Is the Fact that I Am a Woman Considered a Pre-Existing Condition?

Is the Fact that I Am a Woman Considered a Pre-Existing Condition?


The male body has long been considered the “standard” for health care coverage. Having a woman’s body is seen as an expensive anomaly, and women pay dearly for being different.

When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women. Some argue that this is fair: after all, a woman could become pregnant, and labor and delivery are costly.

But the truth is that, even when maternity benefits are excluded, one-third of all health plans charge women at least 30 percent more, according to a report released just last month by the National Women’s Law Center.

In 36 states, “92 percent of best-selling plans charge 40-year-old women more than 40-year-old men,” the Center reports, and “only 3 percent of these plans cover maternity services … One plan in South Dakota charges a woman $1252.80 more a year than a 40-year-old man for the same coverage.”

Today, less than half of American women can obtain affordable insurance through a job, which explains why millions buy their own insurance in the individual market. In that market, just 14 states ban gender rating:  California, Colorado, Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, New Jersey, New York, North Dakota, Oregon, Vermont, and Washington.

Pricing based on gender also plagues the small group market, where insurers frequently jack up premiums if a small or mid-size business employs too many women. This means that many of these employers just can not afford to offer insurance. Only 17 states address the problem.

Insurers explain that women cost them more, even if policies don’t cover maternity, because “they are more likely to visit doctors, get regular check-ups, take prescription drugs, and have certain chronic illnesses.”

In other words, women are penalized for taking care of themselves, As for those “female chronic ailments,” men also are more vulnerable to certain diseases – including many caused by smoking (23 percent percent smoke vs. 17 percent of women).

But insurers ignore male vulnerabilities. As Soraya Chemaly points out on BlogHer: “In most markets if you are a non-smoking female you will pay more than a smoking male of the same age because you possess ovaries and not testes.”

And that is if you can get insurance.

All too often, a woman is closed out of the individual health insurance market because her medical history reveals a pre-existing condition.

For example, if a woman lives in North Carolina, Oklahoma, North Dakota, or Mississippi, and has been the victim of domestic violence, it is perfectly legal for a company to refuse to sell her a policy.

In 45 states, insurers can reject her because she has had a C-section – even if it was medically mandated.

Insurers see “Caesareans or beatings as pre-existing conditions that are likely to be predictors of higher expenses in the future,” the New York Times explains, pointing to Peggy Robertson, a 41-year-old Colorado mother who was denied insurance in 2007. A broker advised the Robertson’s to switch their insurance to Golden Rule (owned by United HealthCare), where they would get a better rate. But when they applied, the company spotted a C-section on Robertson’s record, and sent her a letter, explaining that if she wanted insurance she would have to be sterilized.

If a woman is raped she, too, risks being shunned. When Christina Turner was attacked by strangers, doctors advised that she take HIV medication “just in case.” Insurers then refused to cover her because the HIV drugs “raise too many health questions.” They told her they would reconsider her in three years if she could prove she did not have AIDS.

Turner went without insurance for three years. Other rape victims report being denied because they suffered from post-traumatic stress syndrome.

These are the most shocking cases. Other rules discriminate against millions of women for a long list of commonplace reasons:

  • If a woman has survived breast cancer, this is a pre-existing condition.
  • If she is pregnant when she applies, this also is considered a pre-existing condition, just like cancer. Most likely, she will be turned down.
  • If she is of child-bearing age and has children, this may well viewed as a pre-existing condition, leading to higher premiums.
  • On the other hand, if she is infertile, this too, can be labeled a pre-existing condition.

Not long ago, House Minority Speaker Nancy Pelosi summed up the hurdles: “If you’re a woman, it’s a pre-existing condition.”

When Vice President Joe Biden told President Barack Obama that health reform is a BFD, he wasn’t kidding. The Affordable Care Act (ACA) represents a major victory for women across the nation. Today, state law decides what insurers have to cover. Under reform, federal law will call for equal benefits in all states.

Begin with maternity benefits. In the 41 states where they are not mandated, a 30-year-old woman will find that only 6 percent of plans in the individual market now offer coverage. Guess how expensive those plans are. Under the ACA, maternity care will be considered an “essential benefit” that all insurers selling policies to individuals and small businesses must cover, without charging extra, beginning in 2014.

Some argue that women who want maternity benefits should pay more. “I don’t need maternity care,” Senator Jon Kyl (R-Ariz.) groused when the Senate Finance Committee debated “essential benefits.” Sen. Debbie Stabenow (D-Mich.) didn’t miss a beat: “I think your mom probably did.”

Enough said. One way or another, all of us benefit from prenatal care.

But maternity benefits represent just one way that reform addresses women’s health. The Affordable Care Act (ACA) also calls for:

Preventive services with no co-pays or deductibles: New Policies (issued or renewed on or after September 23, 2010) are required to cover services that many women need – mammograms, Pap smears, at least one well-woman care visit a year, contraceptive products and counseling, and screening and counseling for interpersonal and domestic violence. In 2018, these requirements will apply to all plans.

Essential benefits: In 2014, both all plans sold inside the new state-run health insurance exchanges and all new plans sold outside of the exchanges will be required to cover a specific set of essential health benefits. For women, these include maternity and newborn care; mental health services (including counseling for post-partum depression); preventative and wellness services; contraception; chronic disease management; and pediatric services for her children, including dental and vision care.

At the same time, the legislation bans:

Gender rating: In 2014, charging women more because they don’t have a Y chromosome will be outlawed both in individual and small employer markets. After 2017, if a state lets large employers into its exchange (and many will), the rule will apply to all large-employer coverage in the state.

Charging more for pre-existing conditions: Starting in 2014, insurers can not charge higher premiums, or deny coverage due to a person’s pre-existing conditions.

The bottom line: Under the Affordable Care Act, women’s bodies will no longer be viewed as exotic, but costly, deviations from the norm that just don’t fit into a health care system designed by, and for, men.

What happens if the Supreme Court overturns the individual mandate?

The Court might rule that if everyone is not forced to buy coverage, insurers shouldn’t be forced to cover everyone – especially if they are suffering from pre-existing conditions. (Without a mandate, the reasoning goes, many Americans will wait until they fall ill, and only then purchase coverage, secure in the knowledge that insurers will have to cover them, and can’t charge them more).

Even if you don’t like the mandate, you should consider what it would mean for women if insurers can charge patients suffering from a “pre-existing condition” whatever they like.

  • A recently divorced 62-year-old woman who is no longer covered by her husband’s insurance may find that she is closed out of the insurance market because she is a breast cancer survivor. Even if she can find an insurer who will take her, the penalty for having a pre-existing condition may well be more than she can afford.In insurance parlance, she will have to “go naked” until she is eligible for Medicare, keeping her fingers and toes crossed that her cancer does not recur or spread over the next three years. (If it does, she will have to spend down whatever savings she has, and perhaps sell her home, before she will be eligible for Medicaid.)
  • A young woman discovers that she is pregnant. She and her husband were not planning on having a child so soon. Suddenly, they find themselves facing thousands of dollars in medical bills. If the mother needs a C-section they may wind up owing as much as $24,400. (Five percent of U.S. hospitals actually charge more.) And that is if there are no serious complications.

Congress could vote to kill health reform

It is extremely unlikely that the Supreme Court will declare the entire Patient Protection and Affordable Care Act unconstitutional. Whatever the Court decides in June, women will retain protection against much of the sexual discrimination embedded in our current health care system – unless lawmakers set out to eviscerate the ACA.

As Soraya Chemaly points out on BlogHer: “The openly stated primary priority of the Republican Party is to overturn this law.” If that happens, “these discriminatory practices will continue and women will pay in complex ways.”

Even if President Obama is re-elected, Republicans and Democrats who oppose reform could constitute a majority in both houses, and might even have enough votes to overturn a veto on certain controversial issues – such as gender rating, or essential benefits. Many men believe that women should pay more. And they are not happy about covering maternity benefits, contraception, or post-partum depression.

Meanwhile, without the Affordable Care Act, we can not count on insurers to mend their misogynistic ways. Four years ago, the Women’s Law Center issued a national report titled “Still Nowhere to Turn: Insurance Companies Treat Women like a Pre-Existing Condition.”

Back then, the Center reached conclusions very similar to what it said in the report released last month. In 2008, “Some insurance executives “expressed surprise at the size and prevalence of the disparities,” Chemaly notes, but “apparently these executives weren’t surprised enough to do anything about it. . . By failing to rectify clearly discriminatory policies despite years of awareness, they continue to demonstrate their untrustworthiness.”

This is why, in the run-up to this fall’s election, voters should take a close look at their Senators’ and Representatives’ records when voting on major health legislation.

Not only women – but the many men who care deeply about their daughters, wives, mothers, and sisters – should think carefully about what repeal could mean for those they love.

Maggie Mahar is an author and financial journalist who has written extensively about the American health care system. Her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, was the inspiration for the documentary, Money Driven Medicine. She is a prolific blogger, writing most recently for TIME’s Moneyland. Previously she wrote and edited the Health Beat blog for the progressive think tank, The Century Foundation. Previous work for the Health Insurance Resource Center includes Will the Supreme Court strike down health reform? She also recently provided background on Congressional health care legislation for, a special project of the Health Insurance Resource Center. This post first appeared at

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121 Comments on "Is the Fact that I Am a Woman Considered a Pre-Existing Condition?"

May 2, 2012

I can’t speak to the pricing practices of all the insurers out there, but the fact of the matter as I understand it, based on over 30 years in the health plan business, is that women do cost more, until at least mid-50’s. Whether this is “penalizing” them for taking care of themselves or simple medical economics depends on one’s POV, I suppose.

There are two separate questions: what is the actuarial cost of various classes of individuals, and to what extent is society willing to allow pricing variations based on those classes. For example, I hope no insurer is pricing differently based on race, but I doubt any don’t factor in geography. If we say gender should not be a considered factor in setting premiums, we need to have our eyes open to the fact that means men will have to subsidize women (until later in life, anyway). This is not whacking those evil insurance companies, it is talking money out of men’s pockets in the interest of perceived social justice. As an older male, I don’t much mind, but if I were a healthy young man who wasn’t too keen on buying insurance anyway, I very well might.

Community rating was once, decades ago, the norm, but it fell apart because people opted to shop for lower prices that benefit them instead of being fairest to everyone. Jeremy Bentham might have objected but Adam Smith would not have been surprised.

Nate Ogden
May 2, 2012

I don’t think it is all greed that people shopped. When your young your income is usually at it’s lowest. before you retire your usually experiencing your highest earnings. Why are we asking young people to subsidize old people? This is on top of the huge generational transfer as a result of Social Security and Medicare. In my late 30s I am already looking at 70% SS benefit, I’ll be the first generation to receive less from SS then I put in.

PPACA is going to distort the cost of insurance so badly majority of people under 40 would be better off paying the penalty. They already have depressed wages and higher unemployment and now we are going to hit them again.

look at home equity and business equity of those 45 to 65 compared to those under 35. It’s criminal that we are stealing more money from the future to satisfy the greed of the older generations. 55 to 64 is by far the wealthiest bracket and Maggie wants us to believe they need more.

May 2, 2012

“For example, I hope no insurer is pricing differently based on race”

Why not? Why, as a healthy white male, should I have to pay for the health problems associated with being another race?

May 2, 2012

Peter1: you may be being facetious, but I’ll reply seriously just in case. Well, in addition to the fact that pricing based on race would probably be illegal, it’s not realistic. The concept of race is pretty murky — where’s the bright line between “races”? Pricing one “race” differently than another smacks too much of the Nazis or KKK ideas about racial purity. We’re all the same race, basically.

Plus, at some point there are socioeconomic issues cloud race distinctions in health spending as well, and it’s not fair to penalize people for that.

Nate Ogden
May 2, 2012

if a Ashkenazi Jew wanted to buy a policy to cover Tay–Sachs disease should they pay the same price?

What about African Americans buying coverage for sickle cell anemia?

Actuarial analysis is not racist, misogynist, or discriminatory in any manner. The results are not inflicted on someone because of those conditions it’s an outcome from those conditions. If a white person was predisposed to sickle cell anemia they would be charged more for a policy as well.

May 2, 2012

Nate, I don’t think we’re actually on different sides of the original issue, but your points illustrate my comment. For example, “race” is not always quite a clear-cut factor in sickle cell anemia — people with many genetic backgrounds can get it, and even among those of African origin it is not uniformly distributed. Charging by “race” would just be lazy underwriting, using an inexact proxy.

I believe use of genetic testing in pricing is not generally allowed, so looking for these genetic predispositions is (fortunately) hard to do.

May 2, 2012

“I believe use of genetic testing in pricing is not generally allowed, so looking for these genetic predispositions is (fortunately) hard to do.”

Yes, wouldn’t insurance companies love to get their hands on that information. I was being facetious, but as you can see Nate is never that way.

Insurance is never about health care, nor will it solve our cost problems. And I think your statement, “Community rating was once, decades ago, the norm, but it fell apart because people opted to shop for lower prices that benefit them instead of being fairest to everyone.” says much about where American society is today.

May 2, 2012

Kim & Peter 1


Thanks for your comment.

You’re right that women of child-bearing age do cost more. (Most comparisons of insurance costs assume that pre-natal care, labor, delivery contraception , etc. are an insurance plan )

But I think most of us would agree that, as a society, we benefit if all
women have good prenatal care, good care during labor and delivery– as well as the opporunity to avoid becoming pregnant when they are not in a position to support and care for a child.

Otherwise, we all wind up paying for the cost of caring for children born with serious health problems. Some will be very, very expensive for a few years–until they die. Others will be in need of care for many years, and in some cases, unable to contribute to society.

No one wants to live in a community where children and pregnant women dont’t get the healthcare they need.

I realize that healthy young men may not be enthusiastic about paying for health care for others, but the vast majority of healthy young men who I know (including my son and his friends) understand that all of us are connected: Sons and mothers, and sisters and lovers, husbands and wives. We’re all vulnerable to the accidents of fate, and , in the long run, what happens to some of us is going to affect all of us.

When we are very young, we all tend to think only in terms of “I.” (This includes young women: talk to a 17-year-old women and listen to how often the words “I” or “:me” come up. This is entirely human– young people are anxious, finding their place in the world, so they are concentrated on themslves.

But as we mature, we pay more attention to others. What one novelist has called “the speck of self” no longer blinds us to the larger world.

And we realize that we are all connected in a living organism, a web called
“society” or a “community”.

Finally, Kim thanks for your rational and respectful response to other readers.

As Peter 1 points out, he wasn’t being facetious, but Nate will say anything to get a response. This is why I don’t respond to him.

Peter 1– Thanks much for pointing out the difference)

May 2, 2012

It’s interesting that your son feels that way, Maggie. I’m not sure I feel comfortable asking men to pay more for the costs of a group that they’re not related to. Personally I’m not crazy about the idea of paying more for my car insurance to help cover men my age who are more likely to get into car accidents.

On the other hand, I do get what you’re saying about pitching in for others.

I’m willing to contribute more (even more than men do) so that women, a group I feel connected to, can get the health care they need. And I feel comfortable asking other women to do the same so that I can get care if/when I need it.

Then again, I actually haven’t ever seen a bill. You’ll have to come back to me in a few years when I’m off my mom’s health insurance and ask me how I feel.

Nate Ogden
May 2, 2012

“Nate will say anything to get a response. This is why I don’t respond to him.”

Ya that is why, it has nothing to do with being factually wrong.

No matter how simple or polite the comment you can’t respond.

Why when this issue affects less then 10% of women do you make such a big deal out of it? None of this applies to Medicare, Medicaid, Group insurance which is 70%+ of the population. Majority of the uninsured choose to be uninsured because of the cost, and you propose asking them to pay more.

You never had a problem slandering people and calling them misogynst but as soon as someone factually challenges you the rules change. If you don’t like a harsh critique maybe you shouldn’t attack others so harshly? And try to so some fact checking outside the DNC talking points.

bev M.D.
May 2, 2012

This is why I have always said that insurance and health care are mutually exclusive. Routine practices to minimize risk on the part of insurance companies are (properly) decried as discrimination or cruelty by the public. You can’t have it both ways – insurance executives think like insurance executives. We need another system entirely for health care.

Nate Ogden
May 2, 2012

by nature don’t doctors make people better? Even to a fault, do we need another system for treatment?

Insurance when used as insurance works incredibly well. Insurance used as wealth redistribution doesn’t. Which makes perfect sense, why design an insurance plan supposedly based on acturial risk when your goal is really to take $100 from one person and give it to another, is that’s that what taxes are for?

It would seem the simple solution instead of bastardizing the concept of insurance would be to subsidize women’s premium if you believe the world is sexist.

Which reminds me, what does WIC stand for again Maggie?

Ah that’s right an entire government program for women that excludes men. Damn this sexist society we live in.

Now that I got that out of my system, WIC would actually be a better vehicle for addressing Maggie’s concern then distorting the functionality of insurance and demonizing everyone along with it.

Speaking of Maggie’s militant femonism, how many young women die in war compared to young men….there goes that sexist society again.

May 2, 2012

“Ah that’s right an entire government program for women that excludes men. Damn this sexist society we live in.”

What does WIC stand for? All three letters? The program is not titled W. If you want to acknowledge the actuary generated data that women cost more, then you should also acknowledge that it is women who (usually) end up caring for the kids when families go bad or when births are out of wedlock (84%).

Also, the plan does cover men when they are caring for children.


Nate Ogden
May 2, 2012

You don’t see me advocating to eliminate WIC do you? I was pointing out the sexist hipocracy of Maggie and those that think like here. When it benefits them they want discrimination, when it doesn’t they attack everyone as misognyst.

May 2, 2012

Disclaimer up front, I can’t read Ms Mahar’s posts and voluminous retorts on accompanying threads, because every one has a limit to reading pontificating. So, if that diminishes this comment, so be it.

However, what I could digest above is easy to me: another hack job by a Democrat operative to sell PPACA as part of the overtly identified smear campaign regarding who is caring about women for this election by Democrats. Yeah yeah yeah, republicans aren’t doing themselves any good by the stupid and ignorant stuff they have overtly said to now, but 2 wrongs don’t lead to validation.

Frankly, I’m surprised if Ms Mahar was genuine in her concerns about women to not see PPACA will continue to discriminate against women with the eventual IPAB behaviors. $100 says 3 or less members will be female!

May 2, 2012


I would just say that car insurance and health insurance are very different.
First, in many (not all) parts of this country, one doesn’t have to have a car
(or auto insurance). You can get to work via public transportation

Health insurance, on the other hand, is a necessity. None of us know when we will need health care , and when we reallly do, it’s not a choice.

In addition, women in this country earn less than men doing exactly the same jobs. And women are less likely to work for employers who provide insurance (Only 50% have work-based heatlh insurance.) Therse are reasons why men need to help subsidize health insurance for their
daughters, sisters, future wives and mothers.

I appreciate the fact that you’re willing to help out other women, because you feel a connection with them.

But I’d urge to “feel connected” to men too. Or let me put it this way: those are the men you want to date, and eventually marry.

Barry Carol
May 2, 2012

To equalize insurance costs for men and women of similar age, men will have to pay more so women can pay less because, as noted by others, women consume more healthcare than men until they reach their late 50’s. After that, men use more.

At the same time, at the population level, insurers will tell you that people in the 55-64 age cohort use 5 to 7 times more healthcare than those in their 20’s. Even PPACA allows a 3 to 1 premium differential based on age and 4 to 1 for the high risk pools. So, the age band limits require the young to pay more than what’s actuarially justified so older people can pay less. At the same time, again at the population level, their income and assets are considerably lower than people in their 40’s and 50’s as the young are just starting out in entry level jobs. The fact that many are also saddled with significant school loans to repay only adds to their burden and the feeling of being put upon when it comes to paying for health insurance that they are likely to use comparatively little of.

Within Medicare, beneficiaries in the least expensive counties use one-third to one-half as much healthcare as those in the most expensive (Miami-Dade) but everyone pays the same Part B premium. Is that fair? In Switzerland, by contrast, premiums vary among the 26 cantons so that the same policy in the most expensive canton costs twice as much as it does in the least expensive canton. That makes more sense to me.

People who live in high cost areas are paid higher nominal wages than those who live in low cost regions for similar jobs. Yet, our progressive income tax structure requires the family with the higher nominal income to pay more in federal income taxes even though the standard of living that the pretax wage can support may be lower in the high cost region.

As Nate notes, larger employers already equalize insurance costs for men and women. Over 160 million people, including family members, get their insurance through an employer with most of those in medium size and large groups. The issue is also irrelevant for Medicare and Medicaid as Nate points out.

Personally, though I’m now insured by Medicare, I wouldn’t have a problem equalizing insurance rates for men and women even if I were younger and accessing insurance in the individual market. I would be willing to pay more so women could pay less but I always earned a pretty good income and could afford to. However, I think this argument might be more credible if women also supported equalization of insurance rates when it works against them including for auto and life insurance premiums.

May 2, 2012

Bev M.D.

I agree with your point that people need health care–not heatlh insurance.
And, unfortuantely, in this country health insurance has been all about
“underwriting ” (figuring out who is likely to get sick, and discriminating against them.)

But in other countries, that is not true. Throughout Euopre, private sector health insurance companies are part of the system. (Single-payer exists in Canada & the UK but not on most of Western Europe)

Those private sector insurers are regulated by the government, and are not
allowed to discriminate.

The Affordable Care Act follows the European example: it regulates insurers in a way that will force them to change how they do business..

As the CEO of Aetna recently said, insurers are going to have to entirely change their business model: they won’t be underwriting, they are going to have to manage the health of large populations (i.e. try to keep their customers healthy, much the way Kaiser Permanente (a non-profit iinsurers in the U.S.) tries to do.

In Northen California, Kaiser Permanente has succeeded in making heart disease no longer the No. 1 killer among its customers. (Throughout the rest of the country, heart disease remains the #1 killer.)

May 2, 2012

I am genuinely curious what is the number 1 cause of death among Kaiser members?

Barry Carol
May 2, 2012

Maggie –

Recent data that I’ve seen show that cancer is now the #1 killer by a small margin of people less than 65 years old. Heart disease is a close 2nd and is still the #1 killer across the entire population. I don’t know how many Medicare Advantage enrollees Kaiser has a percentage of its total membership. My sense is that it’s not a big player in the MA space.

Insurers with a sizeable Medicare Advantage business are already providing insurance without underwriting. United and Humana are the two biggest MA insurers and, for Humana, it’s the bulk of their business. They do receive risk adjustment payments based on each individual’s risk score, however. Roughly 25% of Medicare enrollees are now in MA plans and that share is growing steadily. In Germany, 80 different factors are used to assess health risk and the Central Fund distributes risk adjustment payments to individual insurers as warranted. In effect, that replaces underwriting.

On the commercial side of the business, a steadily increasing share of the market is fee based as opposed to risk based. Self funded insurers assume the risk and pay all claims though some may buy stop loss coverage as well. Insurers earn a fee to administer the plan, pay claims, provide a network and negotiate contract payment rates. The individual market is small in terms of members and even smaller in terms of revenue.

May 2, 2012

Determined M.D.–

Cancer, of all types. is the #2 cause of death throughout the U,S. and so it seems reasonable to assume it’s now the #1 cause of death in N.

It’s worth noting that many (not all) cancers seem to be genetic, or caused by environmental factors. The patient hasn’t done something reckless.,

And a great many cancers cannot be cured, even if detected through screening. Often, a patient’s life may be extended for some time, but in the
end, many cancers are fatal diseases.

These are the accidents of fate that I was talking about in an comment above.

We can’t blame the paitents, or the doctors. Medical science just hasn’t cracked the mystery of cnacer.

On the other hand, when patients and doctors work together to manage heart disease, a combination of low-cost medications (aspirin) , changes of diet and exericse can greatly reduce mortalities. Kaiser provided
incentives, and mortalities fell.

May 2, 2012

Thank you.

Legacy Flyer
May 2, 2012

Presumably Maggie is also in favor of equalizing premiums for life insurance (higher for men based on their lesser longevity) and auto insurance (higher for men based on their driving habits).

If not, one must ask why one type of insurance that most of us need (health insurance) would be treated in a different way than another insurance that most of us also need.

May 2, 2012

Health insurance companies discriminate against women for having ovaries in the same way that auto insurance companies discriminate against men for having testicles.

Or at least that’s the flawed logic that passes for discourse on this thread. What a joke!

May 3, 2012

Nate and Barry have made a valid point, which is…….

the individual insurance market has a lot of problems, a lot of inequities
that do not exist in the larger group and medicare sectors….

and by the way, it has had these problems for over 50 years. I once had a job with an insurance company administering health plans sold to seniors before Medicare. These were disgusting pieces of swiss cheese non-coverage, and this was a well-respected insurer.

The PPACA attempts to tame the rough edges of the individual market, through the pricing and underwriting reforms that Maggie describes.
Health care experts told the administration that this reform could not be accomplished without an individual mandate, given what happened in Washington, New Jersey, et al and their rather stunning anti-selection.

Personally I had a soft spot for the idea of letting individual buyers into the Federal employee program. (John Kerry proposed this among others.)
This would raise rates for Federal employees, which would ultimately impact the taxpayers…….but I thought and still think that this would be workable. If anyone in this country can afford to take a little hit for the public good, it is federal employees.

As Barry says, the very same insurance companies that run away from young risky patients are on television, every single night, advertising for medicare business and saying NOTHING about pre-existing conditions.

Of course this is entirely due to risk adjustment programs, and Maggie herself has pointed out how Medicare-Advantage insurers have manipulated these programs already. They make more money on patients who can be classified with pre-existing conditions, at least for a few years. This totally reverses the insurer’s business plan, witness those TV ads that are otherwise completely bizarre to a veteran health care watcher.

I would be fine with risk adjustment as a way to cure the individual market, but it would not be cheap. A lot of dollars have to move around, and the real bottom feeders of the individual market would make less profit. It would require higher taxes.

Republicans have made the cynical calculation that the people who get hurt in the individual market are not a voting bloc that can hurt any incumbent. So they feel no guilt in abandoning this group.

The Democrats showed more heart but not necessarily more brains so far.

Bob Hertz, The Health Care Crusade

Nate Ogden
May 3, 2012

more heart Bob? PPACA whiped out the entire individual market for those under 18, how can you claim the right doesn’t care when the left killed their insurance? The reality contradicts your politics, it’s like claiming the left is more compassinate because they pushed poor people into public housing projects.

How has MA manipulated anything? They have done exactly what the politicians designed the program to do, create an alternative to Medicare with additional benefits.

Democrat reform efforts have lead to higher group cost which has increased the uninsured rate, if it wasn’t for bad reform from the left these poor people in the individual market abandoned by the right would have good group coverage.

May 3, 2012

What worked in MA does not mean it can work nationally! American is far and wide and very different from MA! Trying to implement a program of national healthcare won’t work. We don’t have the money, nor do we have the the will to make it happen. For those who want FREE everything it can’t work. Go to Russia and see how it works there or even England and Ireland (you wait almost a year for cancer surgery there) that is coming to USA if Obamacare stays in place. Healthcare is so expensive now because Americans are fatter and more unhealthy than they ever been and frankly it is not hte taxpayers job to pay for anyone’s healthcare. I am amazed that the few want to revamp the healthcare system for those who think everything shoujdl be free. Without capitalims all this goes away. Everyone lives in a 600 sq foot apartment and rides a bike! This is such a silly argument women love to have. Just because you are a woman and I am a woman myself does not mean you have some right to use your sex to push the envelope for services. Women are not mistreated in America get a grip.