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We recently worked with a client who is a Colorado REALTOR and a member of the National Association of REALTORS. She mentioned that she was eligible for coverage through NAR, but wanted to compare her options in the individual market with the policies that she could get as a NAR member. She sent over the details for us to look at, and we noticed that the coverage that NAR was touting as a benefit for members is basically just a guaranteed-issue limited benefit indemnity plan. Members have a choice of three different policy designs: The Physician Plan ($200/month for our client’s family of four) doesn’t include any inpatient benefits at all; it covers up to $100 per visit for office visits and ER visits, and up to $1000 for accidents. The Value Plan ($300/month for our client’s family) and Platinum Plan (almost $500/month) included limited inpatient and surgery benefits, but even the Platinum plan capped its benefits at $1000/day for inpatient care and $3000 per operating session for inpatient surgery. The plans are all guaranteed issue, but they have a 12 month pre-existing condition exclusion for any hospital or surgical expenses.

NAR makes it clear on their website – for people who are detail oriented – that the coverage offered through the REALTORS Core Health Insurance is not major medical and that the benefits are limited. They also provide a good informational page on their site about the struggles that self-employed people face when it comes to securing health insurance, and the efforts that NAR has made and continues to make in terms of making true group health insurance available to independent contractors who are part of a large association-type group like NAR. Presumably all of this will be a moot point as of next January when the individual mandate and guaranteed issue individual health insurance are implemented, but for now, it does appear that NAR is cognisant of the problems faced by many self-employed people who are trying to obtain medically-underwritten individual health insurance.

My concern is […]

Senator Aguilar’s plan for universal healthcare in Colorado is based on a genuine need: even with current and planned state and federal healthcare reforms, there will still be a lot people in Colorado without health insurance. The CBO estimates that on a national level, we’ll have 30 million uninsured people in the US a decade from now. That’s taking into account the fact that SCOTUS struck down a provision in the ACA that would have required states to expand their Medicaid programs. States have flexibility with that now, and some will likely choose not to expand. Colorado, however, is expected to expand its Medicaid program (not surprising, given how much work the state has already done on that front). The uninsured population in Colorado hovers somewhere in the 600,000+ range, depending on how and when the samples are studied. If the ACA is expected to reduce the national uninsured population from 53 million to 30 million, and taking into account the fact that Colorado will likely be one of the states that opts for Medicaid expansion, I would say it’s reasonable to expect that the uninsured population here will be reduced by at least 50% once the ACA is fully implemented. But that still potentially leaves a few hundred thousand people – not an insignificant number by any stretch – with no health insurance. Those are the people Senator Aguilar is trying to help.

[…] Is it fair to say that health insurance carriers shouldn’t be able to use genetic testing information during underwriting, but that they should have to pay for preventive healthcare that results from genetic testing? I don’t think there’s an easy answer there. It’s hard to put a price tag on health and life, and it’s difficult to say that a person who is making such a hard decision should also be faced with a potentially very large medical bill at the same time. But if we’re going to categorically state that genetic testing cannot be used to the advantage of health insurance carriers, it’s hard to turn around and say that the carriers should also be required to pay for treatment that comes about as a result of that same testing.

What do you think? As technology moves forward, I have no doubt that genetic testing will become more routine, and various preventive measures based on those tests will likely become fairly commonplace. If they become a larger part of our general healthcare process, I would say that it’s reasonable to assume they will also be covered more frequently by health insurance carriers. And as of 2014, some of the issues addressed by GINA will become moot points too, as health insurance will all be guaranteed issue. So this is a subject that might just work itself out naturally over the next decade or so. But for now, it does leave plenty of room for debate.

The reason we have health insurance is to protect against the things we don’t expect to happen. The things we can’t foresee. The things that would blow though most households’ life savings very quickly. Doctor visits, routine medications, even the occasional trip to urgent care – these are relatively predictable. And relatively inexpensive, compared with the cost of care for a serious illness or injury.

If health insurance did cover everything, without any additional out-of-pocket costs for the insured, health insurance premiums would go up by about as much as people currently spend on out-of-pocket costs. Health insurance carriers would have to start generating enough revenue to cover those claims, and that would translate directly into higher premiums for everyone.

I know that the comparisons between health insurance and auto or home insurance have been made many times, but I’ll bring it up again here. When you buy car insurance, you don’t expect it to cover oil changes, new tires, or even a whole new engine if your car ends up needing one. When you buy home insurance, you don’t expect it to pay for home maintenance or repairs. In both cases, we expect the insurance to cover the unexpected. We know that if we have a car or a house, they’re going to need maintenance. And we know that we’ll have to budget for those things, however much we might dislike that fact. We hope that we never have to use our car insurance or our homeowner’s insurance. The same should be true of our health insurance. It’s there in case something unforeseen and expensive occurs (and it’s useful to remember that “expensive” is a relative term… although $1000 is “expensive” as far as most family budgets, it’s a tiny fraction of the total medical bill that would be incurred in the event of a major illness or injury). When you take that view of health insurance, it becomes a more realistic product. With most policies, the money you’re paying in premiums is not intended to cover routine, minor healthcare (with the exception of preventive care). But it will cover the potentially enormous claims that could result from a serious illness or injury.