The Need for Health Care Reform

[StefanM]

The price of a group plan is usually better, but the coverage is generally the same, given equal plans. But even this isn't really a problem.

That's completely false. HIPPA regulations govern pre-existing condition exclusions in group plans. Individual plans don't have to consider prior coverage, and they can deny a policy or permanently exclude conditions. Group plans are prohibited by law from doing this.

 

[StefanM]

Simple economics. Which is why the reforms that have been shot down by this congress that would allow persons to pool together (through myriad ways) to buy group coverage in a free market sense has harmed average Americans.

Exactly. We should be able to establish group plans by free choice.

As a Southern Baptist minister, I could greatly benefit by this. As it stands now, you have to be in a church with 10 or more employees to get on a group plan through Guidestone. Otherwise, you have to be underwritten for an individual plan. It's hard to get accepted.

If we could voluntarily associate, then all of the SBC ministers in the state who have to get individual insurance could pool together for a group plan.

I'd love to see that option.

 

[TomVols]

I think you're confusing HIPPA with COBRA.

Still, group plans are likely better because groups have more purchasing power than individuals for obvious reasons.

 

[StefanM]

I think you're confusing HIPPA with COBRA.

Still, group plans are likely better because groups have more purchasing power than individuals for obvious reasons.

They hit some of the same things. COBRA brought along the continuation coverage, but HIPPA requires that group plans honor prior continuous coverage to reduce exclusions for pre-existing conditions.

 

[Pastor Larry]

That's completely false. HIPPA regulations govern pre-existing condition exclusions in group plans. Individual plans don't have to consider prior coverage, and they can deny a policy or permanently exclude conditions. Group plans are prohibited by law from doing this.

Actually it's not false at all. Notice, I said "equal plans." Given an equal plan, the coverage will be the same. It's not equal if something is excluded.

Secondly, I think every state has at least one "must cover" company which cannot exclude. Here in MI is it Blue Cross/Blue Shield. I have been through this to know. Again, the issue will be pricing, and group plans are almost always better. But health insurance is still available. I think the better way to go these days is a high-deductible plan with an HSA.

But I think there is a more fundamental issue, namely, whose responsibility is it to provide health care? Some say the government, and they want a single-payer system. Some say companies, and they want companies to do it. Some say it is the individual, and individuals should take care of it.

I think the latter is true. It is not now, nor has it ever been, the governments job to provide health care. We shouldn't start now. If you can get it through your company, then get it. If you can't, then get it yourself.

And BTW, I think it is HIPAA, not HIPPA.

 

[StefanM]

You are correct, it is HIPAA.

As far as your statement is concerned, group plans and individual plans are governed differently. In that sense, there can be no true equals across these lines.

 

[Pastor Larry]

They are not governed that differently, with the exception in most cases of maternity benefits (which make no sense on an individual plan). My plan being having individual insurance is almost the same as my plan was when I was working through a company. I am sure there are some plans that are radically different, but for every group coverage plan, you can likely find a very similar plan for individual coverage.

 

[StefanM]

They are not governed that differently, with the exception in most cases of maternity benefits (which make no sense on an individual plan). My plan being having individual insurance is almost the same as my plan was when I was working through a company. I am sure there are some plans that are radically different, but for every group coverage plan, you can likely find a very similar plan for individual coverage.

As far as what they cover, I agree. They can be similar.

However, individual plans rate you based on your health and age. Group plans have more flat rates. Unhealthy people can get excellent, affordable coverage through group plans. Healthy people can barely afford good coverage through individual insurance.

Of course, the other major disparity is in the tax system. Individual insurance (except for the self-employed) is not even partly deductible unless you itemize. Group plans are pre-tax.

 

[Pastor Larry]

Unhealthy people can get excellent, affordable coverage through group plans. Healthy people can barely afford good coverage through individual insurance.

I think the rates aren't as different as is the fact that in group plans, people generally do not see their premiums. I am sure the rates are different as well, but good coverage is not that unaffordable. Here in Michigan, for generally less than $200/month, an individual can get a $1500 deductible plan with 100% after the $1500. That's not unaffordable.

 

[StefanM]

I think the rates aren't as different as is the fact that in group plans, people generally do not see their premiums. I am sure the rates are different as well, but good coverage is not that unaffordable. Here in Michigan, for generally less than $200/month, an individual can get a $1500 deductible plan with 100% after the $1500. That's not unaffordable.

The rates are dramatically different for some. For example, a 55 year old man can generally get better coverage at a better rate through a group plan than he can obtain through an individual plan. Why? As an older individual, he's going to be rated higher. Group plans are not allowed to rate someone by age, so the risk is spread.