Medical Insurance Thailand – The Dilemma

[The Man Who Sold the World]

OK – Mandatory Health Insurance – many threads covering the newly implemented OA requirement.

 

I request the “solutions” in this thread. The discussions concerning the enforcement of the new requirement and who it will impact are far reaching and “at this point in time” unknown. How the new requirement is enforced we will know soon as it evolves. 

 

Quick search provided a couple of articles with actual numbers. Links and reduced copy provided below. 

 

Point is – a problem does exist. And not a recent problem – been going on for some time now. Earliest numbers below are from 2008. More than a decade ago. So, the hospitals have a right to complain and pretty much demand a solution to the problem of “non-paying” customers. 

 

So, I agree and admit that the problem exists. I understand that hospitals and health care providers are compassionate -but cannot work for free. 

 

The recent “solution” of mandatory insurance for OA visa applicants (holders?) does little, really nothing to fix the problem.

 

On a personal note, I am the spouse of a Thai citizen on a Non Imm O doing annual “retirement” extensions with THB 800k deposited. I carry a USD $1M medical insurance policy that covers both myself and my wife world-wide. It does not satisfy the Thai criteria, no OP and not a Thai Insurance provider. Yet, when I’ve used the insurance they readily provide a “letter of guarantee” the Thai hospital and do pay any invoices.

 

Now, the twelve authorized Thai insurance companies TGIA website do not, and will not provide medical insurance for many folk. If you are old chronologically - you are out of luck. Also, “exclusions” run rampant, making insurance policies “incomplete”. There is no “self insurance” provision. So, there are many folk who are "Uninsurable".

 

So, put yourself in the shoes of the administration. They have a valid complaint from Hospitals concerning “unpaid” bills of foreigners. And yes, medical service(s) is a deep and far reaching subject worldwide. Medical services are a “life” situation so they must be provided. There are many different methods of administering the costs associated with medical services. Which work and which work best?

 

What would be your solution? What steps or regulations would you implement to reduce, if not eliminate, the “unpaid” bills?

 

My input(s) multipronged: a) self-insurance provision (designated “medical only” account), mandatory travel insurance, travel insurance providers cannot “deny” claims – if the company sells travel insurance they must cover their clients, travel insurance part of the tourist visa fee, VOA or visa exempt stipulation of travel insurance or denial of entry (yes, the airlines will review before boarding), a government controlled assigned risk insurance pool for the “uninsurable” elderly population, resident (long-stay) foreigners able to access Thai health insurance public hospital (yes, with a buy in fee).

 

 

https://www.bangkokpost.com/learning/learning-news/217882/destitute-foreigners-and-thailand-hospitals

 

Destitute foreigners and Thailand's hospitals       24 Jan 2011     WRITER: JON FERNQUEST

 

PHUKET : State hospitals in the southern province are shouldering a heavy burden for treating elderly foreigners who cannot afford to pay their medical bills.

The state-run Vachira Phuket Hospital admitted a record 377 foreign patients, mostly Britons, in the 12 months to Sept 30, 2010. 

The hospital last year spent 1.3 million baht treating 17 penniless foreigners. It was the third consecutive year that the hospital had logged unpaid bills. 

The hospital bore costs of more than 1.2 million baht in 2009 for 22 foreign patients, a 50% rise from the 800,000 baht in costs to treat 17 patients in 2008, the centre said.

"These patients are mostly European men," the source said. "They didn't take out health insurance. They renew their visas every year and have no savings."

Some of them produced fake financial statements to have their visas renewed. Each foreign national seeking the renewal of his or her retirement visa must have at least 800,000 baht in their bank account or show they have earnings of at least 65,000 baht a month.

 

https://scandasia.com/uninsured-foreigners-burdens-thai-public-hospitals/

 

Uninsured foreigners burdens Thai public hospitals by Frederik Guy Hoff Sonne • March 7, 2016 

 

Three public hospitals reports of million baht expenses from unpaid hospital bills by foreigners.

ScandAsia have gotten insight in Vachira Hospital in Phuket’s outstanding balance on unpaid bills by foreigners and it counts almost 20 million baht negative in recent 8 years. Scandinavians forms 20 percent of this loss. Banglamoong Hospital in Pattaya and Patong Hospital in Phuket claims they have the same problem.

 

Methanee Marenia and Vachira Hospital are paying the consequences for this. Since they began to account for the losses in 2008, they have a total outstanding balance on 19.827.858 baht concerning a total of 189 foreign patients. In 2015 the loss counted 3.837.583 baht.

 

Dr. Bancha Kakong, Director of the Phuket Provincial Health Office, assess that the expenses are approximately 10 million baht a year for the Public Hospitals in Phuket. He also claims that Patong Hospital has an outstanding on around 2-3 million baht each year. At The Banglamoong Hospital in Pattaya they had a loss of 1.918.790 baht in 2015 from unpaid bills by foreigners. They can’t provide numbers further back than 2015.    

 

Scandinavians plays a notable part

Germans and Brits tops Vachira Hospitals list over outstanding balance since 2008 but Swedes are placed fourth with a liability for losses of 1.914.368 baht. Finns are eight with unpaid bills for 733.551 baht. Norwegians and Danes are listed 11th and 17th with respectively losses on 674.760 baht and 489.182 baht. 

In total Scandinavians are guilt in a loss of 3.811.862 baht at the Vachira Hospital. In 2015 it was 742.722 baht, merged with Banglamoong Hospital numbers from 2015 it’s a total loss of 787.454 baht in 2015 caused by Scandinavians unpaid bills. 

Tourists, young as old, and retirees living in Thailand are the usual suspects. People working in Thailand usually have a work insurance, so they very rarely loads the hospital, Methanee Mareni explains. 

 “Thailand, and especially health officials in Phuket, are currently pushing to introduce compulsory travel insurance by law. Very soon, all tourists who want to enter Thailand must have travel insurance”, Dr. Bancha Kakong still suggest this, when ScandAsia spoke to him. 

Another likely proposal is being raised by Phuket Governor, Chamreon Tipayapongthad. He suggest to collect a landing fee for tourists so they have a minimum insurance when they enter Thailand. Chamreon Tipayapongthad has presented his view on the topic of travel insurance for the Ministry of Foreign Affairs and the Ministry of Tourism and Sports.

At the Ministry of Tourism and Sports they don’t want to comment on these proposals. They state that they earmark around 200 million baht a year in a tourist fund to cover such losses at the hospitals and “help and support the tourists”. 

Methanee Mareni is familiar with the fund, but it hasn’t had notable impact on their expenses:
“We wrote a letter to the Ministry of Tourism and Sports 7 years ago for the first time, applying for money to cover expenses. Only one time have we received money from the fund”, she says. It was concerning the case when an Italian tourist was robbed and stabbed in Karon in 2014. In that case Vachira Hospital received 100.000 baht.

 

[ukrules]

Tiny amounts of money in the grand scheme of things especially when you consider just how free the treatment for Thais is in places like the UK.

 

You know every tourist pays a 750 Baht departure tax that's included in the airfare, this is the replacement for the old 500 Baht you had to pay in cash at the payment desk before they started billing the airlines directly, so it's a hidden charge these days but it's very much alive and brings in a massive amount of money for the government.

 

If the government wanted a solution they could easily increase this tax by 100 or 200 Baht per year and insure all foreigners to a basic level / cover any losses as it would bring in a massive amount of money but they choose not to.

[timendres]

My hospital solves this problem with the simplest mechanism imaginable.

Before rendering service, they require an upfront payment in the amount of the estimated procedure.

Once completed, the actual amount is calculated and the bill settled.

 

Agree with @ukrules that an extra 100 baht on the departure tax would more than cover any medical expense issues. That is (according to TAT) roughly 30M * 100 baht --> 3 Billion Baht. Done and dusted. That would certainly leave a lot of unspent money, which could in turn be distributed amongst all of the hospitals to help them improve their operations.

Edited November 2, 2019 by timendres

[steve187]

1 hour ago, ukrules said:

Tiny amounts of money in the grand scheme of things especially when you consider just how free the treatment for Thais is in places like the UK.

all visa's over 6 months require a NHS payment, even if working and paying tax

[regularguy]

My proposal would allow anyone to deposit 440,000 bhat into a dedicated Hospital Savings Accont (HSA). You could open this account at participating Thailand banks. The bank could get a small fee to open this special account. With this dedicated HSA account the banks would only allow you to do a debit transaction at any Thailand hospital by locking in only hospitals by merchant ID number. You would get declined if you tried to use it for any other type transaction. You would also not be allowed to do an atm withdrawal. If you closed the account at anytime during your extension you would not be able to get the next extension.

 

Each year prior to going to immigrant for extension you would get your bank letter and passbook updated just like those using 800k balance. If you useany of the money in the account during the year you just reload the account back to 440k prior to the next application date. If you don’t use the funds that year, you just carry over to the next yea.

 

This solves the problem of age restrictions and pre-existing condition exclusions and less paperwork for the hospital having to deal with insurance coverage issues

[ukrules]

33 minutes ago, steve187 said:

all visa's over 6 months require a NHS payment, even if working and paying tax

I'm referring mostly to short term visitors.

 

Get run over by a car while on holiday in England and need a few days in the ICU and a couple of operations, no problem, it's free of charge.

 

In Thailand that's millions of Baht. That's why I spend thousands of pounds every year on top notch insurance.

 

It's also much more expensive for the basic insurance option here in Thailand than the paltry 400 pounds per year (15,600 Baht) they charge in the UK on a long term visa.

Edited November 2, 2019 by ukrules

[Guderian]

Tourism is worth 2 or 3 trillion Baht a year to the economy. The 500 million Baht owing to hospitals is nothing more than a little bit of noise in such a sum. The government should simply reimburse the hospitals and write it off as an inevitable cost of having such a vibrant tourism industry.

[roobaa01]

it is very simple ....1. those new applicants on all visa categories to be requested a health insurance .

2. those already approved inside to be requested to join the public health care system with mandatory contribution as for example in germany.

 

wbr

roobaa01

[berrec]

19 hours ago, ukrules said:

Tiny amounts of money in the grand scheme of things especially when you consider just how free the treatment for Thais is in places like the UK.

 

You know every tourist pays a 750 Baht departure tax that's included in the airfare, this is the replacement for the old 500 Baht you had to pay in cash at the payment desk before they started billing the airlines directly, so it's a hidden charge these days but it's very much alive and brings in a massive amount of money for the government.

 

If the government wanted a solution they could easily increase this tax by 100 or 200 Baht per year and insure all foreigners to a basic level / cover any losses as it would bring in a massive amount of money but they choose not to.

Have to wonder what is the 750 Bath departure tax for; which brown paper bag does all or part of it go into..................... I know many countries have departure taxes or a tax by another name.

 

But I do like the OP idea of Thailand adding a another 200 Baht  *hidden) tax on tourist departures.   

 

With over 40 million + tourists in 2019 that would have created a pool of some 8 Billion Baht ( 265.3 million USD) pool for medical / hospital treatments of all foreigners (tourists & residents) in Thailand.  

 

Would eliminate the need for any foreigners to have medical insurance in Thailand and remove all the government administration paperwork and hospital /medical centers financial burdens. 

 

Maybe it could also help provide some improved free services to the local less privileged Thais. 

 

With TAT predictions of the tourist numbers rising to around 80 million in 2030, that equates to some 16 Billion Baht.........

 

O'h hold the fort; this would not be sustainable, to many people in high places here would want  their slice of this pie and greedy hospitals / medical centres would up their service charges to get in on a bigger slice of the pie also. 

 

And of course the billionaire owned private hospitals here would lobby the government (another bunch of brown paper bags) to prevent a self-funding scheme like this to every get off the ground as it would eat into their profitability.  

 

Well I guess back to the status quo! 

[Momofarang]

The whole shamozzle can be summarize in a few words: This country is unable to come  up with a sensible solution to a real problem. What is currently implemented is glaringly driven by Thai laziness and corruption. Thereforeo we must buy some ridiculous, overpriced coverage, and many of us will have to paid for this in addition to expensive existing covers we can't and don't want to drop.

As far as I am concerned the way to fix this would be to assign to the Ministry of health the responsibility for validating of our insurances. They could do this via hospitals, for instance Bumrungrad, where I spend about 200000 Bahts a year, has all the details of my plan and can even evaluate its performance, they should be entitled to issue the certificate required by Immigration.

Edited November 3, 2019 by Momofarang

[Momofarang]

20 hours ago, timendres said:

Agree with @ukrules that an extra 100 baht on the departure tax would more than cover any medical expense issues. That is (according to TAT) roughly 30M * 100 baht --> 3 Billion Baht. Done and dusted. That would certainly leave a lot of unspent money, which could in turn be distributed amongst all of the hospitals to help them improve their operations.

Makes it difficult to channel these funds into some hiso pockets. The tgia "solution" is way more effective with this regard.

[madmen]

20 hours ago, timendres said:

My hospital solves this problem with the simplest mechanism imaginable.

Before rendering service, they require an upfront payment in the amount of the estimated procedure.

Once completed, the actual amount is calculated and the bill settled.

 

Agree with @ukrules that an extra 100 baht on the departure tax would more than cover any medical expense issues. That is (according to TAT) roughly 30M * 100 baht --> 3 Billion Baht. Done and dusted. That would certainly leave a lot of unspent money, which could in turn be distributed amongst all of the hospitals to help them improve their operations.

In theory . The reality is the desire to pocket that money would be overwhelming

[rwill]

20 hours ago, ukrules said:

If the government wanted a solution they could easily increase this tax by 100 or 200 Baht per year and insure all foreigners to a basic level / cover any losses as it would bring in a massive amount of money but they choose not to.

The problem with that is they would just pocket the money and not spend it on what they justified adding it for.

[jimn]

We passed upon the stair.

We spoke of was and when. 

Although I wasn't there

He said I was his friend, 

Which came as a surprise
I spoke into his eyes
I thought you died alone
A long long time ago

Oh no, not me
We never lost control
You're face to face
With the man who sold the world

I laughed and shook his hand
And made my way back home
I searched for form and land
For years and years I roamed
I gazed a gazeless stare
We walked a million hills
I must have died alone
A long, long time ago

[Thaidream]

23 hours ago, The Man Who Sold the World said:

Point is – a problem does exist. And not a recent problem – been going on for some time now. Earliest numbers below are from 2008. More than a decade ago. So, the hospitals have a right to complain and pretty much demand a solution to the problem of “non-paying” customers. 

 

So, I agree and admit that the problem exists. I understand that hospitals and health care providers are compassionate -but cannot work for free. 

since when are governments supposed to be collection agents.  Certainly, when a foreigner is treated- they provide  identification and an address. If a person has a one year visa/extension- they have reported to immiGration regularly confirming  that address.   It should be no problem to work out a repayment plan with the foreigner  and in fact this often happens.

 

The whole issue has been initiated by doctors in the Ministry of Health who are trained under the US system of for profit medicine and additionally sit on boards of private hospials in Thailand.  These are the same people who have devisd a three or four tier payment schedule for Thai Government Hospitals which is higly discriminatory and a disgrace.

 

It is also a well known fact that the Thai Government is not funding Thai Government hospitals at a high enough rate and Hospital administrators have complained publicly.

 

ISome form of health insurance or funds revoery is needed but certainly not the proposal offered by the Government for retired foreigners in Thailand.

 

The levels of 400K are too low for in patient and the outpatient coverage of 40K is not  not needed.  In adition- the  formation of an insurance pool of ages 50-100 makes all of the policies too expensive.  The only beneficiaries of this plan has to be the insurance companies and its directors.

 

The real solution is varied-

 

1.  As some of the posters suggested- an added 100 Baht or  more aded to a plane ticket or border crossing - It would apply to all-  30-40 million tourists; and long stayers. Anyone can use the Thai medical system at no cost paid by the medical pool.  A small co-pay of 1000per visit could be assessed to avert  using the system for convenience.

 

2.  Long Stay retirees  could and should be allowed to pay into the Thai Social Security System at a reasonable rate of say 1000 Baht per month (Thais pay 457 per month)  This would allow usage of Thai Government Hospitals.

 

3.  Anyprivate insurance policy should be accepted-  Provision of the coverage page is the proof or a letter from the foreign government indicating the person is covered under the military; veterans administration or other.

 

4.   Thai medical insurance companies need to be mandated to provide coverage to any foreigner age 1-100 regardless of any opre existing conditions with a deducticle plan if desired and reasonable rates based on the total population in Thailand not just the age group 50 up.  The whole concept of insurance is that the costs are spread across the whole population not a defined group.   

 

5,  Anyone who cannot obtain insurance  can obtain awaiver just like in the Malaysian long stay program.  These people when applying for an extension of stay sign a document  that they will be responsible for any medical costs.

 

And the most important point- no person currently in Thailand on a Visa or extension of any kind prior to 1 November 2019 is subject to any  type of insurance  coverage under the new police order-  Everyone is grandfathered and the new order applies  only to a person who obtains  a new O-A Visa adter 31 October 2019 and then wishes to extend their stay at some later date.  Any application of the Insurance requirement retroactive is not only against tradition but patently illegal.

 

On a final note- it's time for Governments to start accepting each others medical schemes. In others words  National Health Insurance like the UK NHS and the US Medicare program become portable as well as  Thai Government insurace.  Governments should be able to bill each other for medical issues their citizens encounter while abroad.  I paid into the US Medicare system for over 50 years and I can't use it in Thailand or get the money back.  Other countries currently work the same .  

[Mac98]

Insurance at any price will not solve the problem because there are so many exemptions on what they will cover. Your preexisting condition is what is most likely to put you into hospital and that means no coverage for rich or poor. But if you exact a tourist fee to cover visitors without insurance then nobody would get insurance. How about everyone arriving in Thailand must sign a form before exiting Immigration that any unpaid medical service automatically gives permission for that hospital's doctors to use you for medical experiments at 2,000 baht per day until your debt has been resolved. (A little humor for a difficult problem.)

[Letseng]

4 hours ago, roobaa01 said:

it is very simple ....1. those new applicants on all visa categories to be requested a health insurance .

2. those already approved inside to be requested to join the public health care system with mandatory contribution as for example in germany.

 

wbr

roobaa01

And have you ever tried to join this German public healthcare system? 

You declare your assets, pay income tax and then they assess your monthly payment based on your wealth. Most likely outcome is buying private insurance  (because you have not worked in Germany) = pay big, get no more than govt. insurance will pay for treatment You don't even get free emergency treatment like in UK. 

You picked a really poor example by choosing Germany. 

 

[Jaxxper]

1 hour ago, Thaidream said:

 

Some sense in the post.

[pookondee]

1. They have every foreigners address reporting on thousands of papers.

Also we must all go to immigration or pass through a border or airport sooner or later. 

Why can't these people (supposedly) not paying bills be caught up with??

 

I seem to recall, even a few Ex Isaan GFs claimed they could get me stopped and in trouble at the airport. 

So why cant the authorities do it? 

lol.

 

2. I currently read about this Thai 30baht health scheme...

So surely millions of Thais are getting free health care, 

which must be what is essentually a "loss" of billions upon billions?

 

Consider the amount of foriegn currency being brought into Thailand by tourists, longstayers and money in bank for visa..

 

Then consider the loss of a few foreigners not paying bills against a nation of Thai people racking up billions on free healthcare..

it must be minuscule in comparison.

 

Nup, this is just a nasty, nasty move, however you want to look at it.

 

Its virtually saying:

" Thailand is for Thais..

 we dont care how much you farang bring in, support our poor (whom we dont care about)

buy homes you cant own..etc etc..

you farang will NOT be allowed to get away with 1 satang"

 

[Max69xl]

5 hours ago, roobaa01 said:

it is very simple ....1. those new applicants on all visa categories to be requested a health insurance .

2. those already approved inside to be requested to join the public health care system with mandatory contribution as for example in germany.

 

wbr

roobaa01

Why do you think expats on 1 year extensions based on retirement if using the money in the bank method can't go below 400k from March 1? 

[zaZa9]

3 hours ago, Max69xl said:

Why do you think expats on 1 year extensions based on retirement if using the money in the bank method can't go below 400k from March 1? 

This is the silliest part of it all.

If an O-A retiree should spend any of that 400k on anything , even a health issue , he/she will not be able to apply for an Extension next time.

So you tell us all what its for ?

[BritManToo]

On 11/2/2019 at 1:37 PM, The Man Who Sold the World said:

So, I agree and admit that the problem exists. I understand that hospitals and health care providers are compassionate -but cannot work for free. 

I don't agree the problem exists.

White foreigners are required to submit a copy of their passport before any medical care is started.

Let's have a list of the names and nationalities of all the non-payers, before we admit any liability.

 

Or is it 99% the non-payers are Asian? (Cambodian, Burmese, Viets, Laos)

Most of whom are illegal workers?

 

And if it is anything other than a money grab from what they see as wealthy marks.

Why not let us buy proper insurance, from proper insurance companies worldwide.

Instead of these worthless Thai products.

Edited November 3, 2019 by BritManToo

[BritManToo]

14 minutes ago, zaZa9 said:

This is the silliest part of it all.

If an O-A retiree should spend any of that 400k on anything , even a health issue , he/she will not be able to apply for an Extension next time.

So you tell us all what its for ?

I always saw the 400k as a prop for a countries ailing banking system.

[Max69xl]

6 minutes ago, BritManToo said:

I don't agree the problem exists.

White foreigners are required to submit a copy of their passport before any medical care is started.

Let's have a list of the names and nationalities of all the non-payers, before we admit any liability.

 

Or is it all the non-payers are Asian? (Cambodian, Burmese, Viets, Laos)

Most of whom are illegal workers?

Government hospitals don't have same routines as private hospitals. I know for sure that earlier it was easy to leave without paying and some hospitals didn't even ask for the passport. At private hospitals the don't let you go anywhere on your own before paying the bill. 

[Max69xl]

9 minutes ago, BritManToo said:

I always saw the 400k as a prop for a countries ailing banking system.

Always? The never go below 400k limit started March 1 this year, about the same time they came up with the health insurance with a minimum coverage of 400k for O-A Visa holders. The police order was released in April. I don't think that those matching sums are a coincident. And thai banks have no problems what so ever financially, and they have nothing to do with requirements for expats. 

[ThaiPauly]

Hold on a minute.....nothing has changed or have I missed something?

 

I don't need to purchase mandatory health insurance on a marriage visa do I?

[Max69xl]

10 minutes ago, ThaiPauly said:

Hold on a minute.....nothing has changed or have I missed something?

 

I don't need to purchase mandatory health insurance on a marriage visa do I?

You are not an O-A Visa holder.

[DJ54]

On 11/2/2019 at 3:17 PM, timendres said:

My hospital solves this problem with the simplest mechanism imaginable.

Before rendering service, they require an upfront payment in the amount of the estimated procedure.

When I lived full time in China (10+ years) they had the same policy 

if your admitted to hospital for surgery etc. It works and gives the

hospitals whether your intentions are to pay or not. 

 

I had angioplasty (thru wrists) one for operation and one in other wrist Incase of problems. At check in they go over the procedures

for each day and estimated costs. 

 

You paid or provided insurance the next morning before procedure.

 

The room charges were minimal less than $100 USD. Which was not required to be paid daily. I was in hospital 3 days.

 

Large private AC room with couch and refrigerator, if family was staying to get food etc.

 

Pay as you go and scheduled operations etc, would be paid.

If an emergency it could be left unpaid but non pay occasions

would decrease. If car accident and other person at fault make

them responsible.

[HuskerDo]

On 11/2/2019 at 4:17 AM, timendres said:

My hospital solves this problem with the simplest mechanism imaginable.

Before rendering service, they require an upfront payment in the amount of the estimated procedure.

Once completed, the actual amount is calculated and the bill settled.

 

Agree with @ukrules that an extra 100 baht on the departure tax would more than cover any medical expense issues. That is (according to TAT) roughly 30M * 100 baht --> 3 Billion Baht. Done and dusted. That would certainly leave a lot of unspent money, which could in turn be distributed amongst all of the hospitals to help them improve their operations.

That is an excellent idea. Too bad it hasn't already been implemented so there would be less stress and confusion for the expats that truly want to stay in Thailand.

[ericthai]

On 11/2/2019 at 6:17 AM, regularguy said:

My proposal would allow anyone to deposit 440,000 bhat into a dedicated Hospital Savings Accont (HSA). You could open this account at participating Thailand banks. The bank could get a small fee to open this special account. With this dedicated HSA account the banks would only allow you to do a debit transaction at any Thailand hospital by locking in only hospitals by merchant ID number. You would get declined if you tried to use it for any other type transaction. You would also not be allowed to do an atm withdrawal. If you closed the account at anytime during your extension you would not be able to get the next extension.

 

Each year prior to going to immigrant for extension you would get your bank letter and passbook updated just like those using 800k balance. If you useany of the money in the account during the year you just reload the account back to 440k prior to the next application date. If you don’t use the funds that year, you just carry over to the next yea.

 

This solves the problem of age restrictions and pre-existing condition exclusions and less paperwork for the hospital having to deal with insurance coverage issues

Within a week an "agent" will find a way to work the system and make money.