“WHAT GOOD IS INSURANCE IF IT DOESN’T COVER MY PREEXISTING CONDITION?”

First, insurance was never designed to cover things that had already happened.

Think about car insurance: if you had no insurance and wrecked your car yesterday, do you think you could go to Allstate or Farmer’s today and get them to cover the accident you already had? Or if you had no homeowner’s insurance and your house started burning – could you then call GEICO or State Farm and ask them to cover the damage that already occurred? No.

Health insurance is the same way. It is meant to cover things that have not yet happened. It is about risk, and being prepared for risk.

“WHY SHOULD I GET INSURANCE IF IT WON’T COVER THINGS I ALREADY HAVE?”

To protect you for things that could still happen. After all, if you have hypertension, you didn’t plan on that happening, did you? Or diabetes – no one plans on that condition occurring. And pregnancy – if people planned on getting pregnant, they would get insurance first - so of course, it is a preexisting condition. Breaking a leg, throwing out your back, being in a car accident, developing MS, lupus, rheumatoid arthritis or fibromyalgia, Crohn’s Disease, chronic fatigue, Sjogren’s, osteoporosis… having a by-pass, Hepatitis C, cancer or a mild stroke….. almost all make you uninsurable after the fact.

“IF I DON’T HAVE INSURANCE, WON’T THE STATE STEP IN AND HELP?”

No. Otherwise, why would anyone have insurance? AHCCCS has two programs: Kids Care and the original very low-income plan (call 602-417-4000 for guidelines - it is based on income, not medical need). Premium Sharing has been gone about three years - too much fraudulent usage virtually bankrupted the program. Yes, hospitals can turn you away if you have no proof of insurance. And hospitals and doctors will file liens against property in order to collect on an unpaid medical bill.

“FORMER PRESIDENT CLINTON SAID NO ONE CAN BE DENIED!”

IF you are coming off of 18 months of COBRA, true. If you have 18 months of continuous health coverage with the most recent form of that coverage being a true group plan (employer-paid group plan, not an association) with less than 20 employees, true. That mandate is called HIPAA (Health Insurance Portability & Accountability Act). It is - on average - three to six times higher than regular rates and is available only in post-group or post-COBRA situations. Exiting the military would make you immediately eligible for coverage under HIPAA is your medical background made it difficult to get preexisting conditions covered.

“HOW ABOUT HIGH RISK POOLS?”

Arizona doesn’t have a high risk pool. There are 33 states that do. Premiums in those states start in the neighborhood of $500 per month per person (high risk/high cost) and go up based on age.

“HOW ABOUT MEDICAID IF I’M ILL AND CAN’T AFFORD INSURANCE?”

Our Medicaid program is (or was, as the case may be) AHCCCS. See note above.

“WE NEED NATIONAL HEALTH INSURANCE!”

Healthcare and insurance are NOT synonymous. Agreed, we do need something, but if you think national healthcare is the answer, go to countries that have it. Many people don’t like it, many pay very high taxes or do without other benefits in order to have it (whether they use it or not), many people who can afford it come to the US for their healthcare. In the US we have choice: choice of doctors, treatments, hospitals, etc. In many cases, where it exists, national healthcare makes our HMOs – which are often the source of irritation or criticism due to the “primary care doctor" requirement or cost review guidelines - look terrific.

Yes, we need something, but don’t blame the insurance industry. Insurance is a private business about insuring against future risk – that is all it ever was. Like having car insurance before an accident, or the homeowners coverage before the roof caves in. Insurance and healthcare are different issues – healthcare must be addressed separately from insurance. People who prepare for it, budget for it, take care of their health by watching their diet, not taking drugs, not smoking or drinking excessively, exercising regularly….want those choices.

But, yes, we need a plan in place to pick up when people fall through the cracks, through no fault of their own - especially children. Children more than anyone else should have a right to good medical care, no matter what. We as taxpayers and citizens of a country in which we have the freedom of choice to live and work, want to know that the children of our country will be taken care of. This issue must be addressed by our nation's lawmakers.

High risk pools are achieved in most states by higher taxes. If it goes to a vote, will you vote for higher taxes to support healthcare for those who cannot or will not provide it for themselves in Arizona?

"WILL NOT?"

On a daily basis, we get calls from people who flat-out tell us they believe it is their employer’s obligation to give them health insurance…. or that they will get it when they need it.... or they will go on welfare if they get really ill…. or that having two cars and a boat is more important than covering their family’s medical needs….  Should the state be picking up the tab for those who CAN afford it but just don’t want to pay for it? How would the state make this distinction? Between 15-20% of the people on AHCCCS got there fraudulently – they hid income or assets in order to get “the system” to pick up their medical costs. And now Premium Sharing and the Chronic Illness programs are gone because they ran out of funds.

“I HAD AHCCCS AND MY PLAN WENT AWAY AND NOW NO ONE WILL COVER ME – WHY NOT?”

Many people who went on PSP (AHCCCS’s Premium Sharing Program) did so due to low income – for instance, a household of four could have a pre-tax of income of nearly $3,000 per month and qualify. There weren’t necessarily any preexisting conditions but the cost was so low – under $100 per month for a family – that it seemed like the ideal way to get health coverage. Unfortunately, since PSP wasn’t insurance and was state-funded, when the plan went away there were no provisions for take-over by a regular carrier and no guarantee for continuous coverage under HIPAA or any other law. State-funded programs do not qualify as group plans and many people had developed preexisting conditions while on this program.

Insurance isn’t just about who can afford it: the primary qualification is through your health history. You can have various preexisting conditions and still be insurable – but over 250 ailments will disqualify you for coverage through an HMO or insurance company in Arizona.

"I'M COMING OFF PREMIUM SHARING AND AM HEALTHY, WHY IS INSURANCE SO COSTLY?"

PSP stood for Premium Sharing Program - that meant the person on it was sharing the premium with Medicaid. No one ever questioned how much of that premium Medicaid was picking up. It covered 80% to 90% of what the regular premium would have been. So, yes, many people are experiencing sticker shock.

“I’M HEALTHY BUT MY RATES ARE SKY HIGH!”

If you have a good plan now but the rates seem to keep going up, and you have developed medical conditions requiring surgery in recent years or continued health care in the future, you may want to keep your current plan and - if possible - raise your deductible. If you are in good health and hardly ever use the plan, then get away from plans offering co-pays for every little thing and take a plan whereby you cover the little stuff and they cover the big stuff-– it will cost you a lot less now and in the long run. The more of the little stuff you pay, the less your premium will be. The difference in a $1,000 deductible with co-pays and a $1,000 deductible without co-pays is usually 20-25% at most ages. Figure out what that would be on your plan and decide whether or not that monetary difference is worth paying if you only go to the doctor two or three times a year.
 

Again, insurance is not about covering you for things that have already happened – it is about protecting you against what hasn’t happened. It is about protecting you against risk of the unknown.