Right two or more years ago I suggested somewhere in this thread (or a similar one) that carriers, especially larger diverse carriers would price for market share and hope that consumers would be "sticky". Have suggested it a few times since. For the most part I was told that wouldn't happen, but it seems obvious today. Now I'm sure that sounds an aweful bit like an I told you so post, but the real importance to those that care is to recognize that it happened.I think he means that the first two year of the ACA exchanges carriers purposefully had lower than needed rates in an effort to obtain market share. They knew they were just "teasers" to get the customers and that they would have to increase the rates later.Is there an inherent problem in doing this? I'd understand pointing this out if he were not clearly saying they are proposed numbers, but he's not so I'm not sure why it's an issueYou guys will need to fight amongst yourselves for a while. However, once again someone is talking about "teaser rates"...Rate proposals for South Dakota are in - 42.9% increase.
Here's a good read about how the pieces are coming together, or aren't.
Got it. How do we discern which scenario happened or does it even matter at this point?Right two or more years ago I suggested somewhere in this thread (or a similar one) that carriers, especially larger diverse carriers would price for market share and hope that consumers would be "sticky". Have suggested it a few times since. For the most part I was told that wouldn't happen, but it seems obvious today.Now I'm sure that sounds an aweful bit like an I told you so post, but the real importance to those that care is to recognize that it happened.I think he means that the first two year of the ACA exchanges carriers purposefully had lower than needed rates in an effort to obtain market share. They knew they were just "teasers" to get the customers and that they would have to increase the rates later.Is there an inherent problem in doing this? I'd understand pointing this out if he were not clearly saying they are proposed numbers, but he's not so I'm not sure why it's an issueYou guys will need to fight amongst yourselves for a while. However, once again someone is talking about "teaser rates"...Rate proposals for South Dakota are in - 42.9% increase.
Here's a good read about how the pieces are coming together, or aren't.
Considering that CareFirst PPO which is similar to an ESI plan is still only, yes only $360 something I think rates will continue up until there is more similarity in both price and style. But not all the way up.
About to land...take it from here.
Yup, that's what I thought you meant. So even though prices (unsubsidized) spiked up considerably when ACA individual plans were introduced, they didn't go up high enough to be what they should have been. So now prices are going up since those carriers were able to obtain market share and because the "3 Rs" are either expiring or where really not even there in the first place.Right two or more years ago I suggested somewhere in this thread (or a similar one) that carriers, especially larger diverse carriers would price for market share and hope that consumers would be "sticky". Have suggested it a few times since. For the most part I was told that wouldn't happen, but it seems obvious today.Now I'm sure that sounds an aweful bit like an I told you so post, but the real importance to those that care is to recognize that it happened.I think he means that the first two year of the ACA exchanges carriers purposefully had lower than needed rates in an effort to obtain market share. They knew they were just "teasers" to get the customers and that they would have to increase the rates later.Is there an inherent problem in doing this? I'd understand pointing this out if he were not clearly saying they are proposed numbers, but he's not so I'm not sure why it's an issueYou guys will need to fight amongst yourselves for a while. However, once again someone is talking about "teaser rates"...Rate proposals for South Dakota are in - 42.9% increase.
Here's a good read about how the pieces are coming together, or aren't.
Considering that CareFirst PPO which is similar to an ESI plan is still only, yes only $360 something I think rates will continue up until there is more similarity in both price and style. But not all the way up.
About to land...take it from here.
Doesn't really matter, but I agree that's exactly what happened. Larger carriers purposefully under-priced their products to get customers. When you see some of the rate proposals I've posted in the last few days, they are from the larger carriers (which make the news) who likely have over half of the market share of their state. So now that they have the customers, and the smaller carriers like Assurant have closed or will in the next year or two because they can't scale - they'll increase their prices. That's exactly what we're seeing now.Got it. How do we discern which scenario happened or does it even matter at this point?
This whole legislation is based on a foundation of lies. JHC.Doesn't really matter, but I agree that's exactly what happened. Larger carriers purposefully under-priced their products to get customers. When you see some of the rate proposals I've posted in the last few days, they are from the larger carriers (which make the news) who likely have over half of the market share of their state. So now that they have the customers, and the smaller carriers like Assurant have closed or will in the next year or two because they can't scale - they'll increase their prices. That's exactly what we're seeing now.Got it. How do we discern which scenario happened or does it even matter at this point?
can the Supreme Court do that? Can they say, "OK this part of the law doesn't stand up, but it's going to stay in place until the end of this year"?I doubt they will take away subsidies mid year.We're getting closer to the Supreme Court decision. If they rule to overturn this part of Obamacare, will the repercussions be immediate?
Yes they can do whatever they want. They did in the first place to allow the penalty to stand.can the Supreme Court do that? Can they say, "OK this part of the law doesn't stand up, but it's going to stay in place until the end of this year"?I doubt they will take away subsidies mid year.We're getting closer to the Supreme Court decision. If they rule to overturn this part of Obamacare, will the repercussions be immediate?
Rate proposals for South Dakota are in - 42.9% increase.
Here's a good read about how the pieces are coming together, or aren't.
When it's "free" it's going to get pounded to death.We anticipated we would see higher utilization among these members, and we planned our rates based on that assumption. What we actually observed was more than three times the utilization than what we expected.
Would be fine with me. But at that point shouldn't we just go single payer?ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
I honestly don't know, but the s storm that will follow if they take them away midyear will make the cancellation of all of those policies at the end of 2013 look like nothing.can the Supreme Court do that? Can they say, "OK this part of the law doesn't stand up, but it's going to stay in place until the end of this year"?I doubt they will take away subsidies mid year.We're getting closer to the Supreme Court decision. If they rule to overturn this part of Obamacare, will the repercussions be immediate?
Agree here. Problem is, they have chosen to "collect the funding" from the average individual via the IRS. So, if they stay with that model, the bold isn't going to happen. It can't happen. Two things that have really rubbed me the wrong way about this are the costs in technology and the collection method. At one point I was trying to determine "success" or "failure" but have realized that's not going to happen. We'll never know for a myriad of reasons. All that people are actually going to know is how much money is coming out of their pockets for insurance premiums and how much it costs them to get X procedure done.I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
I'm honestly interested in why you think this, if for any other reason than the number who are "now covered" (which is mostly via Medicaid, by the way). I'm hoping you'll actually answer this one rather than just ignoring the question like what you did when I asked you 4 times to explain your dislike of COBRA, or when I asked you when you first heard of the Milliman Medical Index, which you claim has "mislead you in a systematic way".ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,
Depends. ACA v. single payer would still allow for some choice in plans. Do you think you should have a choice between a bronze/silver/gold plan?Would be fine with me. But at that point shouldn't we just go single payer?ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
You sparked a question in my mind regarding Cadillac plans. Say I work for a company and the total cost for the premium is $1000, but my employer pays $700 of it and I am left to pay $300. Does OOP cost come into play in determining if it qualifies as cadillac or not? Or is it just the fact that it's $1000 for the coverage and it doesn't really matter how much employer or employee is paying?The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
And I don't know about TGunz plan, but I guess it is closer to $800, $900 a month (for an individual) like my dangerously close to the Cadillac tax plan. So the reality is that he (including his "ESI wages") is already paying more than most anyone with an exchange plan. And that is how the large, diverse carriers can sell plans below cost for a while to build market share and still report record profits. And those with MCO business can claim those record profits are largely thanks to ObamaCare. (though I'd think they would use ACA). So in this way those ESI to individual subsidies already exist.
If by now you haven't figured it out those in the individual market create the headlines with the proposed rate increases and how many signup. but the vast majority of Americans benefit from those uninsured and in the individual market paying more of their share. Some of this like ER visits will change over time (assuming we "stay the course"). And most states have figured out that expanded Medicaid will save state tax payers in the whole even when they have to cough up 10%. So right now the numbers do look really good outside of the "noise" of the individual and small groups where you operate. But as I keep cautioning how much of this "good news" is credited to the ACA and how much to other factors is impossible to measure (at least by me). Which is why we will likely have saved the average family $2500 by this time next year versus the 2008 predicted costs for 2016, but it won't entirely be thanks to ObamaCare.I'm honestly interested in why you think this, if for any other reason than the number who are "now covered" (which is mostly via Medicaid, by the way). I'm hoping you'll actually answer this one rather than just ignoring the question like what you did when I asked you 4 times to explain your dislike of COBRA, or when I asked you when you first heard of the Milliman Medical Index, which you claim has "mislead you in a systematic way".ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,
Reasons I don't think it's "succeeding on it's own" at this time:
The state exchanges are failing left and right, costing billions in tax dollars. Why are they failing? Because not enough people have signed up (there is a % the state exchanges make on every policy sold, and since not enough were sold, there isn't enough money for the state exchange to be self-sustaining). States (including your own) had to drastically cut their enrollment goals for 2015, and they didn't even hit those reduced numbers. The risk corridor money isn't nearly what it was projected to be because hardly any carriers made any money in the first year of the exchanges, which is leading to them requesting drastic increases in their premiums now. Utilization of the "newly insured" was far higher than anyone anticipated (Bass quoted over 3x higher above), specifically in ER visits and Rx, leading to the need for increased rates. A carrier that had been around for over 100 years closed within 16 months of the exchanges opening due to quarterly losses in the tens of millions, and many of the "co-ops" that were founded have already filed for bankruptcy. Enrollment into Medicaid has been much higher than what many states expected and budgeted for.
Oh, and New Mexico proposed rates from their market leader have been made public - 51.6% increase. That's "success" to you? That's now 5 states that have proposals from their largest carriers (very important piece there) of 30%+ - (Oregon, Maryland, Tennessee, New Mexico, and South Dakota).
As for the justification of the Tennessee increase - BlueCross BlueShield of Tennessee . . . said it lost $141 million from exchange-sold plans, stemming largely from a small number of sick enrollees. “Our filing is planned to allow us to operate on at least a break-even basis for these plans, meaning that the rate would cover only medical services and expenses—with no profit margin for 2016,” said spokeswoman Mary Danielson.
It is "with annual premiums exceeding $10,200 for individuals or $27,500 for a family starting in 2018" so it is the total sticker. However, I believe it is more than that as the law counts things like FSAs and HSAs as premiums. So say your family's insurance cost are kept to $26,000 by your employer but it has a $1000 deductible which you exceed every year and you also spend another $2000 or so on things that you use your FSA to pay for up to the limit. So you max out that FSA (somewhere in the neighborhood of $2500 - I think) also. Well, if I have it correctly your "premiums" as far as the Cadillac tax is concerned is $28,500 so that $1000 overage would be taxed at 40%. I think!You sparked a question in my mind regarding Cadillac plans. Say I work for a company and the total cost for the premium is $1000, but my employer pays $700 of it and I am left to pay $300. Does OOP cost come into play in determining if it qualifies as cadillac or not? Or is it just the fact that it's $1000 for the coverage and it doesn't really matter how much employer or employee is paying?The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
And I don't know about TGunz plan, but I guess it is closer to $800, $900 a month (for an individual) like my dangerously close to the Cadillac tax plan. So the reality is that he (including his "ESI wages") is already paying more than most anyone with an exchange plan. And that is how the large, diverse carriers can sell plans below cost for a while to build market share and still report record profits. And those with MCO business can claim those record profits are largely thanks to ObamaCare. (though I'd think they would use ACA). So in this way those ESI to individual subsidies already exist.
Ok...that makes a little more sense. Our max is $2500 on an FSA.It is "with annual premiums exceeding $10,200 for individuals or $27,500 for a family starting in 2018" so it is the total sticker. However, I believe it is more than that as the law counts things like FSAs and HSAs as premiums. So say your family's insurance cost are kept to $26,000 by your employer but it has a $1000 deductible which you exceed every year and you also spend another $2000 or so on things that you use your FSA to pay for up to the limit. So you max out that FSA (somewhere in the neighborhood of $2500 - I think) also. Well, if I have it correctly your "premiums" as far as the Cadillac tax is concerned is $28,500 so that $1000 overage would be taxed at 40%. I think!You sparked a question in my mind regarding Cadillac plans. Say I work for a company and the total cost for the premium is $1000, but my employer pays $700 of it and I am left to pay $300. Does OOP cost come into play in determining if it qualifies as cadillac or not? Or is it just the fact that it's $1000 for the coverage and it doesn't really matter how much employer or employee is paying?The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
And I don't know about TGunz plan, but I guess it is closer to $800, $900 a month (for an individual) like my dangerously close to the Cadillac tax plan. So the reality is that he (including his "ESI wages") is already paying more than most anyone with an exchange plan. And that is how the large, diverse carriers can sell plans below cost for a while to build market share and still report record profits. And those with MCO business can claim those record profits are largely thanks to ObamaCare. (though I'd think they would use ACA). So in this way those ESI to individual subsidies already exist.
Sorry, I've lost interest in discussing these issues with you. I'm tired of the game where you see a big number or a scary projection and then post it here as if it's evidence of the ACA failing as a whole.I'm honestly interested in why you think this, if for any other reason than the number who are "now covered" (which is mostly via Medicaid, by the way). I'm hoping you'll actually answer this one rather than just ignoring the question like what you did when I asked you 4 times to explain your dislike of COBRA, or when I asked you when you first heard of the Milliman Medical Index, which you claim has "mislead you in a systematic way".Reasons I don't think it's "succeeding on it's own" at this time:ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,
The state exchanges are failing left and right, costing billions in tax dollars. Why are they failing? Because not enough people have signed up (there is a % the state exchanges make on every policy sold, and since not enough were sold, there isn't enough money for the state exchange to be self-sustaining). States (including your own) had to drastically cut their enrollment goals for 2015, and they didn't even hit those reduced numbers. The risk corridor money isn't nearly what it was projected to be because hardly any carriers made any money in the first year of the exchanges, which is leading to them requesting drastic increases in their premiums now. Utilization of the "newly insured" was far higher than anyone anticipated (Bass quoted over 3x higher above), specifically in ER visits and Rx, leading to the need for increased rates. A carrier that had been around for over 100 years closed within 16 months of the exchanges opening due to quarterly losses in the tens of millions, and many of the "co-ops" that were founded have already filed for bankruptcy. Enrollment into Medicaid has been much higher than what many states expected and budgeted for.
Oh, and New Mexico proposed rates from their market leader have been made public - 51.6% increase. That's "success" to you? That's now 5 states that have proposals from their largest carriers (very important piece there) of 30%+ - (Oregon, Maryland, Tennessee, New Mexico, and South Dakota).
As for the justification of the Tennessee increase - BlueCross BlueShield of Tennessee . . . said it lost $141 million from exchange-sold plans, stemming largely from a small number of sick enrollees. “Our filing is planned to allow us to operate on at least a break-even basis for these plans, meaning that the rate would cover only medical services and expenses—with no profit margin for 2016,” said spokeswoman Mary Danielson.
I think what you said here is true. What's crazy is that it won't take long for the premiums in the individual market to meet or exceed those amounts. $10,200 divided by 12 months is 850 a month. Many platinum and gold plans today (not 2018, but rather now in 2015) already have premiums higher than that for an individual if they are 55 or older. Larger families can hit the 27,500 even quicker if they are a 5+ person family. Are they going to charge a "caddy tax" on folks buying individual plans which they are forced by the individual mandate to obtain?It is "with annual premiums exceeding $10,200 for individuals or $27,500 for a family starting in 2018" so it is the total sticker. However, I believe it is more than that as the law counts things like FSAs and HSAs as premiums. So say your family's insurance cost are kept to $26,000 by your employer but it has a $1000 deductible which you exceed every year and you also spend another $2000 or so on things that you use your FSA to pay for up to the limit. So you max out that FSA (somewhere in the neighborhood of $2500 - I think) also. Well, if I have it correctly your "premiums" as far as the Cadillac tax is concerned is $28,500 so that $1000 overage would be taxed at 40%. I think!
A tax expert will probably tell me I'm wrong or this is an over simplification but I think if "a benefit" is tied to "health care" and is "pre tax" then it applies. (Exceptions would be standalone benefits for things like dental or disability).Ok...that makes a little more sense. Our max is $2500 on an FSA.It is "with annual premiums exceeding $10,200 for individuals or $27,500 for a family starting in 2018" so it is the total sticker. However, I believe it is more than that as the law counts things like FSAs and HSAs as premiums. So say your family's insurance cost are kept to $26,000 by your employer but it has a $1000 deductible which you exceed every year and you also spend another $2000 or so on things that you use your FSA to pay for up to the limit. So you max out that FSA (somewhere in the neighborhood of $2500 - I think) also. Well, if I have it correctly your "premiums" as far as the Cadillac tax is concerned is $28,500 so that $1000 overage would be taxed at 40%. I think!You sparked a question in my mind regarding Cadillac plans. Say I work for a company and the total cost for the premium is $1000, but my employer pays $700 of it and I am left to pay $300. Does OOP cost come into play in determining if it qualifies as cadillac or not? Or is it just the fact that it's $1000 for the coverage and it doesn't really matter how much employer or employee is paying?The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
And I don't know about TGunz plan, but I guess it is closer to $800, $900 a month (for an individual) like my dangerously close to the Cadillac tax plan. So the reality is that he (including his "ESI wages") is already paying more than most anyone with an exchange plan. And that is how the large, diverse carriers can sell plans below cost for a while to build market share and still report record profits. And those with MCO business can claim those record profits are largely thanks to ObamaCare. (though I'd think they would use ACA). So in this way those ESI to individual subsidies already exist.
Agreed. BFS has far more patience than I do at this point.matttyl, you're swimming upstream my friend....better to have these conversations with BFS and the like.
Well I am on borrowed time right now. I'm out of town and only on here because my scheduled activities are being rained on. So I'm going to be even worst than normal when it comes to being able to participate in a back and forth, Normally I'm on when everyone else is off and vice versa. But soon I'll be in a dead zone so if you (or matttyl or anyone else) ask a question and then 10 pages fill up I'll probably miss it.matttyl, you're swimming upstream my friend....better to have these conversations with BFS and the like.
So the largest carrier in the individual market in 5 states (each of them with over 50% of the market) requesting premium increases of 30-50% is a sign of success? Multiple carriers and multiple state exchanges filing for bankruptcy is a sign of success?Sorry, I've lost interest in discussing these issues with you. I'm tired of the game where you see a big number or a scary projection and then post it here as if it's evidence of the ACA failing as a whole.I'm honestly interested in why you think this, if for any other reason than the number who are "now covered" (which is mostly via Medicaid, by the way). I'm hoping you'll actually answer this one rather than just ignoring the question like what you did when I asked you 4 times to explain your dislike of COBRA, or when I asked you when you first heard of the Milliman Medical Index, which you claim has "mislead you in a systematic way".Reasons I don't think it's "succeeding on it's own" at this time:ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,
The state exchanges are failing left and right, costing billions in tax dollars. Why are they failing? Because not enough people have signed up (there is a % the state exchanges make on every policy sold, and since not enough were sold, there isn't enough money for the state exchange to be self-sustaining). States (including your own) had to drastically cut their enrollment goals for 2015, and they didn't even hit those reduced numbers. The risk corridor money isn't nearly what it was projected to be because hardly any carriers made any money in the first year of the exchanges, which is leading to them requesting drastic increases in their premiums now. Utilization of the "newly insured" was far higher than anyone anticipated (Bass quoted over 3x higher above), specifically in ER visits and Rx, leading to the need for increased rates. A carrier that had been around for over 100 years closed within 16 months of the exchanges opening due to quarterly losses in the tens of millions, and many of the "co-ops" that were founded have already filed for bankruptcy. Enrollment into Medicaid has been much higher than what many states expected and budgeted for.
Oh, and New Mexico proposed rates from their market leader have been made public - 51.6% increase. That's "success" to you? That's now 5 states that have proposals from their largest carriers (very important piece there) of 30%+ - (Oregon, Maryland, Tennessee, New Mexico, and South Dakota).
As for the justification of the Tennessee increase - BlueCross BlueShield of Tennessee . . . said it lost $141 million from exchange-sold plans, stemming largely from a small number of sick enrollees. “Our filing is planned to allow us to operate on at least a break-even basis for these plans, meaning that the rate would cover only medical services and expenses—with no profit margin for 2016,” said spokeswoman Mary Danielson.
You're in insurance, so I'm sure you understand why COBRA didn't work for lots of folks. I don't need to explain basic #### like this to you.
I don't have interest in reading the financial statements of individual insurance companies in different states and then pointing out why or why not a single company having a bad quarter or year is or is not reason why the ACA as a whole is failing.
In short, the game of OMG BIG NUMBER!!!!!! OBAMACARE SUXOR!!! is beyond stale. I think the macro trends and big picture stuff is interesting, but shooting down your horror stories - I've simply lost the motivation.
You guys are mean to me and won't let me win so I'm taking my ball and going home.Sorry, I've lost interest in discussing these issues with you. I'm tired of the game where you see a big number or a scary projection and then post it here as if it's evidence of the ACA failing as a whole.I'm honestly interested in why you think this, if for any other reason than the number who are "now covered" (which is mostly via Medicaid, by the way). I'm hoping you'll actually answer this one rather than just ignoring the question like what you did when I asked you 4 times to explain your dislike of COBRA, or when I asked you when you first heard of the Milliman Medical Index, which you claim has "mislead you in a systematic way".Reasons I don't think it's "succeeding on it's own" at this time:ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,
The state exchanges are failing left and right, costing billions in tax dollars. Why are they failing? Because not enough people have signed up (there is a % the state exchanges make on every policy sold, and since not enough were sold, there isn't enough money for the state exchange to be self-sustaining). States (including your own) had to drastically cut their enrollment goals for 2015, and they didn't even hit those reduced numbers. The risk corridor money isn't nearly what it was projected to be because hardly any carriers made any money in the first year of the exchanges, which is leading to them requesting drastic increases in their premiums now. Utilization of the "newly insured" was far higher than anyone anticipated (Bass quoted over 3x higher above), specifically in ER visits and Rx, leading to the need for increased rates. A carrier that had been around for over 100 years closed within 16 months of the exchanges opening due to quarterly losses in the tens of millions, and many of the "co-ops" that were founded have already filed for bankruptcy. Enrollment into Medicaid has been much higher than what many states expected and budgeted for.
Oh, and New Mexico proposed rates from their market leader have been made public - 51.6% increase. That's "success" to you? That's now 5 states that have proposals from their largest carriers (very important piece there) of 30%+ - (Oregon, Maryland, Tennessee, New Mexico, and South Dakota).
As for the justification of the Tennessee increase - BlueCross BlueShield of Tennessee . . . said it lost $141 million from exchange-sold plans, stemming largely from a small number of sick enrollees. “Our filing is planned to allow us to operate on at least a break-even basis for these plans, meaning that the rate would cover only medical services and expenses—with no profit margin for 2016,” said spokeswoman Mary Danielson.
You're in insurance, so I'm sure you understand why COBRA didn't work for lots of folks. I don't need to explain basic #### like this to you.
I don't have interest in reading the financial statements of individual insurance companies in different states and then pointing out why or why not a single company having a bad quarter or year is or is not reason why the ACA as a whole is failing.
In short, the game of OMG BIG NUMBER!!!!!! OBAMACARE SUXOR!!! is beyond stale. I think the macro trends and big picture stuff is interesting, but shooting down your horror stories - I've simply lost the motivation.
COBRA was awesome. I was disappointment I only had 18 months or so of it available. Really wish they could expanded COBRA because I'd still be using it 14 years later.So the largest carrier in the individual market in 5 states (each of them with over 50% of the market) requesting premium increases of 30-50% is a sign of success? Multiple carriers and multiple state exchanges filing for bankruptcy is a sign of success?Sorry, I've lost interest in discussing these issues with you. I'm tired of the game where you see a big number or a scary projection and then post it here as if it's evidence of the ACA failing as a whole.I'm honestly interested in why you think this, if for any other reason than the number who are "now covered" (which is mostly via Medicaid, by the way). I'm hoping you'll actually answer this one rather than just ignoring the question like what you did when I asked you 4 times to explain your dislike of COBRA, or when I asked you when you first heard of the Milliman Medical Index, which you claim has "mislead you in a systematic way".Reasons I don't think it's "succeeding on it's own" at this time:ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,
The state exchanges are failing left and right, costing billions in tax dollars. Why are they failing? Because not enough people have signed up (there is a % the state exchanges make on every policy sold, and since not enough were sold, there isn't enough money for the state exchange to be self-sustaining). States (including your own) had to drastically cut their enrollment goals for 2015, and they didn't even hit those reduced numbers. The risk corridor money isn't nearly what it was projected to be because hardly any carriers made any money in the first year of the exchanges, which is leading to them requesting drastic increases in their premiums now. Utilization of the "newly insured" was far higher than anyone anticipated (Bass quoted over 3x higher above), specifically in ER visits and Rx, leading to the need for increased rates. A carrier that had been around for over 100 years closed within 16 months of the exchanges opening due to quarterly losses in the tens of millions, and many of the "co-ops" that were founded have already filed for bankruptcy. Enrollment into Medicaid has been much higher than what many states expected and budgeted for.
Oh, and New Mexico proposed rates from their market leader have been made public - 51.6% increase. That's "success" to you? That's now 5 states that have proposals from their largest carriers (very important piece there) of 30%+ - (Oregon, Maryland, Tennessee, New Mexico, and South Dakota).
As for the justification of the Tennessee increase - BlueCross BlueShield of Tennessee . . . said it lost $141 million from exchange-sold plans, stemming largely from a small number of sick enrollees. “Our filing is planned to allow us to operate on at least a break-even basis for these plans, meaning that the rate would cover only medical services and expenses—with no profit margin for 2016,” said spokeswoman Mary Danielson.
You're in insurance, so I'm sure you understand why COBRA didn't work for lots of folks. I don't need to explain basic #### like this to you.
I don't have interest in reading the financial statements of individual insurance companies in different states and then pointing out why or why not a single company having a bad quarter or year is or is not reason why the ACA as a whole is failing.
In short, the game of OMG BIG NUMBER!!!!!! OBAMACARE SUXOR!!! is beyond stale. I think the macro trends and big picture stuff is interesting, but shooting down your horror stories - I've simply lost the motivation.
And you still haven't given me one reason why COBRA was a bad idea. I personally think it was a great thing, allowing people to remain on their own insurance if they wanted. I mean, wasn't that one of the broken promises of the ACA itself (if you like your plan you can keep it, COBRA actually allowed that to happen, the ACA didn't). I've now asked at least 5 times and still nothing. Makes me think you know as much about COBRA as you do about human reproduction (remember when you kept asking me why I, as a male, would never need maternity coverage?!).
Thank you! Yes, for some people it was a great thing to have available. It wasn't forced that you accept it, but it was an option, and apparently for you it was a good option to have. If the worst part about it you had was that it was only allowed for a year and a half, then I guess it wasn't a bad thing to have during that time.COBRA was awesome. I was disappointment I only had 18 months or so of it available. Really wish they could expanded COBRA because I'd still be using it 14 years later.
We would need to compare exact plans or at least ones very close. The ACA market has to be trending towards the low end plans. I've got to believe Tommy's pool is much cleaner than the ACA pool. His plan is likely self-insured so the only reason his rate would be higher is if his company has horrible HR people negotiate the cost to process the plan or his company has figured out a way to skim from the top. I do remember that when I was in corporate the company provide tons of literature about the pension plan performance but nothing about the medical plan performance.The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
And I don't know about TGunz plan, but I guess it is closer to $800, $900 a month (for an individual) like my dangerously close to the Cadillac tax plan. So the reality is that he (including his "ESI wages") is already paying more than most anyone with an exchange plan. And that is how the large, diverse carriers can sell plans below cost for a while to build market share and still report record profits. And those with MCO business can claim those record profits are largely thanks to ObamaCare. (though I'd think they would use ACA). So in this way those ESI to individual subsidies already exist.
It was much cheaper the the individual plan I bought after the benefit expired.Thank you! Yes, for some people it was a great thing to have available. It wasn't forced that you accept it, but it was an option, and apparently for you it was a good option to have. If the worst part about it you had was that it was only allowed for a year and a half, then I guess it wasn't a bad thing to have during that time.COBRA was awesome. I was disappointment I only had 18 months or so of it available. Really wish they could expanded COBRA because I'd still be using it 14 years later.
You've been around here long enough to know my bark is as strong as anyone's. Virtually everyone (save 5-6 regulars) has stopped posting in here because it's such a dumpster fire. I'm tired of rehashing the same issues over and over. BFS can continue to bring sense to this thread for as long as he sustain motivation. I'm spent.You guys are mean to me and won't let me win so I'm taking my ball and going home.Sorry, I've lost interest in discussing these issues with you. I'm tired of the game where you see a big number or a scary projection and then post it here as if it's evidence of the ACA failing as a whole.I'm honestly interested in why you think this, if for any other reason than the number who are "now covered" (which is mostly via Medicaid, by the way). I'm hoping you'll actually answer this one rather than just ignoring the question like what you did when I asked you 4 times to explain your dislike of COBRA, or when I asked you when you first heard of the Milliman Medical Index, which you claim has "mislead you in a systematic way".Reasons I don't think it's "succeeding on it's own" at this time:ETA: to clarify, I'd be fine with paying more if need be, but in no way is Bass' solution necessary to "salvage" Obamacare. Despite the horror stories and doom and gloom from 4-5 FFA posters, the law is succeeding on its own and the political repeal nonsense is growing weaker by the day as the masses realize the ACA isn't the evil monster Palin and matttyl hyped it to be,
The state exchanges are failing left and right, costing billions in tax dollars. Why are they failing? Because not enough people have signed up (there is a % the state exchanges make on every policy sold, and since not enough were sold, there isn't enough money for the state exchange to be self-sustaining). States (including your own) had to drastically cut their enrollment goals for 2015, and they didn't even hit those reduced numbers. The risk corridor money isn't nearly what it was projected to be because hardly any carriers made any money in the first year of the exchanges, which is leading to them requesting drastic increases in their premiums now. Utilization of the "newly insured" was far higher than anyone anticipated (Bass quoted over 3x higher above), specifically in ER visits and Rx, leading to the need for increased rates. A carrier that had been around for over 100 years closed within 16 months of the exchanges opening due to quarterly losses in the tens of millions, and many of the "co-ops" that were founded have already filed for bankruptcy. Enrollment into Medicaid has been much higher than what many states expected and budgeted for.
Oh, and New Mexico proposed rates from their market leader have been made public - 51.6% increase. That's "success" to you? That's now 5 states that have proposals from their largest carriers (very important piece there) of 30%+ - (Oregon, Maryland, Tennessee, New Mexico, and South Dakota).
As for the justification of the Tennessee increase - BlueCross BlueShield of Tennessee . . . said it lost $141 million from exchange-sold plans, stemming largely from a small number of sick enrollees. “Our filing is planned to allow us to operate on at least a break-even basis for these plans, meaning that the rate would cover only medical services and expenses—with no profit margin for 2016,” said spokeswoman Mary Danielson.
You're in insurance, so I'm sure you understand why COBRA didn't work for lots of folks. I don't need to explain basic #### like this to you.
I don't have interest in reading the financial statements of individual insurance companies in different states and then pointing out why or why not a single company having a bad quarter or year is or is not reason why the ACA as a whole is failing.
In short, the game of OMG BIG NUMBER!!!!!! OBAMACARE SUXOR!!! is beyond stale. I think the macro trends and big picture stuff is interesting, but shooting down your horror stories - I've simply lost the motivation.
Reading on the latest tax rules...I think this is generally correct. However, we all know there are usually 50ish exceptions to every general rule. This will take some more research.A tax expert will probably tell me I'm wrong or this is an over simplification but I think if "a benefit" is tied to "health care" and is "pre tax" then it applies. (Exceptions would be standalone benefits for things like dental or disability).Ok...that makes a little more sense. Our max is $2500 on an FSA.It is "with annual premiums exceeding $10,200 for individuals or $27,500 for a family starting in 2018" so it is the total sticker. However, I believe it is more than that as the law counts things like FSAs and HSAs as premiums. So say your family's insurance cost are kept to $26,000 by your employer but it has a $1000 deductible which you exceed every year and you also spend another $2000 or so on things that you use your FSA to pay for up to the limit. So you max out that FSA (somewhere in the neighborhood of $2500 - I think) also. Well, if I have it correctly your "premiums" as far as the Cadillac tax is concerned is $28,500 so that $1000 overage would be taxed at 40%. I think!You sparked a question in my mind regarding Cadillac plans. Say I work for a company and the total cost for the premium is $1000, but my employer pays $700 of it and I am left to pay $300. Does OOP cost come into play in determining if it qualifies as cadillac or not? Or is it just the fact that it's $1000 for the coverage and it doesn't really matter how much employer or employee is paying?The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
And I don't know about TGunz plan, but I guess it is closer to $800, $900 a month (for an individual) like my dangerously close to the Cadillac tax plan. So the reality is that he (including his "ESI wages") is already paying more than most anyone with an exchange plan. And that is how the large, diverse carriers can sell plans below cost for a while to build market share and still report record profits. And those with MCO business can claim those record profits are largely thanks to ObamaCare. (though I'd think they would use ACA). So in this way those ESI to individual subsidies already exist.
What is it you believe you've "tried" exactly?Agreed. BFS has far more patience than I do at this point.matttyl, you're swimming upstream my friend....better to have these conversations with BFS and the like.
God bless you BFS, you're doing the lords work in here. I tried, but I'm tired of banging my head into the brick wall.
Again, a tax expert might say I'm wrong but since the individual market isn't pretax I don't think the Cadillac tax applies at all there. And on the off chance that someone eligible for subsidies are buying such a plan those are tied a baseline silver plan (second cheapest) so the subsidies are already capped (and aren't eligible for silver only cost sharing).I think what you said here is true. What's crazy is that it won't take long for the premiums in the individual market to meet or exceed those amounts. $10,200 divided by 12 months is 850 a month. Many platinum and gold plans today (not 2018, but rather now in 2015) already have premiums higher than that for an individual if they are 55 or older. Larger families can hit the 27,500 even quicker if they are a 5+ person family. Are they going to charge a "caddy tax" on folks buying individual plans which they are forced by the individual mandate to obtain?It is "with annual premiums exceeding $10,200 for individuals or $27,500 for a family starting in 2018" so it is the total sticker. However, I believe it is more than that as the law counts things like FSAs and HSAs as premiums. So say your family's insurance cost are kept to $26,000 by your employer but it has a $1000 deductible which you exceed every year and you also spend another $2000 or so on things that you use your FSA to pay for up to the limit. So you max out that FSA (somewhere in the neighborhood of $2500 - I think) also. Well, if I have it correctly your "premiums" as far as the Cadillac tax is concerned is $28,500 so that $1000 overage would be taxed at 40%. I think!
He's not going anywhere...don't worry.I hope you don't leave the thread, tommy. Big fan.
Gunz, for what it's worth I've enjoyed having you (and BFS and even Tim - but don't tell him that - in this thread). You've provided "the other side" and BFS has been great with his links and such, and I've learned things because of it. I'm trying to look maybe not at the "big picture" (the entire health care system as a whole) but more at the "middle picture" - the individual market which has been the part most greatly affected thus far by the ACA (and will remain as the largest affected part of the health care industry as it had the largest changes to make). That's where I make my living as an insurance agent, so I'm extremely vested in it's sustainability, and quite frankly I'm very concerned for it's long term health.You've been around here long enough to know my bark is as strong as anyone's. Virtually everyone (save 5-6 regulars) has stopped posting in here because it's such a dumpster fire. I'm tired of rehashing the same issues over and over. BFS can continue to bring sense to this thread for as long as he sustain motivation. I'm spent.
First couple of sentences is what I mean by differences in plan design. So far the gap has been large but I think over time that you guys in the individual market will start demanding with your purchases better coverage as you learn what is worth more to you and what is not. I think those decisions you guys make as individual will be watched by employers to learn what really matters and those things that are less important to individuals will start finding their way into the group market as the employers look to shed cost. So I think the gap is going to narrow from both directions. But over time.We would need to compare exact plans or at least ones very close. The ACA market has to be trending towards the low end plans. I've got to believe Tommy's pool is much cleaner than the ACA pool. His plan is likely self-insured so the only reason his rate would be higher is if his company has horrible HR people negotiate the cost to process the plan or his company has figured out a way to skim from the top. I do remember that when I was in corporate the company provide tons of literature about the pension plan performance but nothing about the medical plan performance.The average ESI for an individual is over $500 a month. The average ESI is under $350. Now of course plan designs and such explain away a large percentage of the average difference, but when I say that ESI and individuals would stabilize I mean that individual plans will need to keep going up in price and ESI would need to be designed more like individual plans to get there. One of the reasons that the CBO (and I believe the GAO) note that the subsidies are costing us less is because the plans sold on the individual market were less like ESI than expected. One of the reasons the GAO expects individual market prices to go up faster than ESI in the short term is the expectation that the gap will narrow as people demand smaller deductibles and larger networks (like that $365 give or take CareFirst plan).I think the solution to salvage Obamacare is to cap the ACA rates at whatever the averaged employer rate is. The whatever carrier losses are above that would be covered by a tax on employer sponsored plans.
For example, let's say Gunz contribution and his company's contribution to his his Gold 2000 plan is $500 a month. Let's say the the carrier's would have to price a similar ACA plan at $1000 a month for that pool to "break-even". If there are 200 million people in the employer pool and 20 million in the employer pool, the Gunz would have to pay a monthly ACA support surcharge of $500 / 10 or $50 a month. I'm OK with being progressive on this issue. Let's say the median US wage is $26K. If Gunz makes $78K a year then he pays 3x or $150 a month towards the fund.
Bottom line is that if pre-existing condition acceptance is the law of the land, then paying for it should be covered by all the members of the land, not just the 10% of the population.
And I don't know about TGunz plan, but I guess it is closer to $800, $900 a month (for an individual) like my dangerously close to the Cadillac tax plan. So the reality is that he (including his "ESI wages") is already paying more than most anyone with an exchange plan. And that is how the large, diverse carriers can sell plans below cost for a while to build market share and still report record profits. And those with MCO business can claim those record profits are largely thanks to ObamaCare. (though I'd think they would use ACA). So in this way those ESI to individual subsidies already exist.
Once when I changed jobs from a large to a small company, I used my new employer insurance for myself but paid for COBRA for my wife for two years. (She is disabled and thus can go beyond 18 months.) The company reimbursed me for the amount they would have paid for her to be under their plan. That still left us paying some out of pocket every month, but it was well worth it.Thank you! Yes, for some people it was a great thing to have available. It wasn't forced that you accept it, but it was an option, and apparently for you it was a good option to have. If the worst part about it you had was that it was only allowed for a year and a half, then I guess it wasn't a bad thing to have during that time.COBRA was awesome. I was disappointment I only had 18 months or so of it available. Really wish they could expanded COBRA because I'd still be using it 14 years later.
Yup. That's why I thought it was funny when Michigan requested a 10.0% increase, and another state was right at 9.8%.Anything below a 10% increase in premium annually is automatically approved. Anything above a 10% increase must go through Rate Review and be approved by either CMS Oversight, or by the States if they are a direct enforcement State.
What is it you believe you've "tried" exactly?Agreed. BFS has far more patience than I do at this point.matttyl, you're swimming upstream my friend....better to have these conversations with BFS and the like.
God bless you BFS, you're doing the lords work in here. I tried, but I'm tired of banging my head into the brick wall.
Glad to hear it. And yes, you can stay on for over 18 months in that situation, which makes it an every greater option in those situations, as it was for you.Once when I changed jobs from a large to a small company, I used my new employer insurance for myself but paid for COBRA for my wife for two years. (She is disabled and thus can go beyond 18 months.) The company reimbursed me for the amount they would have paid for her to be under their plan. That still left us paying some out of pocket every month, but it was well worth it.Thank you! Yes, for some people it was a great thing to have available. It wasn't forced that you accept it, but it was an option, and apparently for you it was a good option to have. If the worst part about it you had was that it was only allowed for a year and a half, then I guess it wasn't a bad thing to have during that time.COBRA was awesome. I was disappointment I only had 18 months or so of it available. Really wish they could expanded COBRA because I'd still be using it 14 years later.
I also used it at least one other time when changing jobs. It has worked out great for us.
Ignoring the individual market, both of these numbers "average premiums" and "average deductibles" have changed at better rates the past five years than the previous five. And that of course is because health care hasn't been going up. And it is also because employers have shed about 1% of their total operating cost (9% to 8%) by redesigning plans above and beyond the change in cost.And I wish people, and the media, would stop looking at the Premiums as the "end story"..
I fully expect the Average Premium increases to stay at the same levels as we saw before the ACA and what we are seeing now.
But it should not be shocking to anyone to see 10-15% increases in Deductibles and Total Out of the Pocket cost....
Insurance companies know that people see their premiums raise and
But most don't do enough "Fine Print" reading on the Out of Pocket increases until something actual happens, at which point it is too late and you are stuck with the bill.
BFS - this is the part that I never really saw working in the individual market, or at least working well. When looking at large group coverage, the employer (or HR) is making the health care coverage choice for the entire group - maybe offering 2 or more plans as well. But in the individual market, each person (or family unit) is making that choice for themselves, and doing so each year again for themselves.First couple of sentences is what I mean by differences in plan design. So far the gap has been large but I think over time that you guys in the individual market will start demanding with your purchases better coverage as you learn what is worth more to you and what is not.