Big Al's picture

Sounds to me...

Sounds to me like the Governor is studying all of the options. Pam's knee sounds like mine... injections prior to surgery for osteoarthritis. My doc was able to do injections then a brace which allowed me 6 months to get a few decades of weight off. Obesity is a major contributor to osteoarthritis. Summary: I was able to prevent an expensive surgery by getting in shape. Obesity is going to make us look back fondly of the good old days of heavy drinkin' and smokin'.

Pam Strickland's picture

Thanks, Randy.The commenters

Thanks, Randy.

The commenters have elected to attack me. And I've decided to ask for removal of personal attacks that have nothing to do w/ the substance of the column. Last week there were so many personal attacks, Lail opted to shutdown comments.

My knee is a complication from a childhood injury and the fact that my family has bad knees. My weight complicates thing, but it's so bad that even w/out the extra weight I would be facing a replacement sooner rather than later. The plan is that I will continue taking off weight, which I've been doing the last year or so and do my water exercises so that I'll be in better shape when the injections stop giving me relief. I can't tell you the difference that the injection has made in my ability to simply get through the day and focus on what's in front of me to do.

Big Al's picture

I'm sorry

Pam, I'm sorry. My comments were about my experience not yours. Everyone's situation is different but I do believe that personal responsibility needs to be addressed at some point if we're going to be able to move to a single payer system. Again, my previous comments were about my situation only.

Pam Strickland's picture

Yes, I agree that personal

Yes, I agree that personal responsibility is important. You can't just take pills and have surgery for diabetes and heart conditions. You have to consider what you are putting in your mouth and how you are exercising. No doubt about it. But it's also true that unlike Bill Haslam keeps preaching that personal responsibility will only go so far.

No matter if I lose every pound recommended and do every exercise required, I still have to have the knee replacement in a year or two. If I had health insurance, we would have had a formal plan in place sooner. I saw a retired ortho two years ago, because that was all that was available to me. And he refused to give me an injection because he said I needed to lose weight. At that point it had been four years since I'd had an x-ray and no one was willing to refer me for an MRI. I had to get to a point where I could barely get around to get the MRI and back to the active ortho (non-retired). That wouldn't have happened if I had insurance.

Before the injection last week, I was in so much pain I was frequently using a cane, and I couldn't even w/ stand gentle water exercises. I was stuck. Now no cane. And the water exercises are easy. I have hope again.

lonnie's picture

I read the comments. Sounds

I read the comments. Sounds like a lot of twisted individuals. Why is it that people can support huge tax breaks for the rich, large government subsidies to oil companies that have the highest corporate earnings in America, and welfare for thousands of millionaires, but when it comes to healthcare for people that need it and cannot afford it through no fault of their own, they just as soon let them die? Some of these comments, I'm sure, come from people claiming to be Christians. Why don't they try some Christian love and kindness and maybe take some time to review the New Testament. If they did this, they could see that their hateful mean spirit and unwillingness to help people stay alive and healthy is a huge contradiction of the Christian faith or any faith for that matter. I feel sorry for those pathetic and sick individuals. There are good Christians, Jews, Catholics, Muslims, etc that support decent healthcare for everyone. For now, Tennessee should expand Medicaid. Wealth should not buy your health in America or in any country. The United States should not be behind most of the industrialized world, we need a single payer plan that covers every person in our country, anything less is morally wrong.

Big Al's picture

Best of luck

I wish you the best of luck with your recovery. I sure found out that my pounds went on easier than they came off.

Thag13's picture

Hey Ms Strickland

I have to wonder...why do you even bother writing for KNS??? I honestly couldn't take the abuse you suffer there.

A bunch of those folks are one car wreck or illness away from total ruin....

Pam Strickland's picture

I do it because the people

I do it because the people who read the paper, and that includes the hard copy, not just online, deserve to hear from a person who has a different point of view. I don't do it for the insiders, but for the average reader. I don't really care about the commenters, but I do believe they should stick to the subject matter and follow the comment guidelines. They don't really represent the readers. The readers are the people who send me private emails or who come up to me at the co-op or who say, "Don't I know you?" when I give my name at the dry cleaners.

I do it because it's fun and interesting and a challenge. And because my mama taught me to take part and my faith tells me to speak up.

George's picture

Don't forget the truth

Pam, do you understand how insurance companies handle pre-existing conditions? Federal law (since the 1970s) has mandated that denial of coverage of pre-existing conditions last for no more than 18 months. That's right -- the government already says that there are no pre-existing conditions after 1.5 years! But, this law is largely ignored because most insurance companies already cover pre-existing conditions after 6 months!

If you would take the time to research the issue, you would find that pre-existing conditions are responsible for less than 1% of all coverage denials. Obama is saying that a tax impacting about 30% of the population is insignificant because it doesn't impact a lot of people. Thus, they shouldn't be trumpeting the removal of pre-existing conditions, since that impacts far fewer people at less than 1% of the population.

Somebody's picture

Since you have already

Since you have already researched this, could you please provide the sources for your statistics, particularly the 1% figure regarding pre-existing conditions?

Pam Strickland's picture

George (not verified), the

George (not verified), the last time I priced a private policy it was out of my price range. Depending on how much the deductible was and what kind of benefits were involved, the costs was anywhere from $700 to $1,500 a month. The low figure is more than my rent each month. And the deductibles were high. I couldn't afford that. And the cost was directly tied to my pre-existing conditiins.

When the ACA goes into effect the higher rates for pre-existing conditions will be illegal.

bizgrrl's picture

When we moved here from

When we moved here from Florida we couldn't get an individual policy for any price.

George's picture

Pam, you really need to read

Pam, you really need to read the legislation you're trumpeting (although your elected Senators and representatives didn't read it).

Higher rates for different needs will NOT be illegal. In fact, higher rates for different needs will be MANDATED. That is what the mandatory exchanges and high-risk pools will be about. They cover more things, but carry higher premiums. If you want lower premiums, you could opt for a policy that cover fewer items.

You're also not unserstanding the pre-existing condition part. ACA says that you can not be denied coverage for any period of time for a pre-existing condition. It DOES NOT say that you can't be charged more. The exchanges are designed to have you pay more for your risk pool, so others who aren't in that pool don't have to pay as much.

In exchange for gaining coverage right away (instead of waiting 6 months), you pay more for your coverage.

People will be in for a shock when ACA goes into full effect. You're going ot find out that you will be paying an astronomical amount and getting less for it.

Pam Strickland's picture

I've read multiple summaries

I've read multiple summaries of the bill, by multiple agencies and think tanks. Yours is the only one that says this. I think I'll stick with the ones that aren't anonymous and are in agreement.

George's picture

My source

Pam, I don't rely on agencies and think tanks (what is a think tank, anyhow?).

My source is:

(link...)

Relying on think tanks and agencies will always keep you in the dark. Come into the light -- the truth will set you free.

R. Neal's picture

The comments over there at

The comments over there at the KNS (as well as the attacks on Pam Strickland) are very depressing. The intensity of hatred for the poor, underemployed and uninsured is shocking.

I'm just about convinced we will never have a single-payer Medicare for all system in the U.S. because of the simple-minded, Fox News/Rush Limbaugh fueled ignorance that is on display over there. I'm also convinced that Chief Justice John Roberts did the GOP a huge favor by igniting the base, which may have been his intent all along.

The Mrs. says I'm too pessimistic. She notes that a lot of hard work resulted in getting women the right to vote and getting a civil rights act passed. I countered that it took 100 to 200 years. She countered that we've been working on single payer for about 80 years, so maybe the time is nigh.

I am still not optimistic. If I can hang on for just a few more years, though, I'll have Medicare. Then I won't care any more. Unless the GOP eliminates it in the mean time.

Pam Strickland's picture

I could have had comments

I could have had comments turned off, but a few people have jumped in and made supportive and educational comments. But maybe cutting off comments would have been smarter.

Mike Cohen's picture

Headline

I don't see what in Pam's column supports your headline. Could you explain it? What is it Haslam has, by his actions, indicated he doesn't want us to know?

R. Neal's picture

Pay attention. Unfunded

Pay attention. Unfunded mandates,etc.

R. Neal's picture

P.S. I should add that

P.S. I should add that Bredesen, a supposed Democrat, was the source of the "mother of all unfunded mandates" that Republicans quote to this day. He was no better than Haslam with regard to health care.

Mike Cohen's picture

Haslam

Pam's column mentions he is taking a "cautious, pragmatic approach." I don't see where it cites anything he has said or done....or anything he "doesn't want us to know."

Unless its just basic partisan politics. Is that it?

R. Neal's picture

Haslam said he is studying

Haslam said he is studying our options. The correct option is to expand Medicaid for all the reasons stated in Strickland's column, plus set up the state exchange, which he has not done.

If wanting hundreds of thousands of uninsured Tennesseans to have coverage is "basic partisan politics," well, guilty as charged. What's your defense, or better yet, your solution?

Mike Cohen's picture

Haslam

I don't think blindly accepting anything with a huge potential cost attached is responsible. A pragmatic approach, making sure you know what you are getting into, seems pretty sensible to me.

I have no issue with your disagreeing with how the Governor chooses to handle this...not that you would care if I did. My point is that you stated there was stuff he didn't want us to know. And I have yet to see anything that backs that up.

Fine discussion. Good column by Pam. And I personally believe everyone in America should have health insurance, although I'm not sure how and how we pay for it.

But there seems to be zero evidence that Haslam is keeping anything from us or is aware of things he doesn't want us to know.

Your headline and Pam's column just don't connect.

R. Neal's picture

Strickland's column

Strickland's column highlighted several facts that have been missing from the national, state and local conversation about health care reform. Your comment reflects these manufactured misconceptions (e.g "huge potential costs" - did you even read her column?). Haslam has never publicly acknowledged any other point of view.

Mike Cohen's picture

Strickland column

Of course I read her column...and lots of other articles. The fact is there is no clear agreement on how the economics of this shake down. If you choose to believe partisan views you can accept that it is going to be all roses or all crap. The truth probably lies somewhere in the middle. But certainly anyone with a fiscal responsibility has a duty to those they serve to take some time and look at it. There's a reason the plan allows state governments to have a voice in decision making. Thus Haslam has not "rushed to judgement" as some other Governor have done....as noted in Pam's column.

Beat on the overall debate all you want. Hate that Republicans tend not to like it all you want. But a headline slamming Haslam and indicating there is stuff he doesn't want us to know is unfair and unsupported by facts...or by Strickland's column.

R. Neal's picture

Show me where Haslam or any

Show me where Haslam or any TNGOP official has publicly stated any of the facts in Stickland's column and I will concede.

Rachel's picture

I got to agree with Mike on

I got to agree with Mike on this one - the headline does seem misleading.

However, the Feds are going to pick up the total cost of the Medicaid expansion for 3 years, and 90% of the cost after that. Right now the Feds pay an average of 57% of the costs for the existing Medicaid programs.

Hard to see why a state govt would pass this up, unless it's for purely ideological reasons, which we are certainly seeing in other southern states.

Can the governor just decided to participate in the Medicaid expansion? Or does the legislature have to get involved? Cause while Haslam might show some pragmatism, I don't expect much out of Ron Ramsey.

R. Neal's picture

Rachel, show me where Haslam

Rachel, show me where Haslam has publicly acknowledged any of that.

Rachel's picture

As far as I know, he hasn't.

As far as I know, he hasn't. I can't quite extrapolate from that to "he doesn't want you to know it".

If he makes a decision wrt the Medicaid expansion, and doesn't acknowledge the facts while making it, THEN I'll agree with you.

Still wondering who has the authority to make the decision for the state?

R. Neal's picture

P.S. "There's a reason the

P.S. "There's a reason the plan allows state governments to have a voice in decision making."

They didn't, until Roberts' decision, with regard to Medicaid anyway, which was the point of Strickland's column.

They sort of did, with regard to exchanges. Tennessee still doesn't have have a voice in that respect, despite taking $9 million in free federal funding to "study" it.

The only reason Haslam hasn't "rushed to judgement" is that he's still waiting for Ron Ramsey to tell him what to do. Which is odd, because it seems pretty clear.

Keep trying.

Still waiting for your solution.

Mike Cohen's picture

Show me

Anywhere where Haslam has indicated there are things he doesn't want you to know. You made the assertion about him. Prove it.

I'm not defending the entire TNGOP...I don't know them all personally. I know Haslam. I support Haslam. And I think what your headline says is wrong.

And if I didn't regularly read and respect your blog and your view I wouldn't have piped in.

Haslam may absolutely reach a decision that you dislike and oppose. But he won't do it by trying to keep facts from the public.

The headline about Haslam is just wrong.

R. Neal's picture

Again, show ME where Haslam

Again, show ME where Haslam or any other TNGOP hack has publicly acknowledged the facts stated in Stickland's column.

Mike Cohen's picture

Back at you

You made an assertion, not me. Back it up.

R. Neal's picture

I'm still waiting for you to

I'm still waiting for you to prove that Haslam has publicly acknowledged the facts in Strickland's column.

Until then, I stand by the headline and the assessment of Haslam 's policy.

Mike Cohen's picture

OK, then

You just choose to standby something with absolutely no evidence to support it. Got it.

R. Neal's picture

And I'm still waiting for

And I'm still waiting for your evidence to dispute it. Should be pretty easy to produce. Where is it?

You are demanding that I prove a negative.

OK, then.

Mike Cohen's picture

Not exactly

I am asking you to prove what you assert. That's where the burden of proof falls.

R. Neal's picture

Obviously I can't prove that

Obviously I can't prove that Halslam or the TNGOP never ever uttered a word acknowledging the facts in Strickland's column that support expansion of Medicaid.

I'm just asking you to show where they did. It should pretty easy. Where is it?

Mike Cohen's picture

Stalemate

You are rhe one that asserted Haslam didn't want us to know stuff. It simply isn't true. Even Pam says he is taking a "cautious, pragmatic" approach.

Oh, the horror...

R. Neal's picture

Then why hasn't Haslam come

Then why hasn't Haslam come out and explained everything Strickland's column pointed out? Can you show us where he has?

Mike Cohen's picture

Haslam

You, Randy, are the one that asserted something about Haslam

Just prove it.

R. Neal's picture

You are asserting that I'm a

I've made my case. Make yours.

You are asserting that I'm a liar. Prove it.

rikki's picture

delusional party

Mike Cohen is right. Haslam does not operate by preventing the public from knowing the facts; he and the rest of the GOP operate by polluting the public well with lots of "facts" that are actually lies. Happy, simplistic lies that are much more fun than facts!

Haslam doesn't not want you to know the facts. He wants you to not be able to recognize the facts from bullshit. Look how effectively Cohen has mired this thread. It's easier and more efficient to confuse and distract people than to prevent them from knowing stuff.

Everybody KNOWS our health care system is a radically expensive ass-fucking of every principle of market economics. What they don't know is whether anyone proposing solutions is actually trying to solve the problem. Mike Cohen is not trying to solve the health-care problem. He has smaller fish to fry.

Mike Cohen's picture

Haslam

Randy...I think the burden of proof is on you: you asserted something and have offerd no proof. You assert...you prove.

R. Neal's picture

I have. I quoted Haslam's

I have. I quoted Haslam's only public statement on the matter, in which he never acknowledged the facts stated in Strickland's column. He has not been forthcoming, except when he advocated on a taxpayer funded state website for the election of Romney to assure the repeal of health care reform which would include the repeal of Medicaid expansion. Still waiting on your evidence to the contrary.

I will grant you that he hasn't outright lied like his GOP enablers, at least that I know of. But that's a distinction without much of a difference when it comes to honesty in regard to public policy.

Crowley 's picture

For what it's worth.....

Mike Cohen is correct.

Mike Cohen's picture

Haslam

Not the same thing. Haslam is dealing with it. Not aware he's under an obligation to discuss what Pam wants to discuss. I suspect as time goes on, he will. That's been his style. Acting as if he is trying to keep people from knowing something just isn't like him. This is a guy who was so open that he got SoKnox to agree on something...which isn't easy.

And so...we disagree.

This is not about healthcare, which is why I am not bothering with Rikki, who has less ability to see two sides than anybody on the left or right.

Rachel's picture

This is a guy who was so open

This is a guy who was so open that he got SoKnox to agree on something...which isn't easy.

True dat. I will submit that he had help, most notably from Bill Lyons and Dave Hill.

I just wish he had a Bill Lyons in Nashville.

SnM's picture

"Was so open"

Yes, as mayor, Haslam was open. Was.

(link...)

(link...)

(link...)

(link...)

rikki's picture

serve it up

Mike, bullshit is not a side. It's the main course.

Pam Strickland's picture

I have agree that I don't

I have agree that I don't completely understand Randy's headline here. Nonetheless, so far, neither Haslam nor Ramsey et al have said much more than the are looking at the options and that the care mostly agin the ACA. Also that they are studying the state's options and eon't make any decisions until after the presidential election, which they believe will be won by Romney who wants to see the ACA repealed, which makes no sense because he basically put it in place in Masssachusetts when he was governor there.

Clearly what I wrote about are the things that the citizens need to be aware of when those guys do start talking about the state's role in the ACA this fall.

Mike Cohen's picture

Pam

I agree...the issue needs a good public discussion.

bizgrrl's picture

What Haslam and the TNGOP

What Haslam and the TNGOP don't want you to know about Medicaid expansion

I'm not sure I understand how commenters here don't think this headline is relevant to Strickland's column. Pam attempts to explain Medicaid expansion. Haslam and the TNGOP aren't open as to the details of the proposed Medicaid expansion except to say it costs too much.

A part of Haslam's response to the constitutionality of ACA:

What was unanticipated is the section of the opinion that says states cannot be forced to expand their Medicaid program. This particular portion of the ruling is significant, but it is premature to know the exact ramifications.

Now it is up to Tennesseans and Americans to turn their attention to the November election. By electing Mitt Romney, we can be sure that the entire law will be repealed.”

“I’m committed to controlling health care costs and finding meaningful ways to improve the health of Tennesseans by encouraging healthy choices, personal responsibility and accountability. Forcing mandates on states and individuals is the wrong approach, and if Obamacare is implemented, healthcare costs will rise significantly, putting a serious strain on state budgets across this country.”

As of the 2010 census, about 930,000 people or 15 percent of Tennesseans did not have individual, employer-sponsored or government-sponsored health insurance coverage.

Up Goose Creek's picture

Sex discrimination

I can understand the republican argument that the money for medicaid expansion has to come from somewhere, it is not falling free from the sky. Maybe a GREATLY increased clinic system could keep many low wage workers out of the hospitals and lower the total health care cost.

That said - I am wondering why men are not arguing sex discrimination that they are shut out of the medicaid system. Isn't it equally important that kids have healthy fathers contributing to their upbringing?

Up Goose Creek's picture

Minimum wage

I predict that Haslam will expand medicaid coverage and here's why-
Did anyone notice the upper limit for eligibility is a few cents above minimum wage? So the effect will be a huge pool of workers who DON'T want their wages increased. What's not to love if your employee base is store clerks.

And Haslam just might expand medicaid because it's the Christian thing to do. If not - look for a huge expansion of low wage industries in Kentucky.

CathyMcCaughan's picture

Opting out chart and

Pam Strickland's picture

The KNS has closed comments

The KNS has closed comments on my column.

Average Guy's picture

Commenters = voters Haslam

Commenters = voters

Haslam knows knows the climate of his base. He knows these are are the same voters that gave him the House and Senate he has to deal with.

Or not deal with:

The bill received strong bipartisan support, passing the House and Senate by a three-to-one margin, but good legislation should bring clarity and not confusion. My concern is that this bill has not met this objective. For that reason, I will not sign the bill but will allow it to become law without my signature.

(link...)

I predict he will, like in the case of the Monkey Bill, opt out of taking any leadership on the Medicaid matter. Instead of explaining anything to "the people", he will listen to "the people", and it's pretty clear from recent legislative history how that's going to go.

Bbeanster's picture

Yeah, he's pincered between

Yeah, he's pincered between the Teabag set and Big Business. That's a tough spot for him, as he has little appetite for controversy.
At heart, though, he is a creature of the country club set -- people who run/are connected to entities like HCA and Vanderbilt, which stand to make money (because they'll be reimbursed for the cost of treating the poor).
He's not going to like this at all, but when the time comes that he cannot waffle, he'll come down on the side of business.

metulj's picture

Exactly. All of the back and

Exactly. All of the back and forth above is trumped by moolah.

Average Guy's picture

GOP Voters vs. Donors – not the same thing

I’ve been amazed to see a Party so at odds with itself gain so much traction.

This playing out as you suggest, should be telling for Teavangelicals. If the radio ever gets turned off, this part of the Republican base might just come to figure out they’re a hell of a lot more 99% than they are 1%.

Or they’ll stay the course, that of being thoroughly confused, and we’ll see more “Keep Your Government Hands Off My Medicaid!” signs.

Rachel's picture

I think so. I hope so. And

I think so. I hope so.

And again, I can't find the answer to this: Does the governor have the power to unilaterally opt in or out on the Medicaid expansion? Or does the legislature have to get involved?

I think my reasons for asking are obvious.

Pam Strickland's picture

I don't know for sure,

I don't know for sure, Rachel. However, I'm under the impression that the legislature has to act on it. I'll find out though and let you know.

EconGal's picture

Unilateralists

Medicare in Tennessee is administered by the Bureau of TennCare, within the Tennessee Department of Finance and Administration . The Bureau has the authority to do things like enforce regulations, request waivers, request rulings and decline to do same. Disclosure: This, from the former legal counsel to a Tennessee governor and current counsel for a Tenn Care contractor. FWIW

R. Neal's picture

I think you meant Medicaid.

I think you meant Medicaid. Anyway, if expansion requires increased state spending, as the governor and lt. governor claim, I believe it would require legislation. I could be wrong, though. It's happened before.

Rachel's picture

Here's the detailed

Here's the detailed implementation plan for Medicaid expansion for Washington State.

Omg, they have a DETAILED EXPANSION PLAN. Folks, we are living in the wrong state.

Anyhow, it calls for legislation at certain pts. That might just be stuff specific to Washington law, but my guess, based on this, is that all states might require some legislative changes.

That does not bode well for Tennessee. Even if the Governor decides that opting in is the right decision, and even if he can muster facts about how the state only pays 10% (after 5 years; the Feds pay 100% the first three years and 95% the next two), the savings from various places such as emergency room care for the indigent may make up more than the difference, AND that it's foolish for Tennessee taxpayers to be sending $$ to Washington that benefits other states and not us - the legislature will be a tough sell.

EricLykins's picture

the savings from various

the savings from various places such as emergency room care for the indigent may make up more than the difference

Who knows? The American Medical Association and American College of Physicians think so.

Mike Cohen's picture

Chas Sisk take

Blog post from the legislative reporter for the Tennessean:
(link...)

Rachel's picture

Ah, but the exchanges aren't

Ah, but the exchanges aren't the same thing as the Medicaid expansion.

From all I've read, and from econgal's post, it sounds like that decision is the governor's to make.

fischbobber's picture

Interesting

And truly Haslam. Pensions, homelessness, greenways, bridges, roads and now healthcare. Let's kick this ball down the road, pretend we're concerned and duck the issue.

As long as this man can keep getting re-elected using this technique, is there truly reason for him to change?

Average Guy's picture

Nope

Alexander got jumped from his right for advocating cleaner air.

If a fundamental element of good health can't be acknowledged, nothing beyond it will.

Pam Strickland's picture

The exchanges are separate

The exchanges are separate from Medicaid. The exchanges do require legislative action and both Ramsey and Haslem and willing to put that off until January, which is crazy if you ask me. But clearly nobody did. I'm still not sure about the Medicaid expansion. I'll find out Monday.

Rachel's picture

But then there's this....

But then there's this....

lonnie's picture

Haslam & Co. will make their

Haslam & Co. will make their decision based on how business will profit, not what is best for millions of Tennesseans.

Up Goose Creek's picture

44,000

For individuals who earn less than 44,000 a year, the cost will be limited to 9.5% of income. That's a lot less than individual coverage for a middle age American.

I'm not crazy about my tax dollars providing a subsidy to the insurance companies but it will mitigate the shock to the pocketbook.

BTW George, you may not be aware that if you are an individual with a preexisting condition more serious than a stubbed toe, you just don't get coverage. Period. Or your coverage doesn't apply to anything that might be remotely related to your condition. We didn't have the protection offered to group plans.

George's picture

Not so fast ...

Your info is not accurate, Goose Creek. You may not qualify for the cheapest policy, but Federal law (ERISa of 1974) does not allow refusal of purchase of insurance for ANY reason.

But, don't confuse that with ERISA's (and HIPAA's) mandate that pre-existing conditions must be covered within 18 months of purchase (known as an exclusion period).

But, I think most people are misunderstanding pre-existing conditions to begin with. A pre-existing condition doesn't just happen. A pre-existing condition is one of a specific list of medical conditions that occurred during a gap in coverage for a specified period of time. HIPAA mandates that any condition be covered with (no exlusion period), so long as you have had at least one year of creditable coverage during your lifetime and you were not without any type of insurance for at least 63 days before your current purchase. But, don't get hung up on that 63 days, because the industry standard is 6 months.

So, as long as you've had insurance for at least one year in your lifetime (and that includes MedicAid), and you don't have a gap of more than 6 months, you will have your condition covered from Day 1. If you don't match these criteria, you will be covered after 6 months of maintaining coverage.

Remembre, too, that the pre-ex only applies to conditions for which you have sought treatment during the lookback period. If you had high blood pressure, but didn't get it treated before you lost coverage, you are covered from Day 1 under your new policy.

Quit listening to the think tank soundbites and learn what is really happening!

Up Goose Creek's picture

Individual coverage

George, If I knew who you were I could send you a copy of a letter denying me coverage. I think you are living in the world of employer based plans, where there are protections. It's a whole different world for the self employed. Trust me on this.

Do you know any freelancers, contract laborers, part time workers, or people who work for themselves and don't have employees they insure? People who don't get coverage from a spouse's employer? Those are the people you should speak to.

bizgrrl's picture

It's a whole different world

It's a whole different world for the self employed. Trust me on this.

I concur. Trust her on this. We even contacted the State of Tennessee, when we moved back here from Florida, they basically said we were SOL.

George's picture

I do know of a freelancer who

I do know of a freelancer who buys a personal policy -- ME! My mother and father also buy their own policy.

The same pre-existing conditions rules apply to ALL policies! Sure, you may not qualify for all policies, but that doesn't mean that you're uninsurable. Just because you didn't qualify for the first policy you applied for or you don't qualify for the cheapest policy doesn't make you uninsurable. People who are prone to car accidents are in the same boat with their auto insurance. They certainly can buy some, but it may not be their first choice.

But, I will grant you that our current government policies (all enacted under democrat leadership, BTW) incentivize group purchase over individual purchase. Democrats thought it would be a good idea to give employers tax breaks to incentivize them to provide insurance for their workers. They thought that only rich people buy their own insurance, and those dirty rich people don't need any tax breaks.

Now, they're finally seeing that not-so-rich people are buying individual policies, but the democrats still don't want you to get a tax break for buying it.

bizgrrl's picture

I would appreciate it if you

I would appreciate it if you would provide the name of the insurance company/agent so I can contact them.

Up Goose Creek's picture

Tax breaks

If your income is within below 400% of the poverty level you will get a tax break.

Here's an estimated calculator that explains the breaks pretty well.

(link...)

We are very fortunate to live in a state where you can live pretty well below the 400% limit, at least as asingle person.

I'm not too thrilled that my tax dollars will be going to subsidize the insurance companies but there you have it.

Pam Strickland's picture

I'm telling you that I could

I'm telling you that I could not get a policy for less than $700 a month and this was in 2008. Before that the policies I was offered, if I was offered anything, and Blue Cross Blue Shield would not offer me anything, for example, were between $500 and $600 and excluded what I needed coverage for so were useless because I couldn't pay for the insurance policy and then pay twice that much to get the medication I needed for the excluded condition.

I am uninsurable for all practical purposes because I cannot afford the policy. If it is offered to me. Period.

And you, George (not verified), are not living in a real world, or you've got more money than you've got sense. The most recent quotes given to me were between $700 and $1,500 a month depending on co-pays and deductibles. Not counting my emergency asthma inhaler and the over the counter pain medicine that I take for my knee, I take eight prescriptions daily. Nothing is serious. It's all manageable. But any one of them freaks out the insurance company. Two of the medications are necessary because of side effects from medications that must be taken for a chronic condition. There's nothing that can be done about the chronic condition, I will always have it. So, are you so damned sure you know everything now.

George's picture

I don't know everything about

I don't know everything about your personal health, but I don't need to. As well, even my meager command of the English language allows my to respond to your post without profanity, which you are unable to do (... so damned sure ...).

You seem to think that you are owed an insurance policy for whatever price you see fit. Why do you think that an insurance company should pay for your personal needs?

I understand that insurance is expensive. It was made that way because our government thought it was helping people, but all it did was make insurance more expensive for everyone. This is where the free market comes into play. Without all the government intervention, insurance would cost MUCH less than it does now (just like it did before all the regulation).

The bottom line is that you will have to bear some of the responsibility for your own health care. Your personal health issues don't give you the right to a company's medications or a doctor's services at a price other than their choosing.

Similarly, my car problems don't give me the right to demand that you sell me your car for a price less than that of your choosing.

bizgrrl's picture

Hey, George, how about the

Hey, George, how about the name of the insurance company/agent that provides individual coverage to anyone so I can contact them?

Somebody's picture

"This is where the free

"This is where the free market comes into play. Without all the government intervention, insurance would cost MUCH less than it does now (just like it did before all the regulation)."

Insurance "without all the government intervention" is no insurance at all. Insurance companies' allegiance is not to the customer, but to the bottom line. Their goal, if unregulated, is purely to maximize profit. The actual service is a distant second to that priority. The result is that insurance companies will seek to provide the least amount of service for the most amount of income. This means they'll provide just enough to keep healthy customers paying in, and will do everything they can to assure that people with claims won't be customers for long. This is where you get the horror stories of rejections for pre-existing conditions, drastic price increases and policy cancellations for customers who get sick, insurance bureaucrats* getting between patients and doctors by denying coverage for needed treatments, and prohibitive prices to keep individual policy seekers and people who already have health issues from enrolling in the first place.

Because most humans have this absurdly strong desire to not die, insurance companies have the ability to charge customers more and provide worse service for the price than just about any other business. People will pay handsomely for the abuse because it's the only hedge available against having no access to healthcare at all.

(Of course, some consumers in the free market will also try to game the system, by choosing to buy into insurance only when they think they will have a greater likelihood to need more out than they pay in. That's why Republicans invented the individual mandate concept that they were for before they were against it.)

So again, insurance without all the government regulation is barely insurance at all. This is one business that needs a cop on duty at all times. Even if the regulation and enforcement isn't perfect, there is at least a chance regulators will feel more accountability to the general populace than the insurance companies, whose accountability is strictly to the share holders.

*The horror stories of insurance company bureaucrats getting between patients and doctors are so well documented and widespread, it's unlikely that there are many Americans who don't have firsthand or very direct secondhand knowledge of this experience. This is why it boggles my mind that the Republican fear mongering about government bureaucrats doesn't fall flat. As bad as insurance companies have been in this area, it seems difficult to imagine it could be made worse. Every time someone parrots this particular Republican talking point, that person should be reminded of the insurance company bureaucrats who have already reamed them or a loved one.

rikki's picture

Your personal health issues

Your personal health issues don't give you the right to a company's medications or a doctor's services at a price other than their choosing.

Do you even understand what a free market is? It's certainly not a market where doctors and drug manufacturers get to dictate prices. In a free market, prices are the result of free negotiations between a willing buyer and a willing seller.

The free-market model simply does not apply to our health care system. There is no such thing as a willing buyer, because no one chooses to be sick or disabled or to age. Competition is also necessary for market freedom, but many features of our health care system limit competition.

A free market for health care would look radically different from what we have. For starters, it would eliminate exploitation of the sick and injured by distributing risk across the broadest pool of participants possible. Next you would need to empower a rational agent to make buying decisions, and the best candidate is doctors. In other words, we need universal coverage and a system where doctors profit by finding the most cost-effective treatments or lose money through unnecessary or excessive care.

While your avoidance of profanity might give you a feeling of smug righteousness, your assertion that free-market forces operate within our health-care system is far more profane than any bad word.

George's picture

Is anyone here old enough to

Is anyone here old enough to remember a time when a doctor visit or even a hospital stay didn't require filing a claim with insurance? This is what happened when the market was free!

Government intervention brought on a system whereby the insurer paid the bills and the cost was hidden from the consumer. Most of us wouldn't dare buy a pair of pants without knowing the price, but we're willing to see a doctor for the slightest sore throat WITHOUT knowing the price! BTW, the willing buyer is the purchaser of health services. You may not have wanted to get sick, but if you choose to see a doctor about it, you're a willing buyer. Just like you didn't want your shoes to wear out, you still bought new shoes and were a willing buyer of new shoes. You could have gone without shoes if you wanted to.

But, the idea you're promoting is that you are entitled to products and services WITHOUT having to pay for them!

Why should someone else have to pay for your purchases?

R. Neal's picture

I haven't filed a health

I haven't filed a health insurance claim in more than 30 years. And I have health insurance. I pay cash. (And get a discount.)

metulj's picture

Your whole argument relies on

Your whole argument relies on health responding to market forces. It is external to markets. You will notice that no matter how many umbrellas one buys, it still rains.

Somebody's picture

"Is anyone here old enough to

"Is anyone here old enough to remember a time when a doctor visit or even a hospital stay didn't require filing a claim with insurance? This is what happened when the market was free!"

Yes, yes, way back when, doctors made house calls, and they took livestock as bartered payment, too.

They were also pretty inexpensive, because most of the tools and medications they could use all fit in that one black leather bag they carried around with them. Also, a lot of their patients died of things now considered preventable or easily curable.

A lot more has changed since your idyllic days of yore, besides government regulation and participation in healthcare.

For that matter, if everything was so wonderful back in the day, why was national healthcare reform a major topic of debate during Woodrow Wilson's presidency, at a time before the insurance business was even involved in healthcare?

P.S. The answer is because the human desire not to die blows out the demand curve in your free market concept. Back when physicians were bloodletting and operating with filthy tools, that wasn't such a problem, because they weren't that much more effective than mom's chicken soup and a cool cloth on your forehead. Now that medicine has demonstrable curative powers, everybody wants access to the opportunity not to die.

rikki's picture

But, the idea you're

But, the idea you're promoting is that you are entitled to products and services WITHOUT having to pay for them!

You didn't understand what I said.

fischbobber's picture

I remember that time!

In fact, one of my earliest memories is losing my sister soon after she was born because we couldn't afford to save her.

The last time I visited her grave I noticed that the headstone was beginning to crumble, probably because of acid rain.

What was your question again?

Pam Strickland's picture

Plus 1 to both Somebody and

Plus 1 to both Somebody and Rikki.

The thing that you aren't getting is that I, like so many, many others, have no choice when it comes to my health issues. I have to go to the doctor and the pharmacy. I have to shell out money. It's not a choice like it is when I decide to buy a car or take the bus. If I want to live my life, to be part of the world, I have to take care of the the health issues that my body presents for me to be taken care of. There is no choice. That's the difference between car insurance and health insurance.

So, George (not verified), I apologize for the profanity. However, my frustrations had reached the end because you and others refuse to understand the reality of those of us who cannot get health insurance.

George's picture

Life

To say that you have no choice when it comes to your health issues is blatantly false. While I understand that it is not always appealing to consider other options (using fewer medications, visiting the doctor less, using MedicAid, or visiting the Remote Area Medical FREE medical clinics), you need to understand that they ARE a choice. Millions of people choose to go or not go to the doctor each and every day.

***Remember, your desire to live a life of a particular quality does not entitle you to someone else's goods and services any more than my desire to drive to work entitles me to take your car!!!***

For those who MUST know, I am a black male, 55 yrs old, BMI of 24 (upper end of proper weight), high blood pressure, don't smoke, don't drink and I purchased a policy that covers myself, my wife, and our two youngest children (ages 22 and 19). Our 25 year-old is not on our policy. I purchased it from Blue Cross/Blue Shield of Tennessee and pay $600/month. Is affordable insurance available for the individual purchaser? you bet it is. If you can't afford it, we have TennCare and MedicAid.

If you take anything from my posts here, understand that life is full of choices and circumstances. I do not ask any of you to finance my choices and I know that circumstances will arise that are costly, yet are no fault of my own (my car problems or my broken leg last year). I know that if I want these circumstances corrected (repaired car, repaired leg), I will have to pay for them.

Sometimes life isn't fair and sometimes difficult circumstances occur. However, nothing gives me the right to shift my expenses to others. You would do well to learn the same.

bizgrrl's picture

Thanks for the information,

Thanks for the information, George. Interesting that you say it is BC/BS Tennessee. When we were shopping for an individual policy, they were one of the ones that said they did not offer an individual policy.

Maybe they've changed, or maybe you had BC/BS TN through some sort of employment and transferred it to an individual policy. I vaguely remember them saying that was the only possibility back when we were trying to work with them on an individual policy. However, we did not fit their criteria, we were transferring from an individual policy out of Florida, not any sort of employers' policy.

I'll contact them again.

Barker's picture

old info

Back in the 90s, when I was a freelancer, I obtained a BC/BS family policy through the Farm Bureau. You didn't have to be a farmer (thank goodness -- I manage to kill everything that's not a weed). It was expensive, but it was a policy. I don't know what it's like now, but a call to the Farm Bureau wouldn't hurt anybody who needs insurance before the exchanges are put in place.

bizgrrl's picture

Back in 2000/2001 we tried

Back in 2000/2001 we tried the Farm Bureau for a BC/BS individual/family policy. No go. They would not offer such a policy, to us at least, at any price. As I said before, we even called the State of Tennesse, Dept. of Insurance... They said nothing could be done. No insurance company had to offer us a policy, at that time anyway.

Barker's picture

Farm Bureau

I went to their web site and it appears they no longer offer health insurance. Too bad. You had to join the Farm Bureau ($20 a year in those days, $25 now) and it was expensive, but not prohibitively so.

Midori Barstow's picture

Try (link...) to access

Try (link...) to access health plans through
membership with the Farm Bureau

bizgrrl's picture

Thanks!

Thanks!

Somebody's picture

"...Remote Area Medical FREE

"...Remote Area Medical FREE medical clinics..."

Stan Brock would be the first to say that he is appalled that RAM has any reason to offer services in this country. RAM was created to serve people living in remote jungles of South America, places where there is no infrastructure. Then RAM began operating clinics in this country because it became clear that people in Brock's own back yard had the same needs as his friends in Guyana. RAM operates here not because anybody thinks it's the right way for the poor to access health care. It operates here because it is too often the only way for the poor to access health care.

lonnie's picture

You haven't got a clue.

George, you haven't got a clue. People with your attitude are a huge problem in America.It is very difficult to make progress in healthcare in our country when people have this notion that it is okay to suffer and die just because life has always been unfair and we need to accept that fact.What a pathetic attitude! What is more important than staying alive and healthy? Nothing. Many people in America have died from the lack of healthcare. This is wrong. When you accept this and do nothing to change it, you are morally wrong.I will never accept the idea that a person's wealth should buy their health. You would do well to understand the pettiness of your acceptance of the unethical and unfair healthcare system in America. Our government gives out billions of dollars in welfare for the wealthy.They subsidize planes and trains and big oil and corporations that need no help from government, so why can't the government help ordinary citizens stay healthy? We have the best doctors and medicine in the world. Why can't we use them to save lives? Because we have so damn many mean, selfish, ignorant people that always want to have somebody below them on the social ladder and just do not care about others. This is BULLSHIT!

redmondkr's picture

"Come into the light -- the


"Come into the light -- the truth will set you free."

The Great Karpoozie, and a large glass of cheap red plonk, tell me this is a comment from a Republican female.

redmondkr's picture

You have yet to name your

You have yet to name your mystical insurance company. Do they only insure trolls?

Pam Strickland's picture

I've checked with a couple of

I've checked with a couple of sources and so-far, no one is clear on whether the legislature has to sign off on the Medicaid expansion or if it's just the governor's decision. I haven't been able to devote myself to just this issue or I would have had it nailed down by now. I'll keep asking til I get an a clear answer.

Up Goose Creek's picture

Cash

Is anyone here old enough to remember a time when a doctor visit or even a hospital stay didn't require filing a claim with insurance? This is what happened when the market was free!

Yes, I remember this - the year was 1994 and the location was...... France.

Even more amazing - The doctor came to visit me at the hostel! That's Hostel, not Hospital. The cost was somewhere between $20 & 30.

Pam Strickland's picture

The mention of France reminds

The mention of France reminds me of a conversation I had with my cousin the other day. She own an advertising agency in Florida. It's pretty successful. They frequently get addies. But she told me she can't afford to provide insurance to her employees. And she has glaucoma. She's an extremely talented artist. I can't imagine what the threat of losing her eye sight means. Currently, her medication costs $250 a month without insurance. She's threatening to move to the South of France because the the light there is so beautiful and she there she would get free healthcare. Oh, the catch, she's as Republican as they come, but this issue has her siding with me.

redmondkr's picture

I can remember when the

I can remember when the charge for the operating room at St. Mary's was $20.

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