a cost-sharing mecha10
nism (such as deductibles, copayments, or coin11
surance), the absence of a surcharge, or the
12 value of a benefit that would otherwise not be
13 provided under the plan. The Secretaries of
14 Labor, Health and Human Services, and the
15 Treasury may increase the reward available
16 under this subparagraph to up to 50 percent of
17 the cost of coverage if the Secretaries determine
18 that such an increase is appropriate.

The bill does temper this by allowing individuals to get certification from a doctor that it is inadvisable for them to participate in the wellness program due to their medical condition. I generally sympathize with the potential benefits of incentivizing good health so I can see why this stuff is in there. But if you read this WaPost article you can see how this could be seriously abused. An employer can tell his employee to meet weight loss goals or suffer a 30% increase in his health insurance premiums or cost sharing. And unless his doctor can give certification that there is some medical reason for him not to lose the weight he is screwed. In addition to seeming unfair on its face, this does smack of immense intrusion of government into the private lives of citizens. A way to really control private behavior. I can understand getting a discount on my premiums if I regularly see a nutritionist or join a gym, but if I have risk factors for serious disease I can’t imagine being forced by the government to have my blood pressure not only regularly monitored but required to be under control in order to maintain affordable health insurance. Please take a look at this issue as it has the potential to be an explosive one similar to the revelation that Harry Reid snuck in the provision removing lifetime caps.

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