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Individual Insurance Rates in NY to fall 50% in 2014 - Obamacare works


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#351 matttyl

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Posted 22 July 2013 - 03:43 PM


I don't know, health care is a particularly big chain. Even if you save up to quit your job, it is early impossible to save up enough to go without insurance.

 

So then save up enough to go on COBRA, if you're the person that can't obtain individual coverage because of your health and you don't have a spouse's plan option.  I mean you've already saved up enough for all your other living expenses in your example. 





#352 matttyl

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Posted 22 July 2013 - 03:44 PM

 

 

Thanks for affirming that folks with pre-existing conditions (10s of millions of Americans) were previously chained to their jobs b/c they could not take a chance on losing their insurance.  Now they are far more mobile and able to leave jobs or the workforce entirely, w/o the risk of losing their insurance until they became Medicare eligible.

Who's chained to anything?  Why can't they just get another job that they don't mind being "chained to"?  Why not just enroll on a spouses plan so that you can go do whatever you want?

Why are you advocating that sick people should leave their jobs to go travel the world without coverage?!

What if they're too sick to work? Or don't have a spouse?

 

Then you have disability insurance, and you still have options for continuous health insurance.



#353 matttyl

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Posted 22 July 2013 - 03:46 PM

 


I'm guessing you don't have any experience with COBRA.

Yep

Actually I have far more experience with it than likely every person on this site.



#354 Slapdash

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Posted 22 July 2013 - 03:46 PM

I don't know, health care is a particularly big chain. Even if you save up to quit your job, it is early impossible to save up enough to go without insurance.

So then save up enough to go on COBRA, if you're the person that can't obtain individual coverage because of your health and you don't have a spouse's plan option.  I mean you've already saved up enough for all your other living expenses in your example.

Cobra isn't permanent.

#355 Slapdash

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Posted 22 July 2013 - 03:47 PM

Thanks for affirming that folks with pre-existing conditions (10s of millions of Americans) were previously chained to their jobs b/c they could not take a chance on losing their insurance.  Now they are far more mobile and able to leave jobs or the workforce entirely, w/o the risk of losing their insurance until they became Medicare eligible.

Who's chained to anything?  Why can't they just get another job that they don't mind being "chained to"?  Why not just enroll on a spouses plan so that you can go do whatever you want?
Why are you advocating that sick people should leave their jobs to go travel the world without coverage?!

What if they're too sick to work? Or don't have a spouse?
Then you have disability insurance, and you still have options for continuous health insurance.

Disability insurance isn't automatic.

#356 matttyl

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Posted 22 July 2013 - 03:49 PM

 

 

I don't know, health care is a particularly big chain. Even if you save up to quit your job, it is early impossible to save up enough to go without insurance.

So then save up enough to go on COBRA, if you're the person that can't obtain individual coverage because of your health and you don't have a spouse's plan option.  I mean you've already saved up enough for all your other living expenses in your example.

Cobra isn't permanent.

 

It lasts for up to 18 months, then you are HIPAA eligible for guranteed acceptance (understandably at a high rate).  You have the right to continuous coverage.



#357 matttyl

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Posted 22 July 2013 - 03:50 PM

 

 

 

 

Thanks for affirming that folks with pre-existing conditions (10s of millions of Americans) were previously chained to their jobs b/c they could not take a chance on losing their insurance.  Now they are far more mobile and able to leave jobs or the workforce entirely, w/o the risk of losing their insurance until they became Medicare eligible.

Who's chained to anything?  Why can't they just get another job that they don't mind being "chained to"?  Why not just enroll on a spouses plan so that you can go do whatever you want?
Why are you advocating that sick people should leave their jobs to go travel the world without coverage?!

What if they're too sick to work? Or don't have a spouse?
Then you have disability insurance, and you still have options for continuous health insurance.

Disability insurance isn't automatic.

 

What's that mean?  Most carriers' definition of when benefits kick in is the inability to perform your job.  In your example the person was "too sick to work".  Based on the facts presented, they would qualify.


Edited by matttyl, 22 July 2013 - 03:50 PM.


#358 MaxThreshold

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Posted 22 July 2013 - 03:50 PM

 

 

 

I don't know, health care is a particularly big chain. Even if you save up to quit your job, it is early impossible to save up enough to go without insurance.

So then save up enough to go on COBRA, if you're the person that can't obtain individual coverage because of your health and you don't have a spouse's plan option.  I mean you've already saved up enough for all your other living expenses in your example.

Cobra isn't permanent.

 

It lasts for up to 18 months, then you are HIPAA eligible for guranteed acceptance (understandably at a high rate).  You have the right to continuous coverage.

 

 

yep.



#359 Slapdash

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Posted 22 July 2013 - 04:01 PM

I don't know, health care is a particularly big chain. Even if you save up to quit your job, it is early impossible to save up enough to go without insurance.

So then save up enough to go on COBRA, if you're the person that can't obtain individual coverage because of your health and you don't have a spouse's plan option.  I mean you've already saved up enough for all your other living expenses in your example.

Cobra isn't permanent.
It lasts for up to 18 months, then you are HIPAA eligible for guranteed acceptance (understandably at a high rate).  You have the right to continuous coverage.

Not sure why you think such a fragmented, very costly system is what people should be subjected to if they happen to have chronic serious conditions.

#360 Slapdash

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Posted 22 July 2013 - 04:02 PM

Thanks for affirming that folks with pre-existing conditions (10s of millions of Americans) were previously chained to their jobs b/c they could not take a chance on losing their insurance.  Now they are far more mobile and able to leave jobs or the workforce entirely, w/o the risk of losing their insurance until they became Medicare eligible.

Who's chained to anything?  Why can't they just get another job that they don't mind being "chained to"?  Why not just enroll on a spouses plan so that you can go do whatever you want?
Why are you advocating that sick people should leave their jobs to go travel the world without coverage?!

What if they're too sick to work? Or don't have a spouse?
Then you have disability insurance, and you still have options for continuous health insurance.

Disability insurance isn't automatic.
What's that mean?  Most carriers' definition of when benefits kick in is the inability to perform your job.  In your example the person was "too sick to work".  Based on the facts presented, they would qualify.

I assumed you were talking about SSDI, my bad.

#361 Just Win Baby

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Posted 22 July 2013 - 04:04 PM


 

I didn't say their healthcare is perfect and ours is awful. I didn't even say it's better. All I asked is why we live shorter lives if our healthcare is so much better than theirs. That's the goal of healthcare, right? Stay alive?

My post addressed this. If we adjust for homicide, auto accident deaths, and suicides, the U.S. is first in life expectancy. Do you think that our high homicide rate and high rate of auto accident deaths should be viewed to reflect poorly on the quality of our healthcare system?

You don't think teen births are a healthcare issue? Do you subscribe to the weird Republican mindset going around that prenatal care isn't healthcare?

I agree prenatal care is healthcare. My point was that the fact that the U.S. has the highest teen birth rate is not reflective of the quality of our healthcare system. It is a cultural and socio-economic issue. But it doesn't matter. The rest of my post on infant mortality rate showed that when comparing apples to apples, the U.S. rate is very good, with only a very few countries with a rate that is substantially better.

Given your questions, I have to ask if you read the articles I posted.
 
Funny how you took suicides out when you then asked if we should consider it a healthcare issue.

I took suicides out because the article I linked said they didn't make a difference in the analysis. Suicides are certainly tied to healthcare, though my guess is that a high percentage of them never seek out mental health treatment.

Regardless, if you adjust for auto accidents and homicides, the US has the highest life expectancy. Do you think homicides and auto accidents are reflective of the quality of our healthcare system?

Why did you ignore the rest of my post?

#362 Arsenal of Doom

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Posted 22 July 2013 - 04:06 PM

 

 

I'd rather be able to make the decision, regardless of what anyone else thinks is smart, and know that I'd still be able to get affordable coverage again when I need it. Paying 2% to opt out for a year is a small cost against guaranteeing you'll be able to have coverage again.  

 

So then it should be well worth it to you to keep your coverage in tact while you travel.  It's kinda dumb to travel the world anyway totally uninsured, any number of things could happen to you - which is why you have the coverage in the first place.  Are you somehow immune to things because you're traveling for a year?

 

Many insurance plans will still provide some coverage while you are abroad, sometimes even "in network".

 

 

Possibly. You seem to be trying to justify a way that pre-existing conditions aren't really a problem, or at least when people have a problem with them it's problems that could have been avoided if they made different choices. The issue with that reasoning is that 1) pre-existing conditions have long been acknowledged as a problem with our private insurance system and 2) it ultimately doesn't matter why people end up in their situation. You want it to matter, and I get that, but it doesn't. We can't, and shouldn't even try, to arbitrate if someone has a disease because of their lifestyle choices. Or whether or not they could afford to pay COBRA, or if they made the right choice to go without coverage for a year. That's not a path anyone should want to go down who values living in a society that is still relatively free by historical standards. 



#363 humpback

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Posted 22 July 2013 - 04:14 PM

This thread is even dumber than I anticipated. 

Must have misread the OP.



#364 tommyGunZ

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Posted 22 July 2013 - 04:18 PM

 

 

 

I'd rather be able to make the decision, regardless of what anyone else thinks is smart, and know that I'd still be able to get affordable coverage again when I need it. Paying 2% to opt out for a year is a small cost against guaranteeing you'll be able to have coverage again.  

 

So then it should be well worth it to you to keep your coverage in tact while you travel.  It's kinda dumb to travel the world anyway totally uninsured, any number of things could happen to you - which is why you have the coverage in the first place.  Are you somehow immune to things because you're traveling for a year?

 

Many insurance plans will still provide some coverage while you are abroad, sometimes even "in network".

 

 

Possibly. You seem to be trying to justify a way that pre-existing conditions aren't really a problem, or at least when people have a problem with them it's problems that could have been avoided if they made different choices. The issue with that reasoning is that 1) pre-existing conditions have long been acknowledged as a problem with our private insurance system and 2) it ultimately doesn't matter why people end up in their situation. You want it to matter, and I get that, but it doesn't. We can't, and shouldn't even try, to arbitrate if someone has a disease because of their lifestyle choices. Or whether or not they could afford to pay COBRA, or if they made the right choice to go without coverage for a year. That's not a path anyone should want to go down who values living in a society that is still relatively free by historical standards. 

 

 

exactly.



#365 matttyl

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Posted 23 July 2013 - 05:52 AM


Not sure why you think such a fragmented, very costly system is what people should be subjected to if they happen to have chronic serious conditions.

 

Not sure why you think an ACA plan would be any less costly for these people?

 

In the current system, if a person loses employer provided coverage for their family (of four lets say), they all have the ability to apply for individual coverage.  Any person without serious conditions will likely be accepted at a MUCH lower cost than COBRA, and have continuous coverage.  Any person not able to obtain individual coverage would still have the right to remain on their employer plan with COBRA for up to 18 months.  A HUGE bonus for them to do so would be that any deductible they have met (quite likely a lot, possibly all of it if they have these serious chronic conditions you mentioned) wouldn't be reset to $0 like it would be if they switched plans to an individual plan.  That very key factor is why COBRA is actually a great option for people with these serious health conditions.

 

Under this new system, all the healthy members of the family would now be forced to obtain coverage more costly than what they had.  On top of that any sick person who would have been on COBRA now has a new plan (which is also not exactly "cheap" as we've seen from the numbers coming out), and they will have to start with a brand new deductible from $0, and a brand new out-of-pocket maximum (which for a plan on the California exchange that I saw will have a $6,000 annual out-of-pocket max). 

 

Just because the monthly premium for those folks in total may be cheaper than the current system (again, that would depend on the employee's family makeup and people's health situations and such), when you consider all the costs associated with having to switch coverage and "start again", it may not be better at all and may end up with much higher total costs.



#366 matttyl

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Posted 23 July 2013 - 05:53 AM

 

This thread is even dumber than I anticipated. 

Must have misread the OP.

 

Fixed.



#367 matttyl

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Posted 23 July 2013 - 06:08 AM

 

 

Possibly. You seem to be trying to justify a way that pre-existing conditions aren't really a problem, or at least when people have a problem with them it's problems that could have been avoided if they made different choices. The issue with that reasoning is that 1) pre-existing conditions have long been acknowledged as a problem with our private insurance system and 2) it ultimately doesn't matter why people end up in their situation. You want it to matter, and I get that, but it doesn't. We can't, and shouldn't even try, to arbitrate if someone has a disease because of their lifestyle choices. Or whether or not they could afford to pay COBRA, or if they made the right choice to go without coverage for a year. That's not a path anyone should want to go down who values living in a society that is still relatively free by historical standards. 

 

 

exactly.

 

I fully understand that pre-existing conditions are a problem for many.  I get that.  I personally had a pre-existing condition that I was "forced" to pay a much higher premium for in my past.  That's behind me now, and no longer an issue that raises my premiums like it did in the past.

 

In many, many cases people can still have coverage for these conditions (employer coverage, spouses employer coverage, having coverage in force prior to the condition being an issue).  It's the system we have today, and I'm not saying it's perfect by any means, it's not.  All I'm saying is that I don't believe the ACA setup is the proper way to go about fixing it. 

 

I feel that the ACA in general looks at the problem, acknowledges it, and "masks it" more than it "fixes it".  The problem (the overall cost of care), is still there and I don't believe is being addressed adequately, or at all - it's just being shifted from the old to the young, from the sick to the healthy, from the poor to the rich.  Maybe that's the right way to do it.  Maybe it isn't.  I, for one, just don't think it's fair that many, many millions of Americans who have made the right decisions and had proper coverage for themselves (either individually or with a small group employer) will now have to pay much more.  I don't believe that people who haven't made proper decisions (gone without care when they could have obtained it and then a health issue comes up) should now be given this handout (and I'm not saying that's the issue with all current uninsured).  I see people in my industry choose to go without coverage even though they could easily obtain it individually (with underwriting) or through their employer (without underwriting). 

 

I'm not saying I have the answer, it's really too complex of an issue for one answer to fix.  I'm just saying I don't think the ACA is it.



#368 Slapdash

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Posted 23 July 2013 - 06:13 AM

 

Not sure why you think such a fragmented, very costly system is what people should be subjected to if they happen to have chronic serious conditions.

Not sure why you think an ACA plan would be any less costly for these people?


Because I recognize there is a large subsidy component to the law and don't buy your arguments that it will be more expensive for those with serious pre-existing conditions (which mostly seem to depend on the time of year one is seperated from work).  

I don't think people should be tied to an employer's health care plan in the first place.

#369 matttyl

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Posted 23 July 2013 - 06:36 AM

 

 

Not sure why you think such a fragmented, very costly system is what people should be subjected to if they happen to have chronic serious conditions.

Not sure why you think an ACA plan would be any less costly for these people?

 


Because I recognize there is a large subsidy component to the law and don't buy your arguments that it will be more expensive for those with serious pre-existing conditions (which mostly seem to depend on the time of year one is seperated from work).  

I don't think people should be tied to an employer's health care plan in the first place.

 

We still haven't fully seen how the subsidies will operate.  From things I've seen, your ability to qualify for a subsidy on your ACA plan that begins in 2014 may depend on what your income was on your last filed tax return - which would be your 2012 return.  So if you lose your job in 2014 but your last income return (from 2012) shows that you made $50k a year, where would that put you? 

 

That's just another thing that hasn't been fully explained by anyone (add that to the rates for these new plans, difference between benefits of bronze and silver and gold plans, how these new plans will cover certain things with deductibles and what a person's maximum out of pocket will be.....).

 

Many people aren't tied to their employer group plan.  It may be a great option (and only option) for someone with health issues, though.  If you can obtain individual coverage, for the most part you can still get it and opt out of your employer plan. 



#370 matttyl

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Posted 23 July 2013 - 06:41 AM

 

Because I recognize there is a large subsidy component to the law and don't buy your arguments that it will be more expensive for those with serious pre-existing conditions (which mostly seem to depend on the time of year one is seperated from work).  
 

It very easily can be.  As we haven't seen exactly how the new plans will operate, and what an out of pocket max will be for it - someone could easily be out more money paying ACA rates for all members of their family PLUS a brand new deductible and new out of pocket maximums on a new plan (and everything I've seen thus far has individual deductibles and out of pockets for each member of the family - not family deductibles and out of pockets like most employer groups have)....than by paying COBRA rates for a plan where they may have already met their deductible and out of pocket max for the year.

 

Obviously it wouldn't happen for everyone, I understand that.  But for an individual with serious health issues who loses their job in November - it would likely be MUCH better for them to stay on their group plan till the end of the year rather than being forced to immediately move to a brand new plan and start over from scratch for the remaining 2 months of the year before it resets again (assuming calendar year deductibles rather than plan year, again something that hasn't been disclosed).



#371 matttyl

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Posted 23 July 2013 - 07:19 AM

Not sure I agree with it, but here's an interesting tactic.....

 

Mike Lee: Republicans Will Shut Down Government To Block Obamacare

http://www.huffingto..._n_3634456.html



#372 Arsenal of Doom

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Posted 23 July 2013 - 07:28 AM

 

 

 

Possibly. You seem to be trying to justify a way that pre-existing conditions aren't really a problem, or at least when people have a problem with them it's problems that could have been avoided if they made different choices. The issue with that reasoning is that 1) pre-existing conditions have long been acknowledged as a problem with our private insurance system and 2) it ultimately doesn't matter why people end up in their situation. You want it to matter, and I get that, but it doesn't. We can't, and shouldn't even try, to arbitrate if someone has a disease because of their lifestyle choices. Or whether or not they could afford to pay COBRA, or if they made the right choice to go without coverage for a year. That's not a path anyone should want to go down who values living in a society that is still relatively free by historical standards. 

 

 

exactly.

 

I fully understand that pre-existing conditions are a problem for many.  I get that.  I personally had a pre-existing condition that I was "forced" to pay a much higher premium for in my past.  That's behind me now, and no longer an issue that raises my premiums like it did in the past.

 

In many, many cases people can still have coverage for these conditions (employer coverage, spouses employer coverage, having coverage in force prior to the condition being an issue).  It's the system we have today, and I'm not saying it's perfect by any means, it's not.  All I'm saying is that I don't believe the ACA setup is the proper way to go about fixing it. 

 

I feel that the ACA in general looks at the problem, acknowledges it, and "masks it" more than it "fixes it".  The problem (the overall cost of care), is still there and I don't believe is being addressed adequately, or at all - it's just being shifted from the old to the young, from the sick to the healthy, from the poor to the rich.  Maybe that's the right way to do it.  Maybe it isn't.  I, for one, just don't think it's fair that many, many millions of Americans who have made the right decisions and had proper coverage for themselves (either individually or with a small group employer) will now have to pay much more.  I don't believe that people who haven't made proper decisions (gone without care when they could have obtained it and then a health issue comes up) should now be given this handout (and I'm not saying that's the issue with all current uninsured).  I see people in my industry choose to go without coverage even though they could easily obtain it individually (with underwriting) or through their employer (without underwriting). 

 

I'm not saying I have the answer, it's really too complex of an issue for one answer to fix.  I'm just saying I don't think the ACA is it.

 

 

I agree with 90% of this. ACA is primarily a coverage law, and more people will have health insurance as a result of it. On balance, I think that is probably a good thing. There will obviously be some shifting of cost, as people are brought into the private insurance that were previously costed out of it and those will be distrubuted across newly insured and otherwise healthy health consumers. Unfortuantely that's the only way to address the issue of pre-existing conditions and adverse selection in the private insurance market. There should also be fewer free riders in the system. On the flip side, more people covered increases the potential for moral hazarrd, though the trends in cost-sharing as parts of insurance plans should keep that in check.

 

Will that be enough to adequately bend the cost curve?  Probably not fully. I would rather have seen an overhaul that included rolling in Medicare and Medicaid as opposed to continuing to isolate those costs, which acts as sort of a private insurance subsidy by taking out the highest cost users. But I also know that nothing more than what was put through had any chance of passing. So I'm willing to wait and see how things develop and am open tot idea that addtional reform will likely be needed 10-15 years down the line.



#373 Foosball God

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Posted 23 July 2013 - 07:48 AM

Not sure I agree with it, but here's an interesting tactic.....

 

Mike Lee: Republicans Will Shut Down Government To Block Obamacare

http://www.huffingto..._n_3634456.html

I'm sure that would work out really well...


RIP Shining Path. You were a great poster and a great friend.

#374 matttyl

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Posted 23 July 2013 - 08:10 AM

 So I'm willing to wait and see how things develop and am open tot idea that addtional reform will likely be needed 10-15 years down the line.

 

No way this plan makes it that long without the need for it being blown up, totally revamped, or done away with entirely.  As I've said, it doesn't address the "problem", it just "covers it" up (pun intended).

 

A lot of these things just don't make sense to me and won't work when placed into the market place.  First is the idea of no pre-ex combined with being able to jump in and out whenever you want to.  On the surface I understand that no pre-ex may be a great thing to many Americans, but put it into practice.  People will drop their health insurance due to it's cost long before they drop their cell phone bill or cable bill, or car payment for more care than they need.  Then, with no health insurance at all and paying a 1% or 2% of income fine our fictional character healthy Jenny ends up pregnant in August and enrolls into the plan the following open enrollment in January - we all pay for her child to be born (average cost well above $10k per birth), then she'll just jump out of coverage afterwards because the monthly cost (with or without subsidy) is too much.  We'll see that situation happen over and over with many different things. 

 

So maybe the answer is making the penalty for not having coverage too much to bear - say 8% of income.  But that won't work.  At that point it won't make much of a cost difference between paying for the coverage or paying for the fine - and with no real cost difference the person is getting the coverage for "free".

 

I'm not saying I have the answer, I just can't see this being it.  Too many young and healthy will opt out early (1% tax will be MUCH less than paying for coverage, as will 2% and 2.5%), leading to large price increase upon renewal in 2015 and 2016 - further increasing the gap between the 2% and 2.5% "tax" and the cost to enroll (unless some health issue has come up for them in which case they will chose to enroll and burden the system further with their large claims and only a year of premiums to offset them). 

 

This will be another death spiral like the insurance market place has seen over and over again.



#375 cstu

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Posted 23 July 2013 - 10:09 AM

 

 So I'm willing to wait and see how things develop and am open tot idea that addtional reform will likely be needed 10-15 years down the line.

 

No way this plan makes it that long without the need for it being blown up, totally revamped, or done away with entirely.  As I've said, it doesn't address the "problem", it just "covers it" up (pun intended).

 

A lot of these things just don't make sense to me and won't work when placed into the market place.  First is the idea of no pre-ex combined with being able to jump in and out whenever you want to.  On the surface I understand that no pre-ex may be a great thing to many Americans, but put it into practice.  People will drop their health insurance due to it's cost long before they drop their cell phone bill or cable bill, or car payment for more care than they need.  Then, with no health insurance at all and paying a 1% or 2% of income fine our fictional character healthy Jenny ends up pregnant in August and enrolls into the plan the following open enrollment in January - we all pay for her child to be born (average cost well above $10k per birth), then she'll just jump out of coverage afterwards because the monthly cost (with or without subsidy) is too much.  We'll see that situation happen over and over with many different things. 

 

So maybe the answer is making the penalty for not having coverage too much to bear - say 8% of income.  But that won't work.  At that point it won't make much of a cost difference between paying for the coverage or paying for the fine - and with no real cost difference the person is getting the coverage for "free".

 

I'm not saying I have the answer, I just can't see this being it.  Too many young and healthy will opt out early (1% tax will be MUCH less than paying for coverage, as will 2% and 2.5%), leading to large price increase upon renewal in 2015 and 2016 - further increasing the gap between the 2% and 2.5% "tax" and the cost to enroll (unless some health issue has come up for them in which case they will chose to enroll and burden the system further with their large claims and only a year of premiums to offset them). 

 

This will be another death spiral like the insurance market place has seen over and over again.

 

 

Leading to...wait for it...universal healthcare.


“He who climbs upon the highest mountains laughs at all tragedies, real or imaginary.”

 

 


#376 DrJ

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Posted 23 July 2013 - 11:00 AM

This thread is even dumber than I anticipated.

Must have misread the OP.
Fixed.

Indeed. I already had high expectations coming in. It has exceeded them.

#377 humpback

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Posted 23 July 2013 - 11:14 AM

 

 

 

This thread is even dumber than I anticipated.

Must have misread the OP.
Fixed.

Indeed. I already had high expectations coming in. It has exceeded them.

 

Simply reading the heading should have been enough to know that this was going to be incredibly dumb.



#378 -jb-

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Posted 25 July 2013 - 09:06 AM

Thought this might  :stirspot: a little.

 

 

 
Are Cadillac plans responsible for rising health costs?

CHRIS RANGEL, MD | POLICY | JULY 23, 2013

If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are too generous. These so called “Cadillac” health care plans that are very expensive, very inclusive, and have relatively low deductibles are usually offered by employers as part of a generous benefits package to attract talent to their companies.

 

So not only do Cadillac health care plans violate the the liberal directive of health care egalitarianism, they are a tax loophole for highly educated and highly trained employees. In order to fix this affront to the socialist gods the Affordable Care Act (ACA or ObamaCare) handicapped these plans with a 40% tax starting in 2018 for health plans costing more than $10,200 a year for single coverage and $27,500 for a family.

Ostensibly, the tax on Cadillac health care plans was done to try and pay for part of the massive spending bill that was the ACA but Congressional Budget Office estimates of the yearly revenue from this tax have fallen from $24 billion to only $12 billion starting in 2018. And this revenue is likely to continue to decrease as the tax has the intended purpose of eliminating as many of these plans as possible. Additionally, labor unions, a major purchaser of these plans for their members – and a major backer of the Democratic Party – are excluded from this tax which just proves the old saying about socialism, “all people are equal but some are more equal than others.”

But perhaps the wackiest reason that liberals oppose Cadillac health care plans is that they are convinced – a priori – that these plans are a significant reason why health care is so expensive in this country.

The [lack of a current tax on high cost, low deductible employer sponsored health care plans ] creates a bias toward people over-consuming health care services and under-consuming everything else that money might buy. This bias especially advantages people with high incomes, for whom tax subsidies are very large due to their relatively high marginal income tax rates.

Of course there is no proof for this assumption. It’s like claiming that gas prices are high because of rich people driving Hummers. It’s even worse than that.  People don’t consume health care like other consumer products. It’s not like people who have Cadillac health plans – most of whom are relatively young, affluent, and healthy – are having more joint replacements, cardiac procedures, screening colonoscopies, MRI scans, or pregnancies than similar people who have far less expensive plans.

Health care resources are utilized the most by those who need it the most and not by those who can afford it the most. As an example of this we can use data from ER visits as a measure of health care usage by insurance type. It turns out that the vast majority of patients who visit an ER have government insurance coverage and Medicaid beneficiaries under the age of 65 utilize the ER far more than those under 65 who have private insurance such as a Cadillac health care plan. The irony is that the total spent on the much lower cost government insurance of Medicare and Medicaid was actually $65 billion more than the total spent on private insurance (for year 2011) of which only a percentage was from Cadillac health care plans.

One of the biggest attractions of a Cadillac health plan is the low deductibles that liberals claim are “encouraging” over-utilization of health care. These deductibles can be as low as a few hundred dollars and $20 per office visit. Instead, a lower cost private insurance plan can have deductibles of several thousand dollars per year. But wait a minute. The deductibles for Medicaid tend to be only $200 to $300 hundred dollars a month for a small family and Medicaid beneficiaries utilize far more health care resources than the average person under 65 with private insurance. What the heck is going on?

What appears to be going on is that the ACA was designed to give the shaft to people with private insurance plans by forcing their employers to pass more and more of the cost of health care on to their employees in the form of higher deductibles under the farcical liberal notion that excessive medical spending by the privately insured middle and upper middle class is driving up health care costs for Medicaid and Medicare beneficiaries. Unfortunately, this is socialist thinking. Blame those with money for causing the unfortunate circumstances of those without money. Good luck with that logic.

Chris Rangel is an internal medicine physician who blogs at RangelMD.com.

 

 

http://www.kevinmd.c...alth-costs.html



#379 Arsenal of Doom

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Posted 25 July 2013 - 09:51 AM

Thought this might  :stirspot: a little.

 

 

 
Are Cadillac plans responsible for rising health costs?

CHRIS RANGEL, MD | POLICY | JULY 23, 2013

If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are too generous. These so called “Cadillac” health care plans that are very expensive, very inclusive, and have relatively low deductibles are usually offered by employers as part of a generous benefits package to attract talent to their companies.

 

So not only do Cadillac health care plans violate the the liberal directive of health care egalitarianism, they are a tax loophole for highly educated and highly trained employees. In order to fix this affront to the socialist gods the Affordable Care Act (ACA or ObamaCare) handicapped these plans with a 40% tax starting in 2018 for health plans costing more than $10,200 a year for single coverage and $27,500 for a family.

Ostensibly, the tax on Cadillac health care plans was done to try and pay for part of the massive spending bill that was the ACA but Congressional Budget Office estimates of the yearly revenue from this tax have fallen from $24 billion to only $12 billion starting in 2018. And this revenue is likely to continue to decrease as the tax has the intended purpose of eliminating as many of these plans as possible. Additionally, labor unions, a major purchaser of these plans for their members – and a major backer of the Democratic Party – are excluded from this tax which just proves the old saying about socialism, “all people are equal but some are more equal than others.”

But perhaps the wackiest reason that liberals oppose Cadillac health care plans is that they are convinced – a priori – that these plans are a significant reason why health care is so expensive in this country.

The [lack of a current tax on high cost, low deductible employer sponsored health care plans ] creates a bias toward people over-consuming health care services and under-consuming everything else that money might buy. This bias especially advantages people with high incomes, for whom tax subsidies are very large due to their relatively high marginal income tax rates.

Of course there is no proof for this assumption. It’s like claiming that gas prices are high because of rich people driving Hummers. It’s even worse than that.  People don’t consume health care like other consumer products. It’s not like people who have Cadillac health plans – most of whom are relatively young, affluent, and healthy – are having more joint replacements, cardiac procedures, screening colonoscopies, MRI scans, or pregnancies than similar people who have far less expensive plans.

Health care resources are utilized the most by those who need it the most and not by those who can afford it the most. As an example of this we can use data from ER visits as a measure of health care usage by insurance type. It turns out that the vast majority of patients who visit an ER have government insurance coverage and Medicaid beneficiaries under the age of 65 utilize the ER far more than those under 65 who have private insurance such as a Cadillac health care plan. The irony is that the total spent on the much lower cost government insurance of Medicare and Medicaid was actually $65 billion more than the total spent on private insurance (for year 2011) of which only a percentage was from Cadillac health care plans.

One of the biggest attractions of a Cadillac health plan is the low deductibles that liberals claim are “encouraging” over-utilization of health care. These deductibles can be as low as a few hundred dollars and $20 per office visit. Instead, a lower cost private insurance plan can have deductibles of several thousand dollars per year. But wait a minute. The deductibles for Medicaid tend to be only $200 to $300 hundred dollars a month for a small family and Medicaid beneficiaries utilize far more health care resources than the average person under 65 with private insurance. What the heck is going on?

What appears to be going on is that the ACA was designed to give the shaft to people with private insurance plans by forcing their employers to pass more and more of the cost of health care on to their employees in the form of higher deductibles under the farcical liberal notion that excessive medical spending by the privately insured middle and upper middle class is driving up health care costs for Medicaid and Medicare beneficiaries. Unfortunately, this is socialist thinking. Blame those with money for causing the unfortunate circumstances of those without money. Good luck with that logic.

Chris Rangel is an internal medicine physician who blogs at RangelMD.com.

 

 

http://www.kevinmd.c...alth-costs.html

 

Moral Hazard, the specific problem being addressed here is a pretty well researched area. Even looking beyond the "Cadillac" plans there is some evidence that any insurance leads to greater consumption of health care. But there isn't one single thing responsible for increased costs, in fact just off the top of my head here a quick list contributing factors (in no particular order): 

 

Moral hazard - overconsumption of expensive healthcare based on access to insurance and in the case of employer provided coverage lack of visibility in to the true cost of coverage

Adverse selection - people staying out of the insurance market when they don't need care (young/healthy) making those in the insured pool naturally more costly to insure

Free riders - people without insurance seeking care from emergency care because they can't pay and can't be turned away

Innovation - Innovation has an inverse relationship with cost in healthcare, particularly in the long term. In virtually every other area, innovation lowers costs in the long term while in health care it tends to raise it. There is also questionable innovation, where new drugs are rolled out when patents expire with little documented benefit over older drugs.

Chronic care - A huge portion of our health care costs are related to chronic conditions that are poorly managed by individuals and not well coordinated by providers

Defensive Medicine/Malpractice Costs - The overtreatment of patients by doctors trying to avoid malpractice claims, and the high cost of liability coverage

 

There are certainly others, not even getting into 2 layers of profit margin (providers and insurers) that are in the cost of non-public care, There's no magic bullet though.



#380 matttyl

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Posted 25 July 2013 - 10:12 AM


Adverse selection - people staying out of the insurance market when they don't need care (young/healthy) making those in the insured pool naturally more costly to insure


Defensive Medicine/Malpractice Costs - The overtreatment of patients by doctors trying to avoid malpractice claims, and the high cost of liability coverage

 

Will the ACA improve adverse selection, or hinder it?

 

I totally agree with the 2nd part, which is why tort reform is greatly needed, and should have been a part of ACA (but of course that's not the American way). 



#381 Arsenal of Doom

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Posted 25 July 2013 - 10:38 AM

 


Adverse selection - people staying out of the insurance market when they don't need care (young/healthy) making those in the insured pool naturally more costly to insure


Defensive Medicine/Malpractice Costs - The overtreatment of patients by doctors trying to avoid malpractice claims, and the high cost of liability coverage

 

Will the ACA improve adverse selection, or hinder it?

 

I totally agree with the 2nd part, which is why tort reform is greatly needed, and should have been a part of ACA (but of course that's not the American way). 

 

 

The mechanics of the coverage mandate and penalty structure are designed most specifically to address adverse selection and free riders, out of the list that I mentioned. I know from previous posts you think people will be opting to pay the penalty en masse, which if that happened would potentially lead to an insurance death spiral.

 

While acknowledging that it may be possible, because since this hasn't been implemented on a national scale here we can't say anything with 100% certainty, I think it's far more likely that coverage rates will indeed go up and what's happened in MA with coverage rates and use of emergency services will more or less happen on a national scale. It's not a perfect model of course, MA already had fairly high coverage levels and there will be regional differences.

 

I have no issue with tort reform generally, as long as it's done in a way that still protects consumer rights. In places when it's been enacted on a local level there hasn't been much affect on cost. 1-3% is the number that sticks in my head. But by all means, we should empty the chamber at the problem as far as I'm concerned.



#382 matttyl

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Posted 25 July 2013 - 11:09 AM

 

 


Adverse selection - people staying out of the insurance market when they don't need care (young/healthy) making those in the insured pool naturally more costly to insure


Defensive Medicine/Malpractice Costs - The overtreatment of patients by doctors trying to avoid malpractice claims, and the high cost of liability coverage

 

Will the ACA improve adverse selection, or hinder it?

 

I totally agree with the 2nd part, which is why tort reform is greatly needed, and should have been a part of ACA (but of course that's not the American way). 

 

 

The mechanics of the coverage mandate and penalty structure are designed most specifically to address adverse selection and free riders, out of the list that I mentioned. I know from previous posts you think people will be opting to pay the penalty en masse, which if that happened would potentially lead to an insurance death spiral.

 

While acknowledging that it may be possible, because since this hasn't been implemented on a national scale here we can't say anything with 100% certainty, I think it's far more likely that coverage rates will indeed go up and what's happened in MA with coverage rates and use of emergency services will more or less happen on a national scale. It's not a perfect model of course, MA already had fairly high coverage levels and there will be regional differences.

 

I have no issue with tort reform generally, as long as it's done in a way that still protects consumer rights. In places when it's been enacted on a local level there hasn't been much affect on cost. 1-3% is the number that sticks in my head. But by all means, we should empty the chamber at the problem as far as I'm concerned.

 

Didn't they also do this in NY, which is what's mentioned in the OP?  How'd that work out in the end for rates (I understand that there wasn't a penalty structure in place, aside from not having coverage).

 

As far as the penalty is concerned, I've seen that the IRS has no real way of "enforcing it".  It won't be an additional "tax" on your return, and all they have the ability to do is reduce any refund you might get by the amount of the penalty.  Those without a refund, though, the IRS doesn't have a mechanism for collection.  I can't confirm that, but I've seen nothing that addresses exactly how any penalty will work. 

 

All in all, though, I do feel that many people will opt out (and be subject to a penalty).  There are millions of people today who are totally insurable and who could afford some level of insurance but choose not to.  They do that today when they could obtain coverage for maybe $250 or less per month, but would rather spend their money on a cable bill or cell phone bill or new car payment.  Why would they opt in next year when the lowest rates I've seen are higher than that?






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