Elementary Question- What Was the Purpose of Mandated "Essential Health Benefits"?

[bobson]

It's not the mandatory benefits that are at issue. It's the fact that no part of this is even allowed by the Constitution despite the Supremes as usual making law instead of interpreting.

But keep it mind nothing about this was specifically for health benefits. It's 100% for control by the guberment.

Rick

I thought article 12 of the Constitution dealt with health care????

 

[GreenSky]

I thought article 12 of the Constitution dealt with health care????

You better read that document. Article 12 is where the feds have power over education, drugs and marriage.

Rick

 

[leevena]

I'll buy some of that.

I also think some major employers (a large retail store in particular) had lousy benefits and because they are self funded, where only Federal Law applies, needed EHB, so they could stop offering (and charging for) horrible benefits. There are certain parts of ACA that probably wouldn't be there if it wasn't for them. And the Womens Health and Cancer Rights Act of 98, could have been named for them, too. They also made sure nobody hit over 40 hours a week average, so they couldn't get the "good" benefits.

This is also where NY and CA are different. You don't allow companies to s!%@w their employees like we did in TX and all over the South. I particularly liked how well-man visits were covered at this company, but well-woman visits were specifically excluded until 2000ish.

So while I agree with you...maybe some corporate responsibility wouldn't be amiss, either.

Agree with most of what you said, but keep in mind that self-funded plans do not need to offer EHBs. We have groups that do not offer mental health at all.

 

[kgmom219]

Agree with most of what you said, but keep in mind that self-funded plans do not need to offer EHBs. We have groups that do not offer mental health at all.

My understanding was that self-funded had to hit EHB, too?

Because that big box sure changed theirs....

 

[Josh]

Not for nothing, but a lot of people had shi tty indemnity plans that were offered as "insurance", but if you had a cash payment of $500/day for being admitted to the hospital, you weren't anywhere near being covered. I remember a Denny's employee showing me what they were offered, now bear in mind, this is a person working hard to probably earn less than $10/hour, and they're seeing a premium of a few hundred a month for something that looks a lot like insurance, but isn't anything close to a "real" insurance plan.

 

[leevena]

My understanding was that self-funded had to hit EHB, too?

Because that big box sure changed theirs....

Nope. Must meet actuarial value.

 

[Ann H]

Not for nothing, but a lot of people had shi tty indemnity plans that were offered as "insurance", but if you had a cash payment of $500/day for being admitted to the hospital, you weren't anywhere near being covered. I remember a Denny's employee showing me what they were offered, now bear in mind, this is a person working hard to probably earn less than $10/hour, and they're seeing a premium of a few hundred a month for something that looks a lot like insurance, but isn't anything close to a "real" insurance plan.

I will agree with that. There isn't an experienced agent on this forum that would sell one of those when a better policy is available. However, the huge majority of health insurance that was sold in America was true comprehensive major medical.

 

[Josh]

I will agree with that. There isn't an experienced agent on this forum that would sell one of those when a better policy is available. However, the huge majority of health insurance that was sold in America was true comprehensive major medical.

I don't know how many people Denny's employs or how many folks were on aim plans, but I doubt insurance agents had much involvement in that.

Don't get me wrong, for a long list of reasons I hate the ACA, but it did actually attempt to solve matters of public welfare. There are a lot of people in this country that struggle to understand things and they were susceptible to garbage plans like that. Do I agree with how it was solved? No, but it was a real problem for a lot of Americans.

 

[leevena]

Not for nothing, but a lot of people had shi tty indemnity plans that were offered as "insurance", but if you had a cash payment of $500/day for being admitted to the hospital, you weren't anywhere near being covered. I remember a Denny's employee showing me what they were offered, now bear in mind, this is a person working hard to probably earn less than $10/hour, and they're seeing a premium of a few hundred a month for something that looks a lot like insurance, but isn't anything close to a "real" insurance plan.

Sorry, but difficult for me to agree with you completely. Yes there were many people who purchased less than adequate coverage, but that was their choice. With all the regulation around marketing, I find it hard to believe that those who enrolled did not have the information needed to understand what they were buying. Sure, there there some who did not understand, maybe many, but it was their responsibility. And keep in mind, ACA proponents will tell you that it solved the problem of people getting access to healthcare. We all had access to healthcare prior to ACA.

 

[Josh]

Sorry, but difficult for me to agree with you completely. Yes there were many people who purchased less than adequate coverage, but that was their choice. With all the regulation around marketing, I find it hard to believe that those who enrolled did not have the information needed to understand what they were buying. Sure, there there some who did not understand, maybe many, but it was their responsibility. And keep in mind, ACA proponents will tell you that it solved the problem of people getting access to healthcare. We all had access to healthcare prior to ACA.

Yes it was their choice, but if you take someone with limited education and no advisor, it is complicated. Not everyone in this country is college educated and savvy. Should the government hold everyone's hand? Personally I do t think so, but in a very real sense these non-insurance products were used to take advantage of that group of people.

I grew up in a poor town full of poorly educated folks. When I sold Medicare advantage people had gone their whole lives without understanding insurance. Hell, most people don't know how bad it is to have the state liability minimums and that's a lot less tricky than understanding the costs of healthcare and why a shi try indemnity plan isn't major medical.