Obamacare: Obama just straight up lied to you, in your face (3 Viewers)

[Bottomfeeder Sports]

In Texas, we know from experience that the dangers to the uninsured from greater State authority are real. Not one Texas child has yet received any benefit from the Children’s Health Insurance Program Reauthorization Act (CHIPRA), which we all championed, since Texas declined to expand eligibility or adopt best practices for enrollment. We also know that when states face difficult budget years, among the first programs to see reductions is Medicaid. The Senate approach would produce the same result — millions of people will be left no better off than before Congress acted.

This is a letter from House Democrats to Pres. Obama begging him before passage of the ACA to reconcile the Senate bill with the House bill.

http://www.myharlingennews.com/?p=6426

They were fully conscious of what was about to happen and the deal that had been made in the Senate with the Yellow Dogs on the Finance Committee. They had seen it happen in Texas, and they were right.

Which again you have not tied in any way how this is relevant in to whether subsidies were only intended for exchanges explicitly set up by the states and were never intended for those where the state decided to leave the job to the federal government.

Well I thought it was clear.

Leaving it to the federal government, or delegating it, is essentially the same as creating a federal single exchange. If there is no substantive difference between a state exchange and a federal one beyond the URL source then essentially you have just established a federal exchange, which was clearly not desired by certain Democratic Senators.

And subsidies were not intended to be rewarded to citizens in such states which would delegate because then that would remove the incentive to participate as a state and not as a federal exchange.

Finally it has been done in other instances. Tying subsidies or other benefits to encourage or require state participation is something that is done elsewhere.

Clearly these Democratic Reps were concerned, at the time, before passage. Read the letter to see that this very concern was before them at that time.

How do you get that a letter that insists that the state exchanges in the Senate bill be scraped for a federal exchange in the House bill is evidence that either bill only intended subsidies for states that operated their own exchanges?

Because in the example they mention, the Children’s Health Insurance Program Reauthorization Act (CHIPRA), benefits had been denied to Texas children because Texas did not participate. They were clearly warning that benefits could be denied to non-participating states.

Not even close!

So when they said, "The Senate approach would produce the same result — millions of people will be left no better off than before Congress acted." They meant.... what, exactly? That the citizens would be better off, how, exactly?

Were they just wrong, they were operating under the wrong assumption that Texas citizens would "be no better off", and that's it?

They were saying that we should not trust, not allow Texas to run their own state exchange just like we really shouldn't allow them to run Medicaid. We should instead make Texas (and the rest of the states) use a national or federal exchange. Which is exactly the opposite argument to we should punish Texas if they don't run their own exchange and opt for one run by the federal government.

Now there might be convincing evidence that this incentive/disincentive was the intention of Congress. Or, maybe some evidence for the argument about allowing Texas (and other states) to have much more autonomy (with all of the cascading items that Cato tie to the subsidies). But none of the items you have posted or linked on the debate as to whether the exchanges themselves should be state or federal support either of those arguments. ETA: And of course "legislative intent" might be ultimately irrelevant anyway as it seems yesterday's DC decision seemed simply to be "it says what it says". Maybe for the courts that would be all that matters.

 

[BeaverCleaver]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

 

[SaintsInDome2006]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

 

[BeaverCleaver]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

The subsidies?

 

[SaintsInDome2006]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

The subsidies?

Ok of course I started reading after. I guess people would lie about their income or other qualifications to get subsidies.

That is a problem.

 

[Bottomfeeder Sports]

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

Identity fraud and the potentially liability it creates for health care organizations is probably a top 5 training issue today. The normal example would be someone without insurance claiming to be someone that has insurance. In addition, billions have been spent in the past decade to create the means to roll information from various systems into unified health records. The classic example of err'ing on the side of caution would be to incorrectly "merge" two different people's records that have different blood types.

But you can have multiple insurance polices. But assuming those policies are "assigned" such that the provider assigns the liability to the insurance companies both aren't paying. Now maybe someone is running a scheme where they pay for the services and then ask the insurance companies to reimburse them. But I've never heard of that being something of a concern. (But I haven't been really involved on the insurance side of health care for 15 years or so meaning if others disagree take their word ahead of mine.)

 

[Bottomfeeder Sports]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

The subsidies?

Ok of course I started reading after. I guess people would lie about their income or other qualifications to get subsidies.

That is a problem.

The subsidies go to the insurance companies - don't they? I assume the CEO of United isn't signing up for United under various aliases.

 

[Maurile Tremblay]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

The subsidies?

Ok of course I started reading after. I guess people would lie about their income or other qualifications to get subsidies.

That is a problem.

The subsidies go to the insurance companies - don't they? I assume the CEO of United isn't signing up for United under various aliases.

The subsidies go to individual applicants. They're supposed to be based on income, citizenship status, etc., but it's apparently easy to lie about that stuff.

 

[BeaverCleaver]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

The subsidies?

Ok of course I started reading after. I guess people would lie about their income or other qualifications to get subsidies.

That is a problem.

The subsidies go to the insurance companies - don't they? I assume the CEO of United isn't signing up for United under various aliases.

For someone that acts like they know so much about this I'm surprised you thought the subsidies went to the insurance companies.

 

[Bottomfeeder Sports]

Looks like fraud could be a problem.

So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?

Money from the government?

I honestly don't know. If someone gets medical treatment, and if they got two insurance policies, wouldn't they have to have two different names to get those two policies? But they would only be treated under one name, not two.

:whoosh:

The subsidies?

Ok of course I started reading after. I guess people would lie about their income or other qualifications to get subsidies.

That is a problem.

The subsidies go to the insurance companies - don't they? I assume the CEO of United isn't signing up for United under various aliases.

The subsidies go to individual applicants. They're supposed to be based on income, citizenship status, etc., but it's apparently easy to lie about all of that.

How Do I Get the Money?

If you choose to get the premium tax credit in advance, the government sends the money directly to your health insurance company on your behalf. You'll never actually lay your hands on the money. Your health insurer credits that money toward your cost of health insurance premiums, decreasing how much you'll pay each month.

If you choose to get the premium tax credit as a tax refund, the money will be included in your refund when you file your taxes. This could mean a big tax refund. But, you'll pay more for health insurance each month since you’ll be paying both your share of the premium and the share that would be have been covered by the subsidy if you'd chosen the advanced payment option. It will come out even in the end, but if you're low on cash-in-hand, you might find the advance payment option more user-friendly.

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

 

[Bottomfeeder Sports]

For someone that acts like they know so much about this I'm surprised you thought the subsidies went to the insurance companies.

Because as a rule they do!

 

[Maurile Tremblay]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

 

[BeaverCleaver]

For someone that acts like they know so much about this I'm surprised you thought the subsidies went to the insurance companies.

Because as a rule they do!

No they don't.

 

[Boston]

Fraud in government program...wow, who would of thought that would happen...

 

[Bottomfeeder Sports]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?" The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person? In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person. The person never touches the cash. Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time. With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant. The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment. But Saints wasn't talking about the normal person cheating a bit on the numbers they put in to get help monthly and they'll worry about the consequences later, he was asking about the benefits of enrolling an alias.

So what am I missing with Saint's question?

 

[Bottomfeeder Sports]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

Oh, and exactly! More fun to argue something like mortgage interest deductions or, in this thread employer health insurance deductions. These social welfare programs are all really corporate welfare. Same with the ACA.

 

[BassNBrew]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?" The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person? In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person. The person never touches the cash. Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time. With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant. The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment. But Saints wasn't talking about the normal person cheating a bit on the numbers they put in to get help monthly and they'll worry about the consequences later, he was asking about the benefits of enrolling an alias.

So what am I missing with Saint's question?

They were enrolling alias to test the system.

In addition to getting a subsidy, you also get a policy with lower co-payments and deductibles based on income. The best I've seen is a policy where the payment is $18 a month with $5 co-pays, $500 deductible, and a $700 max out of pocket. Matttyl can comment on what that policy would cost in real life if it were even available.

Here's the sticky wicket. Most of us using the marketplace are self-employed / business owners. We have no idea what our 2014 income is going to be back in 2013. On top of that we can manipulate it by deferring payments, moving deductions, accelerating depreciation to move the number up or down. My opinion is that your better off being on the low side when you estimate and settling up with the gov't on the back end than over estimating and trying to get you money back later. I don't think you're going to get co-pay and deductible money back after the fact.

 

[BassNBrew]

Regarding the fraud, I've heard of people over stating their income so that their kids can be insured.

 

[Captain Quinoa]

Bass is your son insured yet?

 

[snogger]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

Oh, and exactly! More fun to argue something like mortgage interest deductions or, in this thread employer health insurance deductions. These social welfare programs are all really corporate welfare. Same with the ACA.

Did anyone here expect anything different?? When you ask the insurance companies that this law was suppose to curtail help write the law, well...

 

[[icon]]

Looks like fraud could be a problem.

SHOCKED.... SHOCKED I TELL YOU!

 

[fourd]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?" The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person? In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person. The person never touches the cash. Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time. With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant. The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment. But Saints wasn't talking about the normal person cheating a bit on the numbers they put in to get help monthly and they'll worry about the consequences later, he was asking about the benefits of enrolling an alias.

So what am I missing with Saint's question?

In general you're correct. However I suppose you could enroll with an alias to get a large subsidy. You pay virtually nothing for your healthcare for the year. Tax time comes and you're alias doesn't do anything more. No filing, just disappears. This appears to be possible since one of the big red flags from the article is that calls to the Marketplace don't actually require anyone to complete the identity proofing. .

 

[fourd]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?" The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person? In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person. The person never touches the cash. Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time. With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant. The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment. But Saints wasn't talking about the normal person cheating a bit on the numbers they put in to get help monthly and they'll worry about the consequences later, he was asking about the benefits of enrolling an alias.

So what am I missing with Saint's question?

They were enrolling alias to test the system.

In addition to getting a subsidy, you also get a policy with lower co-payments and deductibles based on income. The best I've seen is a policy where the payment is $18 a month with $5 co-pays, $500 deductible, and a $700 max out of pocket. Matttyl can comment on what that policy would cost in real life if it were even available.

Here's the sticky wicket. Most of us using the marketplace are self-employed / business owners. We have no idea what our 2014 income is going to be back in 2013. On top of that we can manipulate it by deferring payments, moving deductions, accelerating depreciation to move the number up or down. My opinion is that your better off being on the low side when you estimate and settling up with the gov't on the back end than over estimating and trying to get you money back later. I don't think you're going to get co-pay and deductible money back after the fact.

The Marketplace has been contacting people requesting income verification. I've had a number of people, mostly self-employed, who have received the request for more info. They are taking 2013 numbers in these cases as it is hard for someone to know final 2014 income.

And to your other post, people have been trying to figure out how to put in their income to avoid having their kids shipped off to Medicaid (CHIP). I've seen families with rather large incomes have the kids sent to the state plan. Then the state comes back weeks/months later and says sorry, they're not eligible. It also reduces the subsidy for the family since they don't count the kids. Even for those that are eligible for Medicaid I'm not sure why they wouldn't give the parents the choice of keeping them on their plan. In most cases the subsidy has to be cheaper than the cost of Medicaid and they can keep their doctors.

 

[Maurile Tremblay]

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?"

Saints initially misunderstood the concern emanating from the GAO report.

The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person?

Maybe that person likes money, so spending less of it to get the same coverage is a benefit.

In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person.

Imaginary people don't need insurance. We're talking about real people.

The person never touches the cash.

The imaginary person? Of course not. He doesn't exist. But a real person gets his health insurance subsidized, perhaps when he's not entitled to the subsidy.

Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

There is no imaginary insurance.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time.

No, the point is that it doesn't ever get reconciled. A person lies about his citizenship status, or about his income, and he therefore gets his health insurance subsidized even though it shouldn't be, and there's no real check on that.

With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant.

Establishing that one qualifies at all (for a subsidy) is the whole point.

The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

They won't be hit with a higher tax bill. The IRS doesn't know whether a person got a subsidy.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment.

Lying on the exchange can get you a subsidy you're not entitled to.

So what am I missing with Saint's question?

You got terribly thrown off by it, apparently, because it caused you to think that this has something to do with imaginary insurance for imaginary people with aliases, or something, instead of just allowing non-imaginary non-citizens, for example, to improperly obtain subsidies. Along the way, it apparently caused you to think that the primary beneficiaries of the subsidies are the insurers rather than the insured, and that the primary beneficiaries of food stamps are grocers rather than low-income people who qualify for nutrition assistance.

 

[fourd]

Seems even real people are getting subsidies they shouldn't - or should - or maybe should - or shouldn't.

http://news.yahoo.com/varying-health-premium-subsidies-worry-consumers-162440133.html

 

[tommyGunZ]

So what am I missing with Saint's question?

You got terribly thrown off by it, apparently, because it caused you to think that this has something to do with imaginary insurance for imaginary people with aliases, or something, instead of just allowing non-imaginary non-citizens, for example, to improperly obtain subsidies. Along the way, it apparently caused you to think that the primary beneficiaries of the subsidies are the insurers rather than the insured, and that the primary beneficiaries of food stamps are grocers rather than low-income people who qualify for nutrition assistance.

I thought that one of the issues raised was of people having the ability to create multiple accounts to apply for a subsidy. That's the "imaginary insurance" part that Bottom seemed to be talking about. If someone creates 12 accounts, that doesn't mean they are receiving 12 checks in the mail for subsidies.

Obviously if folks are lying about their income and other facts on their application, that's fraudulent and needs to dealt with.

 

[matttyl]

Obviously if folks are lying about their income and other facts on their application, that's fraudulent and needs to dealt with.

If someone lies, saying they aren't a smoker when they really are - would you be in favor of them getting that insurance taken away?

 

[BassNBrew]

Bass is your son insured yet?

No. Medicaid has gotten in touch with me requesting more information. I asked them just to reject me but they told me if they did that without providing the information, I wouldn't be eligible for a Marketplace policy even at full price.

 

[BassNBrew]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?" The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person? In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person. The person never touches the cash. Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time. With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant. The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment. But Saints wasn't talking about the normal person cheating a bit on the numbers they put in to get help monthly and they'll worry about the consequences later, he was asking about the benefits of enrolling an alias.

So what am I missing with Saint's question?

They were enrolling alias to test the system.

In addition to getting a subsidy, you also get a policy with lower co-payments and deductibles based on income. The best I've seen is a policy where the payment is $18 a month with $5 co-pays, $500 deductible, and a $700 max out of pocket. Matttyl can comment on what that policy would cost in real life if it were even available.

Here's the sticky wicket. Most of us using the marketplace are self-employed / business owners. We have no idea what our 2014 income is going to be back in 2013. On top of that we can manipulate it by deferring payments, moving deductions, accelerating depreciation to move the number up or down. My opinion is that your better off being on the low side when you estimate and settling up with the gov't on the back end than over estimating and trying to get you money back later. I don't think you're going to get co-pay and deductible money back after the fact.

The Marketplace has been contacting people requesting income verification. I've had a number of people, mostly self-employed, who have received the request for more info. They are taking 2013 numbers in these cases as it is hard for someone to know final 2014 income.

And to your other post, people have been trying to figure out how to put in their income to avoid having their kids shipped off to Medicaid (CHIP). I've seen families with rather large incomes have the kids sent to the state plan. Then the state comes back weeks/months later and says sorry, they're not eligible. It also reduces the subsidy for the family since they don't count the kids. Even for those that are eligible for Medicaid I'm not sure why they wouldn't give the parents the choice of keeping them on their plan. In most cases the subsidy has to be cheaper than the cost of Medicaid and they can keep their doctors.

My guess is the feds don't want to have the subsidy money come out of their bucket when it can come out of the state bucket.

 

[BassNBrew]

So what am I missing with Saint's question?

You got terribly thrown off by it, apparently, because it caused you to think that this has something to do with imaginary insurance for imaginary people with aliases, or something, instead of just allowing non-imaginary non-citizens, for example, to improperly obtain subsidies. Along the way, it apparently caused you to think that the primary beneficiaries of the subsidies are the insurers rather than the insured, and that the primary beneficiaries of food stamps are grocers rather than low-income people who qualify for nutrition assistance.

I thought that one of the issues raised was of people having the ability to create multiple accounts to apply for a subsidy. That's the "imaginary insurance" part that Bottom seemed to be talking about. If someone creates 12 accounts, that doesn't mean they are receiving 12 checks in the mail for subsidies.

Obviously if folks are lying about their income and other facts on their application, that's fraudulent and needs to dealt with.

I know I have two accounts. They told me to do that because they couldn't figure out why the first one locked up.

 

[timschochet]

Just reading the thread about Iraq, and it occurred to me how lucky we are that this (Obamacare) is the sort of issue that we debate in this country, and that concerns us, rather than mutilating women and murdering any religion that doesn't represent the majority. We are so fortunate compared to so much of the world.

 

[Gawain]

Just reading the thread about Iraq, and it occurred to me how lucky we are that this (Obamacare) is the sort of issue that we debate in this country, and that concerns us, rather than mutilating women and murdering any religion that doesn't represent the majority. We are so fortunate compared to so much of the world.

Pangloss, is that you?

 

[fourd]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?" The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person? In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person. The person never touches the cash. Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time. With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant. The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment. But Saints wasn't talking about the normal person cheating a bit on the numbers they put in to get help monthly and they'll worry about the consequences later, he was asking about the benefits of enrolling an alias.

So what am I missing with Saint's question?

They were enrolling alias to test the system.

In addition to getting a subsidy, you also get a policy with lower co-payments and deductibles based on income. The best I've seen is a policy where the payment is $18 a month with $5 co-pays, $500 deductible, and a $700 max out of pocket. Matttyl can comment on what that policy would cost in real life if it were even available.

Here's the sticky wicket. Most of us using the marketplace are self-employed / business owners. We have no idea what our 2014 income is going to be back in 2013. On top of that we can manipulate it by deferring payments, moving deductions, accelerating depreciation to move the number up or down. My opinion is that your better off being on the low side when you estimate and settling up with the gov't on the back end than over estimating and trying to get you money back later. I don't think you're going to get co-pay and deductible money back after the fact.

The Marketplace has been contacting people requesting income verification. I've had a number of people, mostly self-employed, who have received the request for more info. They are taking 2013 numbers in these cases as it is hard for someone to know final 2014 income.

And to your other post, people have been trying to figure out how to put in their income to avoid having their kids shipped off to Medicaid (CHIP). I've seen families with rather large incomes have the kids sent to the state plan. Then the state comes back weeks/months later and says sorry, they're not eligible. It also reduces the subsidy for the family since they don't count the kids. Even for those that are eligible for Medicaid I'm not sure why they wouldn't give the parents the choice of keeping them on their plan. In most cases the subsidy has to be cheaper than the cost of Medicaid and they can keep their doctors.

My guess is the feds don't want to have the subsidy money come out of their bucket when it can come out of the state bucket.

But the feds are already paying all of it for the first few years.

 

[fourd]

Bass is your son insured yet?

No. Medicaid has gotten in touch with me requesting more information. I asked them just to reject me but they told me if they did that without providing the information, I wouldn't be eligible for a Marketplace policy even at full price.

While you may not be able to go through the Marketplace it would not prevent you from going straight to the insurance company and buying the policy.

 

[SaintsInDome2006]

Just reading the thread about Iraq, and it occurred to me how lucky we are that this (Obamacare) is the sort of issue that we debate in this country, and that concerns us, rather than mutilating women and murdering any religion that doesn't represent the majority. We are so fortunate compared to so much of the world.

I can remember when people used to complain about Clinton's income tax hike and ending big government as we knew it, and Bush's social security privatization plan and cutting taxes.

Now we're arguing over constitutional crises.

 

[Bottomfeeder Sports]

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?"

Saints initially misunderstood the concern emanating from the GAO report.

So what am I missing with Saint's question?

You got terribly thrown off by it, apparently, because it caused you to think that this has something to do with imaginary insurance for imaginary people with aliases, or something, instead of just allowing non-imaginary non-citizens, for example, to improperly obtain subsidies. Along the way, it apparently caused you to think that the primary beneficiaries of the subsidies are the insurers rather than the insured, and that the primary beneficiaries of food stamps are grocers rather than low-income people who qualify for nutrition assistance.

You want to try again? One of us was terribly thrown off by this, but it wasn't me. Just because Saints asked a question that you think is a misunderstanding doesn't mean that I was addressing some other question.

 

[Bottomfeeder Sports]

So what am I missing with Saint's question?

You got terribly thrown off by it, apparently, because it caused you to think that this has something to do with imaginary insurance for imaginary people with aliases, or something, instead of just allowing non-imaginary non-citizens, for example, to improperly obtain subsidies. Along the way, it apparently caused you to think that the primary beneficiaries of the subsidies are the insurers rather than the insured, and that the primary beneficiaries of food stamps are grocers rather than low-income people who qualify for nutrition assistance.

I thought that one of the issues raised was of people having the ability to create multiple accounts to apply for a subsidy. That's the "imaginary insurance" part that Bottom seemed to be talking about. If someone creates 12 accounts, that doesn't mean they are receiving 12 checks in the mail for subsidies.

Obviously if folks are lying about their income and other facts on their application, that's fraudulent and needs to dealt with.

I know I have two accounts. They told me to do that because they couldn't figure out why the first one locked up.

Yes, but you didn't purchase insurance as two different people,

 

[Bottomfeeder Sports]

So what am I missing with Saint's question?

You got terribly thrown off by it, apparently, because it caused you to think that this has something to do with imaginary insurance for imaginary people with aliases, or something, instead of just allowing non-imaginary non-citizens, for example, to improperly obtain subsidies. Along the way, it apparently caused you to think that the primary beneficiaries of the subsidies are the insurers rather than the insured, and that the primary beneficiaries of food stamps are grocers rather than low-income people who qualify for nutrition assistance.

I thought that one of the issues raised was of people having the ability to create multiple accounts to apply for a subsidy. That's the "imaginary insurance" part that Bottom seemed to be talking about. If someone creates 12 accounts, that doesn't mean they are receiving 12 checks in the mail for subsidies.

Obviously if folks are lying about their income and other facts on their application, that's fraudulent and needs to dealt with.

Yes. It is the insurance for the alias. Maybe I should say for the alter ego rather than the imaginary person.

 

[Bottomfeeder Sports]

So assuming the person isn't filing multiple tax returns for the various refund, the money goes to the insurance carrier anyway.

That's like saying that food stamps don't go to the poor; they go to big grocery store chains.

If you are buying insurance, you'd much rather have it subsidized than not. (The insurer, meanwhile, like the grocer, doesn't care where the money comes from.) But in order to get the subsidy, you're supposed to meet certain criteria. The problem, according to the GAO report I linked to, is that people can lie about their qualifications to get subsidies they're not supposed to get.

But the question that Saints asked and the context of my answer is "So, what is the advantage of a person creating an alias on HC.gov? They don't get an extra heaping of health care do they?" The reply was they get access to the subsidy. My reply was in the context of how does getting access to the subsidy benefit this person? In the normal case it simply goes to the insurance company to help pay for insurance for an imaginary person. The person never touches the cash. Maybe this person is using this imaginary insurance to accumulate pain medication for their side business or something and the subsidies make it more profitable, but I would hope that we aren't all that worried about this kind of stuff happening in mass.

Now there is also the option to not have the "premium tax rebate" be advanced "to the person" in the form of payments to insurance companies but instead as part of the person tax refund. In fact either way this all gets reconciled at tax time. With the real calculations of the eligibility and the "premium tax rebate" being capped at what was actually being paid for insurance what happens on the exchange, other than establishing that one qualifies at all is ultimately irrelevant. The lies on the exchange simply means that the person is going to be hit with a higher tax bill or they will need to successfully continue those lies at tax time. Especially is the exchange enrollee is an alias.

Either way the lie on the exchange isn't going to create much of a benefit other than postponing the payment. But Saints wasn't talking about the normal person cheating a bit on the numbers they put in to get help monthly and they'll worry about the consequences later, he was asking about the benefits of enrolling an alias.

So what am I missing with Saint's question?

In general you're correct. However I suppose you could enroll with an alias to get a large subsidy. You pay virtually nothing for your healthcare for the year. Tax time comes and you're alias doesn't do anything more. No filing, just disappears. This appears to be possible since one of the big red flags from the article is that calls to the Marketplace don't actually require anyone to complete the identity proofing. .

Yes, but this goes back to identity fraud issue. Healthcare providers that bill for service rendered are supposed to be governed by the FTC Red Flag Rules which means that one should not be able to use just an insurance card to be able to obtain services. Healthcare providers are supposed to verifying identity of the patient using those guidelines (photo id, utility bill, etc.) I'd also assume that beyond the regulatory reasons to be required to check identity that they are also contractually obligated by the contracts of the plans which they participate, So in theory at least, this should be difficult (as well as the scheme I had above) to pull off.

 

[Bottomfeeder Sports]

Would the insurance cover multiple-personality disorder?

Mental health coverage is now an essential benefit so as people start receiving treatment we will be able to address as a society "liberalism is a mental disorder" once and for all.

 

[BassNBrew]

Bass is your son insured yet?

No. Medicaid has gotten in touch with me requesting more information. I asked them just to reject me but they told me if they did that without providing the information, I wouldn't be eligible for a Marketplace policy even at full price.

While you may not be able to go through the Marketplace it would not prevent you from going straight to the insurance company and buying the policy.

I was told by BCBS that once I have the rejection letter I would have a 3 month waiting period if I went that route.

 

[fourd]

Bass is your son insured yet?

No. Medicaid has gotten in touch with me requesting more information. I asked them just to reject me but they told me if they did that without providing the information, I wouldn't be eligible for a Marketplace policy even at full price.

While you may not be able to go through the Marketplace it would not prevent you from going straight to the insurance company and buying the policy.

I was told by BCBS that once I have the rejection letter I would have a 3 month waiting period if I went that route.

That doesn't make any sense. It looks like he would be eligible for a special enrollment period as his status changed - he is no longer eligible (never was, evidently) for his coverage. If you really want him covered I'd just apply. With the way things are going right now you should be able to get him coverage as I'm not aware of insurers checking any reason you give for special enrollment. And in your case it's legitimate.

 

[fourd]

So what does it mean when an ACA architect and proponent believes the subsidies would only be available through a state exchange?

http://www.forbes.com/sites/theapothecary/2014/07/25/obamacare-architect-agreed-with-gop-exchange-subsidies-can-only-flow-through-state-exchanges/?partner=yahootix

I suppose one could argue that he was saying that as part of his sales pitch, looking to get consulting gigs in each state. Then again...

 

[fourd]

Forgive me if this was posted before.

http://www.forbes.com/sites/theapothecary/2014/06/18/3137-county-analysis-obamacare-increased-2014-individual-market-premiums-by-average-of-49/

 

[Bottomfeeder Sports]

So what does it mean when an ACA architect and proponent believes the subsidies would only be available through a state exchange?

http://www.forbes.com/sites/theapothecary/2014/07/25/obamacare-architect-agreed-with-gop-exchange-subsidies-can-only-flow-through-state-exchanges/?partner=yahootix

I suppose one could argue that he was saying that as part of his sales pitch, looking to get consulting gigs in each state. Then again...

If you looked above in my back and forth with Saints I told him that there could be evidence of the legislative intent for this to be an incentive. That being said this consultant disagrees with the major Halbig argument-

Gruber responded: “What’s important to remember politically about [Obamacare] is if you’re a state and you don’t set up an exchange, that meansyour citizens don’t get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this.”

Halbig's argument is that getting rid of the subsidies also means getting rid of all of the taxes. In some cases it likely would (the individual mandate), but I think the consultant's statement is a sales pitch being a bit loose with the facts all around. Sure it is evidence, might be more than enough and accurate enough but the pitch is a bit to self serving to not take with a grain of salt.

Oh, and I confess that I don't know what was said during the creation of all this. The Halbig claims seem to differ from the actions of everyone involved (except maybe this guy) between 2010 and 2013 when states were discussing their plans at least publicly, but again who knows what was discussed behind the scenes before the IRS told the states that the subsidies were available on the federally run exchange. In other words while this case seems counter to what we have seen, who really knows whether the plaintiffs actually have this one correct on what was actually intended. Based on the legislative history of the bill, I'm not even sure those that were there really know. They just each know their own intent which in most cases they probably hadn't given it any thought at all.

 

[Bottomfeeder Sports]

Forgive me if this was posted before.

http://www.forbes.com/sites/theapothecary/2014/06/18/3137-county-analysis-obamacare-increased-2014-individual-market-premiums-by-average-of-49/

Only indirectly (I think) in the post that refuted the methodology and replaced it with the claim that insurance cost (premiums + out of pocket) on the individual market went up 14% to 28% before subsidies.

The climb in prices is smaller than previously anticipated by Obamacare's detractors — smaller, even, than findings in a report released Wednesday by the conservative Manhattan Institute, which alleges an average rate increase of 49 percent.

I think the primary difference is that this study looks at total cost and not just premiums, especially the premiums from some of the stuff that no longer qualifies as health insurance.

Early attempts to estimate Obamacare's "sticker shock" were messy. They often looked at some of the cheapest plans that were available prior to health reform; those cheap plans were often less comprehensive that today's exchange plans — they could cover far fewer benefits, so comparing them didn't make much sense.

More comprehensive care is not without value. "Any analysis of the change in premiums should at least recognize that more comprehensive coverage pays for more medical costs," Pauly — a conservative — writes

Yes, I know this is where the crazies complain about mental health care, and the men complain about maternity care, and we hear about pediatric dental, and other "insurance that people don't want or need" nonsense.

The other factor that might have driven up prices — the essential benefits package — doesn't seem to have played a major role. This new paper finds that the generosity of the insurance benefits offered before Obamacare was roughly similar, on average, to the medium-level plans on today's exchanges. And that suggests the change in who's enrolling in insurance — not the richness of those insurance benefits — is driving the rise in prices.

So sort of...

To calculate these figures, we used the same methodology we’ve used in the past. We compiled an average of the five least-expensive plans in a particular county pre-Obamacare, adjusted to take into account those with pre-existing conditions and other health problems. We then did the same calculation with the five least-expensive plans in each county under the Obamacare exchanges. We then used these county-based numbers to come up with population-weighted averages pre- and post-Obamacare.

In other words they compared only the cheapest junk pseudo-plans of the past that barely covered anything (when available) with the cheapest comprehensive insurance of the present.

 

[fourd]

Forgive me if this was posted before.

http://www.forbes.com/sites/theapothecary/2014/06/18/3137-county-analysis-obamacare-increased-2014-individual-market-premiums-by-average-of-49/

Only indirectly (I think) in the post that refuted the methodology and replaced it with the claim that insurance cost (premiums + out of pocket) on the individual market went up 14% to 28% before subsidies.

The climb in prices is smaller than previously anticipated by Obamacare's detractors — smaller, even, than findings in a report released Wednesday by the conservative Manhattan Institute, which alleges an average rate increase of 49 percent.

I think the primary difference is that this study looks at total cost and not just premiums, especially the premiums from some of the stuff that no longer qualifies as health insurance.

Early attempts to estimate Obamacare's "sticker shock" were messy. They often looked at some of the cheapest plans that were available prior to health reform; those cheap plans were often less comprehensive that today's exchange plans — they could cover far fewer benefits, so comparing them didn't make much sense.

More comprehensive care is not without value. "Any analysis of the change in premiums should at least recognize that more comprehensive coverage pays for more medical costs," Pauly — a conservative — writes

Yes, I know this is where the crazies complain about mental health care, and the men complain about maternity care, and we hear about pediatric dental, and other "insurance that people don't want or need" nonsense.

The other factor that might have driven up prices — the essential benefits package — doesn't seem to have played a major role. This new paper finds that the generosity of the insurance benefits offered before Obamacare was roughly similar, on average, to the medium-level plans on today's exchanges. And that suggests the change in who's enrolling in insurance — not the richness of those insurance benefits — is driving the rise in prices.

So sort of...

To calculate these figures, we used the same methodology we’ve used in the past. We compiled an average of the five least-expensive plans in a particular county pre-Obamacare, adjusted to take into account those with pre-existing conditions and other health problems. We then did the same calculation with the five least-expensive plans in each county under the Obamacare exchanges. We then used these county-based numbers to come up with population-weighted averages pre- and post-Obamacare.

In other words they compared only the cheapest junk pseudo-plans of the past that barely covered anything (when available) with the cheapest comprehensive insurance of the present.

I know it's popular to call many pre-ACA plans "junk", but at least what was being sold in Illinois was certainly not. And it would be at least a little disingenuous to call the current plans "comprehensive" when too many people have unaffordable deductibles.

Regarding mental health, that's one of the most sensible things they did in the ACA. Now people need to use it.

 

[matttyl]

Bass is your son insured yet?

No. Medicaid has gotten in touch with me requesting more information. I asked them just to reject me but they told me if they did that without providing the information, I wouldn't be eligible for a Marketplace policy even at full price.

While you may not be able to go through the Marketplace it would not prevent you from going straight to the insurance company and buying the policy.

I was told by BCBS that once I have the rejection letter I would have a 3 month waiting period if I went that route.

That doesn't make any sense. It looks like he would be eligible for a special enrollment period as his status changed - he is no longer eligible (never was, evidently) for his coverage. If you really want him covered I'd just apply. With the way things are going right now you should be able to get him coverage as I'm not aware of insurers checking any reason you give for special enrollment. And in your case it's legitimate.

I'm not sure the child is. Isn't the qualifying event "loss of coverage", not "loss of eligibility for coverage"? That said, during open enrollment I don't see a reason why you couldn't have just purchased directly through the carrier.

 

[fourd]

Bass is your son insured yet?

No. Medicaid has gotten in touch with me requesting more information. I asked them just to reject me but they told me if they did that without providing the information, I wouldn't be eligible for a Marketplace policy even at full price.

While you may not be able to go through the Marketplace it would not prevent you from going straight to the insurance company and buying the policy.

I was told by BCBS that once I have the rejection letter I would have a 3 month waiting period if I went that route.

That doesn't make any sense. It looks like he would be eligible for a special enrollment period as his status changed - he is no longer eligible (never was, evidently) for his coverage. If you really want him covered I'd just apply. With the way things are going right now you should be able to get him coverage as I'm not aware of insurers checking any reason you give for special enrollment. And in your case it's legitimate.

I'm not sure the child is. Isn't the qualifying event "loss of coverage", not "loss of eligibility for coverage"? That said, during open enrollment I don't see a reason why you couldn't have just purchased directly through the carrier.

I would make the argument that he lost his compliant coverage. He was told his son was eligible for Medicaid, not allowing him to enroll in his plan. Now that he doesn't have that coverage he is newly eligible. I could also make the case that Brew is eligible for premium tax credits since his son coming back on his plan, due to no fault of his, means he would get a greater subsidy. Finally, I could also make the case that this falls under the exceptional circumstances provision.

In any event I'm not sure why Blue Cross would tell him he has to wait 3 months. That doesn't fit any part of the law that I'm aware of.

 

[matttyl]

For those of you who have been #####ing that even before the ACA premiums went up because those "greedy insurance companies" just wanted to make more money, I present to you the case of the hepatitis C drug "Sovaldi". Apparently this is quite literally a "breakthrough drug" for the treatment for the condition which affects about 3.2 million Americans. All great news, right?

The hitch - it costs $84,000 for a 12 week course of treatment. If you have hep. C, you're damn sure going to either purchase either a health policy which covers it or (if your income allows it) enroll into Medicaid and have them pay for it. You do the math on that one - 84,000 times the 3.2m Americans faced with it - yup, $268 billion. That's over a quarter trillion for one specific drug.

There is an article on the front page of the Washington Post about the drug, and Medicaid in Oregon. They are expecting to have to spend $360m to provide the drug to their Medicaid beneficiaries (so just those on Medicaid, not those with private insurance). Just last year, though, the entire program only spent $377m total on all drugs. So to limit costs, they are attempting to limit who has access to the drug.

For reference, the drug company recorded $2.3B in sales of the drug over just the first 3 months of this year, making it the biggest launch for a drug in history. Just two days ago, Gilead (the manufacturer) reported second quarter sales totaling $3.5B. If it's the insurance companies purchasing this drug for their insureds, and they are attempting to turn at least a bit of profit, they need to compensate by upping their rates. After all, no person can be out of pocket more than $6,350 a year for all of their medical expenses on a new ACA plan.....so where is the other ~80k per recipient for this drug coming from?

Sorry for my Friday morning rant......but I just wish people would look at the bigger picture of "increasing medical costs" sometimes, and not just blame the insurance companies.