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You are here: Home / Anderson On Health Insurance / COVID, pre-exisiting conditions and post-facto underwriting

COVID, pre-exisiting conditions and post-facto underwriting

by David Anderson|  September 22, 20209:45 am| 20 Comments

This post is in: Anderson On Health Insurance

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The ACA is before the Supreme Court.  If it is struck down, pre-exisiting condition protections disappear.

COVID is the mother of all pre-exisiting conditions.

It is pervasive.

It is mostly non-symptomatic or at least not differentially symptomatic in the short run from a bunch of other fairly common diseases for large segments of the population.

It is still an unknown as to what long term effects look like.

It is an attack on multiple organs and systems.

Best case scenario is that a good percentage of the population will have COVID and be mostly healthy most of the time by the time that COVID becomes an unusual and infrequent disease as social distancing, ventilation, mask wearing and other public health measures work well enough to buy time to get most of the currently not yet infected portion of the population vaccinated with a highly effective vaccine.

Worse case scenario is that we get herd immunity between the relative inefficacy of vaccines, low vaccination rates, low social distancing, low mask utilization and continual consistent spread over the next year or two.  In that scenario, two thirds or more of the country will have had COVID and some non-negligible percentage of that group will have long lasting effects of their infection.

Under current law, insurers can’t explicitly look at medical history to set rates.

If the Supreme Court overturns significant elements of the ACA, then insurers can and will look at the mother of all pre-exisiting conditions to uprate or deny coverage.  Even if an insurer does not want to do so, competitors that effectively screen and select members based on medical history will de facto make the non-screening insurers pick up only the sick and likely to be sick.

 

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20Comments

  1. 1.

    Jinchi

    September 22, 2020 at 10:06 am

    The ACA is before the Supreme Court. If it is struck down, pre-exisiting condition protections disappear.

    COVID is the mother of all pre-exisiting conditions.

    This seems like something every Democrat in the country should be campaigning on right now. It’s a clear cross cut of every horrible thing that’s happening right now and a sharp contrast between what Democrats stand for and what Republicans do.

  2. 2.

    patrick II

    September 22, 2020 at 10:07 am

    Government officials generally cannot be held responsible for crimes committed when fulfilling their official duties. Campaign rallies are not official duties of the office. Is it possible to sue Donald Trump and the Trump campaign for becoming ill at one of his rallies?

  3. 3.

    Jinchi

    September 22, 2020 at 10:14 am

    @patrick II: Is it possible to sue Donald Trump and the Trump campaign for becoming ill at one of his rallies?

    I’d say it’s worth trying, except you’d have to attend on of his rallies to find out.

  4. 4.

    patrick II

    September 22, 2020 at 10:16 am

    It also sounds like whoever Trump nominates will have promised to be “loyal” and any decisions regarding the election will be ruled in his favor by that justice at least. If he wins, the optimal chance for disease spread and herd immunity will persist.  Being 72 with underlying conditions, and having 68 year old wife, four brothers and sisters in their sixties and seventies and a 97 year-old mother, the re-election of Donald Trump and his socipathic based policies are not something we look forward to. He could wipe us all out.

  5. 5.

    patrick II

    September 22, 2020 at 10:18 am

    @Jinchi:

    I was thinking of trying to talk a litigious acquaintance who I don’t really like into attending.

  6. 6.

    Yutsano

    September 22, 2020 at 10:26 am

    If/when the PPACA goes down, I don’t really see a need to resurrect the old law. Instead, it would be time to advance Medicare for what it was originally intended to do: cover every man, woman, and child in the United States. I know it will take some major retooling for that to really be effective (I’m willing to let go of vision and dental if that gets the price to reasonable) but we’re still the richest fucking country on the planet. We can afford it.

  7. 7.

    taumaturgo

    September 22, 2020 at 10:32 am

    Well, the decision was made by the voters when they voted down to try M4A and decided to keep the insurance they love, for better or for worse. The socialist insurers jumped with joy at this win for them and laughed at the suckers that allowed them to continue their rapacious and dishonest ripof.

  8. 8.

    Cermet

    September 22, 2020 at 10:33 am

    @patrick II: The A$$ wipe isn’t stupid relative to being sued – they require anyone attending to sign a liability waver.  They are fully aware of the dangers of getting covid even if their brain dead followers are not and are told it is safe.

  9. 9.

    Ohio Mom

    September 22, 2020 at 10:33 am

    If the worst case scenario outlined in this post happens, I would expect enough of a backlash that, like the Irish abortion ban, a new law honoring the peoples’ desire will be enacted.

    But it would be a long time and there would much suffering in the interim. And no Republican would ever admit they were responsible so I wouldn’t even have the satisfaction of saying I Told You So.

  10. 10.

    gvg

    September 22, 2020 at 10:39 am

    @patrick II: Campaigning is not an official duty. That is why they are supposed to not do it in the white house, but pay for some venue somewhere else.

  11. 11.

    patrick II

    September 22, 2020 at 10:47 am

    @Cermet:

    Wow, there is cynicism and super death cynicism.  I should have known though.  It amazes me that anyone, even a Trump fan, would sign that without thinking — Wait! Why? They told me there was no danger!

    I think this is what Trump meant by “herd mentality”.  I thought he was confusing words at the time, but I guess herd mentality really is part of the plan to move us to herd immunity. Then it will (jazz hands) just go away…for those left alive.

  12. 12.

    TheTruffle

    September 22, 2020 at 10:57 am

    @Ohio Mom: In the meantime, the GOP brand would become toxic.

  13. 13.

    LeftCoastYankee

    September 22, 2020 at 11:18 am

    Doesn’t this worst case scenario rely on the premise that you can’t get re-infected or at a minimum it’s asymptomatic?

    If these assumptions turn out to be incorrect, there is no herd immunity “strategy” that I can see.  I may be missing something though….

  14. 14.

    dirge

    September 22, 2020 at 11:25 am

    Should I plan to declare bankruptcy immediately when the decision comes down, or wait for the insurance plan year to roll over?

  15. 15.

    David Anderson

    September 22, 2020 at 11:57 am

    @dirge: Keep what you have for as long as you can.

  16. 16.

    Anonymous At Work

    September 22, 2020 at 11:59 am

    2 questions:

    1. Do antibodies or evidence of COVID last long enough for testing months/years later to reveal an asympomatic case?
    2. How would insurance companies treat conditions that are of unknown origin but could be “possible COVID-related sequelae”?  Would they be able to make a person prove it wasn’t COVID or would the assumption be the opposite?
  17. 17.

    balconesfault

    September 22, 2020 at 1:40 pm

    @Ohio Mom: That’s why I don’t think this is worst case.

    I actually think the backlash, and new legislation forcing insurers to cover Covid-related “pre-existing conditions”, will be pretty swift.

    If a LOT of people test positive for Covid, that is.

    Worst case is that only 20-25% test positive – in which case insurers will be able to get away with denying coverage without as much pushback.

    And lots of medical bankruptcies ensue.

  18. 18.

    balconesfault

    September 22, 2020 at 1:42 pm

    @TheTruffle: Ha!

    You made a funny.

    So many things have happened to make the GOP brand toxic.

    As long as there are billionaires to fund it, churchgoers to bow down to it. and dedicated media to promote or at least fluff it … the GOP is going to be stupidly strong in America.

  19. 19.

    Sebastian

    September 22, 2020 at 3:46 pm

    @Anonymous At Work:

    Yes, deny coverage and then wait for you to run out of time or money.

  20. 20.

    Bob Hertz

    September 22, 2020 at 8:54 pm

    A large majority of Americans have never faced the issue of pre-existing conditions. True group employer plans, Medicare, and Medicaid have never excluded any conditions.

    That still leaves  up to 10 million persons in the individual market who are vulnerable.

    I think that even if this particular lawsuit defeats the ACA, some form of guaranteed issue coverage will be maintained.

    The scary thing might be what this coverage will cost.

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