Report your experience with getting insurance via ACA (1 Viewer)

[matttyl]

Based upon a quick review of the executive summary and the entry for Massachusetts, you seem to be misreading this report. From what I see, that report isn't evaluating systems like the ACA at all. It is evaluating the implementation of Guaranteed Issue and Community Rating in several states in the 1990s. As the report states, "[g]uaranteed issue encourages people to wait until they have health problems to buy insurance." This was a big problem with many 1990s reforms, including one in Massachusetts. But Massachusetts instituted another reform, RomneyCare, in 2006. As people may gather, one feature of RomneyCare, which is shared by the ACA, is designed to directly address the chief problem with Guaranteed Issue. The free rider problem identified above. That feature is the individual mandate.
I can find very little criticism of RomneyCare from you own source. When discussing the 2006 Massachusetts reform the paper states, "[v]arious reports indicate a reduction of the individual market premium, due to the merger with the small group market, ranging from 20% to 33%."

I can find several other sources that report the same thing. Individual insurance premiums in Massachusetts have gone down at a time when they have increased throughout the country.

I'll read the other case studies a bit more closely, but I'm reasonably certain that Massachusetts was the first, and the only, state to enact an individual mandate. Which makes your source not particularly useful to this discussion.

People still "game" the Massachusetts individual market, happens all the time and will continue to as long as there is guaranteed issue with no pre-ex.

Also, Massachusetts has the highest insurance premiums of any state in the country. Even in they drop 2% in a year, they are already considerably higher than the average nationwide. You can't claim that "prices are dropping" when they are already starting at a much, much higher spot.

 

[Ramsay Hunt Experience]

Private charity has failed. I am fairly certain you understood that point.

There really just seems to be a general feeling of #### the poor from a couple of you.

if that is true, why would we turn instead to a worse form of charity: government "charity"?

Because government charity isn't a worse form of charity. The War on Poverty dropped the poverty rate from 17% to 11%. Once Nixon gutted the Office of Economic Opportunity, rates crept up around 15% where they've generally hovered, give or take a percentage point, since.

If you can find any evidence that an expansion in private charity has ever achieved anything approaching that level of success, I'd be delighted to hear about it.

 

[matttyl]

Tell me where the argument was made that you "don't want to pay for the lazy fat smoker BUT here are my ideas for caring for those with non-preventable medical problems." I am interested in hearing those solutions.

One word - underwriting. You know, like we have today.

 

[matttyl]

Thanks for telling us what's wrong with the ACA, how about telling us how you plan to help the people we are talking about absent the ACA? I have other options but I am curious to hear yours.

What people are you taking about?

 

[Ramsay Hunt Experience]

Based upon a quick review of the executive summary and the entry for Massachusetts, you seem to be misreading this report. From what I see, that report isn't evaluating systems like the ACA at all. It is evaluating the implementation of Guaranteed Issue and Community Rating in several states in the 1990s. As the report states, "[g]uaranteed issue encourages people to wait until they have health problems to buy insurance." This was a big problem with many 1990s reforms, including one in Massachusetts. But Massachusetts instituted another reform, RomneyCare, in 2006. As people may gather, one feature of RomneyCare, which is shared by the ACA, is designed to directly address the chief problem with Guaranteed Issue. The free rider problem identified above. That feature is the individual mandate.
I can find very little criticism of RomneyCare from you own source. When discussing the 2006 Massachusetts reform the paper states, "[v]arious reports indicate a reduction of the individual market premium, due to the merger with the small group market, ranging from 20% to 33%."

I can find several other sources that report the same thing. Individual insurance premiums in Massachusetts have gone down at a time when they have increased throughout the country.

I'll read the other case studies a bit more closely, but I'm reasonably certain that Massachusetts was the first, and the only, state to enact an individual mandate. Which makes your source not particularly useful to this discussion.

People still "game" the Massachusetts individual market, happens all the time and will continue to as long as there is guaranteed issue with no pre-ex.

Also, Massachusetts has the highest insurance premiums of any state in the country. Even in they drop 2% in a year, they are already considerably higher than the average nationwide. You can't claim that "prices are dropping" when they are already starting at a much, much higher spot.

Massachusetts has 98% coverage since they imposed the individual mandate. If people are still "gaming" the system, it's a truly tiny percentage.*

But never mind that. Do you still contend that white paper is relevant? If so, why? You understand it isn't addressing systems with an individual mandate?

* FWIW, I think it's a legitimate criticism of the ACA to note that the penalty is insufficient to properly enforce the individual mandate. It's probably the most troubling aspect of the law as passed. Of course, it's also the most easily fixed.

 

[matttyl]

I'm bumping this because I'd like to give matty the ability to show how the analysis in his posted whitepaper relates to the ACA.

I'm trying to not assume the worst out of posters, but it's a little strange to see that he had no answer for why his posted white paper would support his claim that premiums are going to rise in this thread, but has since repeated his very specific claim that rates will rise "80%" in the thread about the website problems.

I'm sure he just missed this and isn't being a weasel by posting about in another thread that isn't even supposed to be about the cost of premiums.

Sorry, trying to catch up with all the posts in various threads about the ACA, as well as work and such.

Anyway, the paper I posted talks about states that went with a guaranteed issue individual insurance situation. The vast majority have had "death spirals" in their individual markets, some of which have had to repeal guaranteed issue, community rating, or both. The premiums got so high that all the healthy people jumped out leaving the sick people in the pools, and premiums skyrocketed.

Yes, Mass. is the state that has an individual mandate - and they have the lowest % of uninsured in the country. They also have the highest premiums for insurance of any state in the US. Saying that it's been a success there by constraining premium increases isn't fair at all when you realize that the premiums there already started at such a high point. As I mentioned in either this thread, another, or both - it's not really a "success" for John Q. when his $200 monthly premiums only go up by 3% a year when he already had a plan in place costing half as much but growing by 10% a year. Also, people "gaming" the system in Mass. is a huge problem, and you can't stop that situation as long as you have guaranteed issue with no pre-ex, really no matter how high the penalty is.

 

[matttyl]

But mostly, they think that costs will go down because competition will increase. By most estimates, the ACA puts 30 million new consumers in the individual market. With thirty million more consumers to chase, more firms will enter the individual market (and we've already seen that, as many insurance carriers that had only been in the group market have moved into the individual market).

FWIW, here is a decent, only semi-technical read on the subject from an economist at MIT. http://economics.mit.edu/files/6829

Sounds great in theory, unfortunately the exact opposite has actually occurred. Carriers which had been in the individual market are leaving that market now. Aetna has dropped out of a handfull of states, including the very state they are based in. Other carriers are doing the same.

Here's what Aetna said.

"We have spent considerable time identifying those states in which we can be competitive and add the most value to the market."

So they've dropped out of some state exchanges because the competition was too good. I fail to see how we should consider that a bad thing for consumers.

Connecticut has 3 carriers left in their insurance market. Three. How is that "competition was too good"?

Aetna isn't the only carrier dropping out of exchanges, either. Also in the "white paper" I posted above, it talks about states which have gone GI in the past, and all the carriers that dropped out of those markets afterwards.

 

[matttyl]

Apropos of nothing, it's not at all clear that someone who runs marathons will generate lower health care costs than someone with a high BMI. Endurance training has been linked to a weakening of the heart muscle and a higher incidence of many cancers. And that's leaving aside the studies that have found that lifetime health care costs for the obese were less because they incurred less of the health care costs that otherwise healthy people incur when they get old and unhealthy (because I understand that there are studies going both ways).

The obese cost less because they die much sooner, on average. I've seen the same studies on smokers.

If you were an insurance carrier, would you rather insure the fat guy who pays $300 a month from 30 to 50 and drops dead with $100k in medical claims (only $72k in total premium)

-or- insure the runner who pays $300 a month from 30 to 80 and drops dead with $150k in medical claims (but $180k in total premium)?

 

[matttyl]

Massachusetts has 98% coverage since they imposed the individual mandate. If people are still "gaming" the system, it's a truly tiny percentage.*
But never mind that. Do you still contend that white paper is relevant? If so, why? You understand it isn't addressing systems with an individual mandate?

* FWIW, I think it's a legitimate criticism of the ACA to note that the penalty is insufficient to properly enforce the individual mandate. It's probably the most troubling aspect of the law as passed. Of course, it's also the most easily fixed.

I fully understand that they have the lowest % uninsured. They also have the individual mandate. Of course those two are related.

They also have the highest insurance rates in the nation. That isn't a coincidence. So yes, the paper is relevant. It talks about a state that went guaranteed issue (Mass), and that state now has the highest average insurance premium in the country because of it. That's why I feel my insurance rates (and those of Americans) will go up because of the ACA. Cause you know, it's already happened.

EDIT for some numbers (unfortunately most recent I can find with a 2 minutes google search, I don't live in Mass)- Massachusetts and Vermont led the nation in 2010 with average, individual market health insurance premiums topping $400 per person per month, about double the national average, according to an analysis released Tuesday.

The Kaiser Family Foundation used information culled from insurer filings to the National Association of Insurance Commissioners and found a substantial spread among premiums between the states.

The foundation called its analysis an “important baseline that consumers and policymakers can use to gauge the state of insurance affordability prior to the full implementation of health reform.”

Alabama averaged $136 per month and California, Arkansas, Idaho and Delaware posted average monthly, per person premiums of less than $170. Premiums in Rhode Island, New York and New Jersey were among the nation’s highest, averaging between $344 and $364.

Read more: Massachusetts individual health premiums highest in Nation - Quincy, MA - The Patriot Ledger http://www.patriotledger.com/topstories/x1852604642/Massachusetts-individual-health-premiums-highest-in-Nation#ixzz2ikcMEK86

 

[TheIronSheik]

I know this isn't going to be the most popular opinion, but at some point I do say #### the poor because supporting everyone else is degrading MY quality of life.

Schlzm

Ya know, I'm sure it could have been said a little more eloquently, but I tend to agree with you.

And this is why private charity/market based solutions have failed.

It is shameful that a country as prosperous as ours has homeless, starving citizens who cannot afford health care.

I kind of bowed out of this conversation because they're were people way more intelligent on the subject discussing things. Plus I felt like I was slipping into another political argument and I try to stay clear of those.

But I do want to point something out. You keep saying how we are a wealthy and prosperous nation. If this were true and we had excess money just waiting to be spent on something, I'd think free healthcare would be very noble. But we have hundreds of thousands of people out of work. We have schools that are failing because they have no money to spend on the essentials for learning. We have bridges literally falling down because they are so old and outdated.

There are so many things wrong with this country that money could help fix. And for me, at least, getting poor people free healthcare is very low on the list of what I think we should spend our money on.

 

[Schlzm]

Massachusetts has 98% coverage since they imposed the individual mandate. If people are still "gaming" the system, it's a truly tiny percentage.*

But never mind that. Do you still contend that white paper is relevant? If so, why? You understand it isn't addressing systems with an individual mandate?

* FWIW, I think it's a legitimate criticism of the ACA to note that the penalty is insufficient to properly enforce the individual mandate. It's probably the most troubling aspect of the law as passed. Of course, it's also the most easily fixed.

I fully understand that they have the lowest % uninsured. They also have the individual mandate. Of course those two are related.They also have the highest insurance rates in the nation. That isn't a coincidence. So yes, the paper is relevant. It talks about a state that went guaranteed issue (Mass), and that state now has the highest average insurance premium in the country because of it. That's why I feel my insurance rates (and those of Americans) will go up because of the ACA. Cause you know, it's already happened.

I was told by the office of one of my state senators that my rates are going to increase solely because of ACA. Sure it's "just a little bit" but so is death by a thousand cuts.Schlzm

 

[Woogie Lee]

I know this isn't going to be the most popular opinion, but at some point I do say #### the poor because supporting everyone else is degrading MY quality of life.

Schlzm

Ya know, I'm sure it could have been said a little more eloquently, but I tend to agree with you.

And this is why private charity/market based solutions have failed.

It is shameful that a country as prosperous as ours has homeless, starving citizens who cannot afford health care.

I kind of bowed out of this conversation because they're were people way more intelligent on the subject discussing things. Plus I felt like I was slipping into another political argument and I try to stay clear of those.

But I do want to point something out. You keep saying how we are a wealthy and prosperous nation. If this were true and we had excess money just waiting to be spent on something, I'd think free healthcare would be very noble. But we have hundreds of thousands of people out of work. We have schools that are failing because they have no money to spend on the essentials for learning. We have bridges literally falling down because they are so old and outdated.

There are so many things wrong with this country that money could help fix. And for me, at least, getting poor people free healthcare is very low on the list of what I think we should spend our money on.

Yet Chase is paying 13 billion in fines like it is a drop in the bucket.

 

[Flying Elvis]

My apologies in advance if this is no longer a discussion of the general "exchange" system and the resulting insurance coverage options.

2 years ago my employer stopped offering insurance because I had it elsewhere at a much cheaper price than he could get and the other employee opted out due to obnoxiously high rates that were jumping ~20% annually. At that time the least expensive plan available was a high deductible plan that covered only the annual visit each year until the deductible was reached. Said deductible was $4000 and the premium was $430 monthly. The simple math - I would pay just over $5000 for the privilege of paying the first $4000 of medical expenses.

I recently went on the exchange and did the entire process, application to selection (though I didn't select a plan and pay, yet) because my situation has changed again and I need different coverage.

The system is sloppy technology, which seems to be the case everywhere. I was on in the first week and was constantly receiving error messages that were ambiguous and simply told me to start over. When I did it doubled my family, adding the same people a second time. I could not fix it and had to call. In fact, I called several times over ~3 weeks to get clarification on different things and help for screwy system issues. The support people were all very nice, pleasant, professional and were able to get the questions/issues resolved. The system issues were drastically improved from week 2 to week 5 (give or take) when I took a break and went back. No error messages and it went through each screen well. I think it's important to note that, despite the technology being pretty lousy, I was there to purchase health insurance coverage, not technology.

On to that part, which really is most important. The cheapest (bronze) plan available to me had very similar deductibles to the plan available through my employer 2 years ago. Instead of a $4000 deductible it is $5000. Similar 'non-payment' of any medical costs prior to reaching that deductible. The big difference? The monthly premium rang in at $204. So the monthly premium doing it the old way (small group getting raped by insurance providers) was more than double 2 years ago compared to what it is now via the exchange/ACA. When my employer plugged in numbers using the calculators provided via the employer function on the exchange site the premiums were still nearly $400 per month. Seems stupid, and an obvious flaw that will have employers and employees scrambling to get the hell out of an employer sponsored program to save buckets of cash.

The plan I intend to go with will be $264 per month with a $2600 deductible. Max oop $4000 and reasonable percentages & co-pays from the $2600 to $4000 mark. Though I'm still considering the lowest option simply b/c I hover around $1500-$2000 per year in medical costs for visits, pharmacy, labs, etc. and will only ever reach the deductibles if something drastic happens.

 

[Chaka]

I expect more from government.

Well, there's your problem.

 

[TheIronSheik]

I know this isn't going to be the most popular opinion, but at some point I do say #### the poor because supporting everyone else is degrading MY quality of life.

Schlzm

Ya know, I'm sure it could have been said a little more eloquently, but I tend to agree with you.

And this is why private charity/market based solutions have failed.

It is shameful that a country as prosperous as ours has homeless, starving citizens who cannot afford health care.

I kind of bowed out of this conversation because they're were people way more intelligent on the subject discussing things. Plus I felt like I was slipping into another political argument and I try to stay clear of those.

But I do want to point something out. You keep saying how we are a wealthy and prosperous nation. If this were true and we had excess money just waiting to be spent on something, I'd think free healthcare would be very noble. But we have hundreds of thousands of people out of work. We have schools that are failing because they have no money to spend on the essentials for learning. We have bridges literally falling down because they are so old and outdated.

There are so many things wrong with this country that money could help fix. And for me, at least, getting poor people free healthcare is very low on the list of what I think we should spend our money on.

Yet Chase is paying 13 billion in fines like it is a drop in the bucket.

Geez. What did Chase Stuart do?

 

[Chaka]

You do realize that you are still paying for the overweight & uninsurable, right?

I also hope you realize that all medical problems are not a result of choice.

On the first part - honestly and seriously, explain to me how I still pay that.On the second part - Over 50% are. Studies show that.

On the first one the costs get passed on and medical costs rise. You act like medical costs had been dropping before the ACA.On the second one you are going back to the notion that because some things are a choice then #### everyone. Nice.

You shoot yourself in the foot intentionally I'm not paying for it. Stop using the all or nothing argument for this, it's weak at best. "Oh so because you don't want to pay for some lazy fat smoker to stay a lazy fat smoker then I guess you would rather we have death squads roaming the streets killing off anyone and everyone who can't take care of themselves you hearltess monster!"Schlzm

"shoot yourself in the foot intentionally" Huh? Wow.That is not at all what I am saying and I am pretty sure you know that.

I see the position as you "don't want to pay for the lazy fat smoker AND you don't want to pay for the person with brain cancer, or the person who was hit by a drunk driver." Nothing about death panels or killing people, just not wanting to pay for anyone else's medical care. Is that an incorrect conclusion from those posts?

Tell me where the argument was made that you "don't want to pay for the lazy fat smoker BUT here are my ideas for caring for those with non-preventable medical problems." I am interested in hearing those solutions.

You're the only one making the implication that it's an all or nothing decision. See what you typed in bold above. Pretty much everyone else involved in this discussion is saying #### *that* guy for eating poison and smashing bottles over his head, everyone else who is just in a really unfortunate situation, come over here and let's see what we can do.Schlzm

So if not the ACA then what can we do for them?

First off we shouldn't pass laws and then let people <entities> buy their way out of them. Also there are portions of the ACA that are a pretty good start at getting our healthcare system where it functions at it's best, however there are also huge parts that really don't help anyone long term or based on a series of speculations and what if's, which if don't come to fruition really jeapordize the entire system. Also to truly get things in line we need to look at how many other areas of our country are run, not just the healthcare sectors.Schlzm

Thanks for telling us what's wrong with the ACA, how about telling us how you plan to help the people we are talking about absent the ACA? I have other options but I am curious to hear yours.

How do I plan on helping out people who actually need it? I'll keep paying my ever increasing monetary obligations as dictated by those who feel they are above such petty nonsense. I will keep voting for laws and people that I think will properly balance needs and means vs. methods and actions. I will continue to be active in debate while also keeping myself educated about what is actually happening as opposed to being told what is happening. I will continue to do these things until the weight of doing so is unbearable, at that point I am planning on selling everything I can't take with me and buying a nice boat and becoming a carribean nomad taking money where I can.Schlzm

So, go with the status quo. Got it.

 

[Chaka]

I take care of myself, my BMI is in a very healthy range. In my younger days I even ran marathons as a hobby. I'm very fit and make health lifestyle choices. Shouldn't I pay less for health insurance than someone who doesn't take care of themselves, drinks too much, does drugs, has a BMI over 30 and can't walk up a flight of stairs because of their choices?

So you believe that all people who cannot afford insurance under the current model drink too much, do drugs and are fat and lazy?

 

[Chaka]

Is it just the ACA or are some people simply opposed to the greatest nation in world history providing health care to all her citizens?

We already do through Emergency Rooms is not an acceptable answer.

i support grown-ups taking responsibility for themselves, and providing for their own health protection. I don't see why that needs to be socialized.

Seeing variations on this theme all over the place.

Not everyone who cannot afford insurance under the current model is someone who doesn't believe in responsibility and just wants a free handout.

It needs to be dealt with, somehow because the existing model left tens of millions of people behind. I am not married to the notion of single payer but the old model was unequivocally broken.

 

[Chaka]

On a related note: What is the opposition to a single payer health care system?

if said single-payer is the same entity that cannot build a functioning website with 3 years to plan, and $500 million to spend?

also, in general, monopolies are bad

The rollout has been an unmitigated disaster, however that is not nearly the same thing as the law being an unmitigated disaster.

The rollout is not the actual program but those who are opposed to the ACA like to pretend that it is.

The enrollment process will be fixed.

 

[Chaka]

Thanks for telling us what's wrong with the ACA, how about telling us how you plan to help the people we are talking about absent the ACA? I have other options but I am curious to hear yours.

What people are you taking about?

You really believe that all medical problems are a choice, don't you?

 

[Schlzm]

So, go with the status quo. Got it.

This may come as a shock, but I personally have very little sway in the congressional lawmaking process.Schlzm

 

[matttyl]

I take care of myself, my BMI is in a very healthy range. In my younger days I even ran marathons as a hobby. I'm very fit and make health lifestyle choices. Shouldn't I pay less for health insurance than someone who doesn't take care of themselves, drinks too much, does drugs, has a BMI over 30 and can't walk up a flight of stairs because of their choices?

So you believe that all people who cannot afford insurance under the current model drink too much, do drugs and are fat and lazy?

Didn't say that at all, please stop putting words in my mouth.

I just asked a simple question. Should I be able to pay less for my insurance as a 32 year old with a healthy BMI who has maybe 3-4 drinks a week and has never done any drug (yeah, I'm a square) than another 32 year old who's BMI is over 30, drinks and does drugs (if those are the examples you would like to use).

Apparently the ACA feels it fair to charge up to 50% more if you smoke. Why's that fair if it's not fair to ask someone to pay more who makes other negative lifestyle choices? If neither are fair, would it then be fair to charge all non-smokers 10% more to offset those that do smoke (those smoking numbers are exact since 20% of the US population smokes)?

 

[matttyl]

Is it just the ACA or are some people simply opposed to the greatest nation in world history providing health care to all her citizens?

We already do through Emergency Rooms is not an acceptable answer.

i support grown-ups taking responsibility for themselves, and providing for their own health protection. I don't see why that needs to be socialized.

Seeing variations on this theme all over the place.

Not everyone who cannot afford insurance under the current model is someone who doesn't believe in responsibility and just wants a free handout.

It needs to be dealt with, somehow because the existing model left tens of millions of people behind. I am not married to the notion of single payer but the old model was unequivocally broken.

If they can't afford insurance now that they have this pre-ex.....when why didn't they have coverage before the pre-ex ever occurred? You bring up people who can't obtain coverage now because of their health....but that's like buying an auto policy after you get in a wreck.

 

[matttyl]

Thanks for telling us what's wrong with the ACA, how about telling us how you plan to help the people we are talking about absent the ACA? I have other options but I am curious to hear yours.

What people are you taking about?

You really believe that all medical problems are a choice, don't you?

No, and yet again please stop putting words in my mouth. It's unfair for you to group each and every non-insured American into a group of people with medical conditions when I've already posted that 90% of the currently uninsured can medically obtain coverage (notice I didn't say financially). Roughly half of the uninsured can either already afford coverage or already qualify for public assistance to do so. If the number of uninsured in this country dropped by half, wouldn't ACA proponents like yourself say that insurance rates would then do down because the increased cost of "insuring the uninsured" would drop by half? Wouldn't that then allow even more people the ability to afford insurance with the now lower rates?

As for your question - over half are.

 

[Schlzm]

On a related note: What is the opposition to a single payer health care system?

if said single-payer is the same entity that cannot build a functioning website with 3 years to plan, and $500 million to spend?

also, in general, monopolies are bad

The rollout has been an unmitigated disaster, however that is not nearly the same thing as the law being an unmitigated disaster.The rollout is not the actual program but those who are opposed to the ACA like to pretend that it is.

The enrollment process will be fixed.

No the rollout is not the actual program, however everything that has happened so far is a pretty good indicator of how things are going to run. Crapily.Schlzm

 

[matttyl]

Very, very telling chart about the average price of an individual health insurance policy in each state in 2010 (well after Romneycare in Mass). Oh, and it was done by the KFF, which all the ACA proponents will tell you is the word of the land.

http://kff.org/other/state-indicator/individual-premiums/

The average individual plan nationwide was $215. The average group individual employee was nearly twice that at $420 (due in large part to it being guaranteed issue for groups, and also because group plans tend to have more robust benefits, not unlike the ACA plans will have built in).

34 states had an average individual rate of $250 a month or less. The HIGHEST average rate was not surprisingly in Mass, at $437 a month - over TWICE the national average. Other notable high averages (the ONLY others over $300 per month) are Connecticut, Rhode Island, New York, New Jersey and Vermont - all guaranteed issue states.

 

[Keerock]

The Obamacare website, plagued by major problems since its rollout at the start of the month, should be functioning smoothly by the end of November, according to the official now in charge of fixing it.Jeffrey Zients told reporters today that an outside contractor will handle the task of resolving technical problems that have become a serious political flashpoint for the Obama administration.

"HealthCare.gov is fixable," Zients said on a conference call.

For the latest news updates, go to CNN TV, CNN.com and CNN Mobile.

 

[Chaka]

Is it just the ACA or are some people simply opposed to the greatest nation in world history providing health care to all her citizens?

We already do through Emergency Rooms is not an acceptable answer.

i support grown-ups taking responsibility for themselves, and providing for their own health protection. I don't see why that needs to be socialized.

Seeing variations on this theme all over the place.

Not everyone who cannot afford insurance under the current model is someone who doesn't believe in responsibility and just wants a free handout.

It needs to be dealt with, somehow because the existing model left tens of millions of people behind. I am not married to the notion of single payer but the old model was unequivocally broken.

If they can't afford insurance now that they have this pre-ex.....when why didn't they have coverage before the pre-ex ever occurred? You bring up people who can't obtain coverage now because of their health....but that's like buying an auto policy after you get in a wreck.

No. They can't obtain coverage because they cannot afford it. I never said anything about not being covered because of pre-existing conditions.

 

[Chaka]

Thanks for telling us what's wrong with the ACA, how about telling us how you plan to help the people we are talking about absent the ACA? I have other options but I am curious to hear yours.

What people are you taking about?

You really believe that all medical problems are a choice, don't you?

No, and yet again please stop putting words in my mouth. It's unfair for you to group each and every non-insured American into a group of people with medical conditions when I've already posted that 90% of the currently uninsured can medically obtain coverage (notice I didn't say financially). Roughly half of the uninsured can either already afford coverage or already qualify for public assistance to do so. If the number of uninsured in this country dropped by half, wouldn't ACA proponents like yourself say that insurance rates would then do down because the increased cost of "insuring the uninsured" would drop by half? Wouldn't that then allow even more people the ability to afford insurance with the now lower rates?

As for your question - over half are.

My question has been, absent the ACA what solutions are you suggesting to those who CANNOT AFFORD COVERAGE? Perhaps you assume that is because they have pre-existing conditions but I never presented that as a condition for my question.

 

[Mystery Achiever]

Here's what Aetna said.

"We have spent considerable time identifying those states in which we can be competitive and add the most value to the market."

So they've dropped out of some state exchanges because the competition was too good. I fail to see how we should consider that a bad thing for consumers.

Connecticut has 3 carriers left in their insurance market. Three. How is that "competition was too good"?

Aetna isn't the only carrier dropping out of exchanges, either. Also in the "white paper" I posted above, it talks about states which have gone GI in the past, and all the carriers that dropped out of those markets afterwards.

FWIW, Aetna is stiill offering off-exchange indiv. plans in CT per my ehealth search.

 

[matttyl]

No. They can't obtain coverage because they cannot afford it. I never said anything about not being covered because of pre-existing conditions.

Um, yeah you did (and I have no idea how to copy and paste a post)...


Chaka, on 24 Oct 2013 - 5:07 PM, said:

That is not at all what I am saying and I am pretty sure you know that.
I see the position as you "don't want to pay for the lazy fat smoker AND you don't want to pay for the person with brain cancer, or the person who was hit by a drunk driver." Nothing about death panels or killing people, just not wanting to pay for anyone else's medical care. Is that an incorrect conclusion from those posts?

Tell me where the argument was made that you "don't want to pay for the lazy fat smoker BUT here are my ideas for caring for those with non-preventable medical problems." I am interested in hearing those solutions.

 

[matttyl]

My question has been, absent the ACA what solutions are you suggesting to those who CANNOT AFFORD COVERAGE? Perhaps you assume that is because they have pre-existing conditions but I never presented that as a condition for my question.

As I've said many times, roughly half of the current uninsured can either already afford coverage or they can already qualify for public assistance to do so. With that additional ~25M people now insured (cut in half), insurance rates will go down because they only need to account half as much for coverage for the uninsured (someone earlier posted that in Texas roughly $1,500 of premiums per year per employee are just to offset the uninsured). With the now lower prices, even more people can afford coverage. Since only about 5M of the current 50M people who are uninsured can not obtain coverage for medical reasons, we can set up a program for them - or expand a program already in place like Medicare or Medicaid.

 

[matttyl]

Here's what Aetna said.

"We have spent considerable time identifying those states in which we can be competitive and add the most value to the market."

So they've dropped out of some state exchanges because the competition was too good. I fail to see how we should consider that a bad thing for consumers.

Connecticut has 3 carriers left in their insurance market. Three. How is that "competition was too good"?

Aetna isn't the only carrier dropping out of exchanges, either. Also in the "white paper" I posted above, it talks about states which have gone GI in the past, and all the carriers that dropped out of those markets afterwards.

FWIW, Aetna is stiill offering off-exchange indiv. plans in CT per my ehealth search.

Doesn't do anything for the people who want a subsidy, though. If you want Aetna you have to pay the full price. If you want to get a subsidy, you've got less competition in that market. Time in time again insurance carriers have dropped out of guaranteed issue situations. Now that guaranteed issue is nationwide, I think we'll be seeing a whole lot more of it.

 

[Ramsay Hunt Experience]

Very, very telling chart about the average price of an individual health insurance policy in each state in 2010 (well after Romneycare in Mass). Oh, and it was done by the KFF, which all the ACA proponents will tell you is the word of the land.

http://kff.org/other/state-indicator/individual-premiums/

The average individual plan nationwide was $215. The average group individual employee was nearly twice that at $420 (due in large part to it being guaranteed issue for groups, and also because group plans tend to have more robust benefits, not unlike the ACA plans will have built in).

34 states had an average individual rate of $250 a month or less. The HIGHEST average rate was not surprisingly in Mass, at $437 a month - over TWICE the national average. Other notable high averages (the ONLY others over $300 per month) are Connecticut, Rhode Island, New York, New Jersey and Vermont - all guaranteed issue states.

I completely concede that Mass had the highest average. It still doesn't support your argument. Mass had one of the smallest individual markets before GI. It's market shrunk under GI. It's market began to grow with the individual mandate. We wouldn't expect it's rates to instantly halve or anything, but the entire point of the ACA is that you need market participants to pin the costs down.

Even assuming you were right, you've still never conceded that you're talking about a very small subset of people's insurance premiums rising. Mainly people above 400% of the poverty lines who are still using the individual market. Even among that subset, you're talking mostly about older people with healthy incomes who aren't on group plans. That's a very small segment.

 

[Chaka]

No. They can't obtain coverage because they cannot afford it. I never said anything about not being covered because of pre-existing conditions.

Um, yeah you did (and I have no idea how to copy and paste a post)...


Chaka, on 24 Oct 2013 - 5:07 PM, said:

That is not at all what I am saying and I am pretty sure you know that.
I see the position as you "don't want to pay for the lazy fat smoker AND you don't want to pay for the person with brain cancer, or the person who was hit by a drunk driver." Nothing about death panels or killing people, just not wanting to pay for anyone else's medical care. Is that an incorrect conclusion from those posts?

Tell me where the argument was made that you "don't want to pay for the lazy fat smoker BUT here are my ideas for caring for those with non-preventable medical problems." I am interested in hearing those solutions.

How about that?

Wasn't exactly what I meant when I wrote that but I see how I made that entirely unclear.

What do you propose we do for those who work hard, make good lifestyle choices and cannot afford insurance?

Is that clear enough? Just because that person lives a healthy lifestyle does not preclude them from needing insurance at some point in their life. That person MAY get brain cancer, that person MAY be hit by a car, that person MAY have a child who develops asthma. What is the solution for them?

 

[matttyl]

Very, very telling chart about the average price of an individual health insurance policy in each state in 2010 (well after Romneycare in Mass). Oh, and it was done by the KFF, which all the ACA proponents will tell you is the word of the land.

http://kff.org/other/state-indicator/individual-premiums/

The average individual plan nationwide was $215. The average group individual employee was nearly twice that at $420 (due in large part to it being guaranteed issue for groups, and also because group plans tend to have more robust benefits, not unlike the ACA plans will have built in).

34 states had an average individual rate of $250 a month or less. The HIGHEST average rate was not surprisingly in Mass, at $437 a month - over TWICE the national average. Other notable high averages (the ONLY others over $300 per month) are Connecticut, Rhode Island, New York, New Jersey and Vermont - all guaranteed issue states.

I completely concede that Mass had the highest average. It still doesn't support your argument. Mass had one of the smallest individual markets before GI. It's market shrunk under GI. It's market began to grow with the individual mandate. We wouldn't expect it's rates to instantly halve or anything, but the entire point of the ACA is that you need market participants to pin the costs down.

Even assuming you were right, you've still never conceded that you're talking about a very small subset of people's insurance premiums rising. Mainly people above 400% of the poverty lines who are still using the individual market. Even among that subset, you're talking mostly about older people with healthy incomes who aren't on group plans. That's a very small segment.

Small subset?! There are millions of people in that "subset"! 10% of American's buy their coverage direct, that's over 30M people. And just because someone is at 300% of the FPL doesn't mean that a subsidy (if they ever get one through the exchange marketplace) will be large enough to offset the increase they will get.

Also small group markets are having the same type/style increases, so that's a large chunk of the 55% of Americans who have their coverage through their employer.

I understand that Mass has the largest % of insured, that will come with an individual mandate. For that state, it just means more people are paying the highest average cost in the nation for an individual policy - over TWICE the national average. That's what will come with guaranteed issue with no pre-ex. You asked me point blank why I thought my insurance rates would go up with the ACA - it's because rates have gone up for each and every state that has ever gone GI. Rates HAVE TO go up to offset the additional risk.

So that's my "argument" that prices will go up. They will have to, and they already have for the states that have implemented these types of changes. Are you ready and willing to (on average) pay twice as much for health insurance than we are now?

 

[matttyl]

No. They can't obtain coverage because they cannot afford it. I never said anything about not being covered because of pre-existing conditions.

Um, yeah you did (and I have no idea how to copy and paste a post)...


Chaka, on 24 Oct 2013 - 5:07 PM, said:

That is not at all what I am saying and I am pretty sure you know that.
I see the position as you "don't want to pay for the lazy fat smoker AND you don't want to pay for the person with brain cancer, or the person who was hit by a drunk driver." Nothing about death panels or killing people, just not wanting to pay for anyone else's medical care. Is that an incorrect conclusion from those posts?

Tell me where the argument was made that you "don't want to pay for the lazy fat smoker BUT here are my ideas for caring for those with non-preventable medical problems." I am interested in hearing those solutions.

How about that?

Wasn't exactly what I meant when I wrote that but I see how I made that entirely unclear.

What do you propose we do for those who work hard, make good lifestyle choices and cannot afford insurance?

Is that clear enough? Just because that person lives a healthy lifestyle does not preclude them from needing insurance at some point in their life. That person MAY get brain cancer, that person MAY be hit by a car, that person MAY have a child who develops asthma. What is the solution for them?

Buy coverage before they need it, and keep it through the period when they do need it. Tell me where coverage is too expensive today for someone who makes good lifestyle choices and works hard. I'm sure there are people in that "subset" to steal a term from Ramsay, but that's a small "subset".

You're talking about generally healthy people who "work hard" (should I take that to mean they have a job? and if so have subsidized group coverage already available to them?). You're asking about someone who apparently is in their "child bearing" years, so 20-40 (who will be hurt the most by the new age band restrictions of the ACA by the way).

If they couldn't afford coverage before when the average nationwide is $250 per person across all ages - how in the world are they going to be able to afford it now with the prices we've seen?! Even a single person making $45k will be ineligible for subsidies, as well the guy making $25k who has group coverage available. So how are they going to be able to afford the (actual ACA rate for a 27 year old in Fairfax, VA) $326.33 a month for a $500 deductible (cause he can't afford any higher deductible than that, and even this plan has a $3,750 max out of pocket)?!?!

You keep talking about the person who can't afford coverage today for whatever reason (either financial or medical), but what about all those who can't afford it tomorrow because of the rate hikes?! How is this system any better? All you've got is is a new 50M or more Americans who now can't afford coverage.

 

[Black Box]

So, they picked QSS as the firm to oversee the fixes.

http://www.nytimes.com/2013/10/26/us/politics/general-contractor-named-to-fix-health-web-site.html?_r=0

Quality Software Services already performs several major roles in the federal insurance marketplace. It built a “data services hub,” or pipeline, that transmits data back and forth between federal and state insurance exchanges and federal agencies, including the Social Security Administration, the Internal Revenue Service and the Department of Homeland Security.

The company also developed an “identity management” tool used as part of a registration system that requires consumers to create password-protected accounts before buying health insurance on the federal exchange.

Did they build the part that Foos said was the original culprit or am I misremembering?

 

[TheIronSheik]

So, they picked QSS as the firm to oversee the fixes.

http://www.nytimes.com/2013/10/26/us/politics/general-contractor-named-to-fix-health-web-site.html?_r=0

Quality Software Services already performs several major roles in the federal insurance marketplace. It built a “data services hub,” or pipeline, that transmits data back and forth between federal and state insurance exchanges and federal agencies, including the Social Security Administration, the Internal Revenue Service and the Department of Homeland Security.

The company also developed an “identity management” tool used as part of a registration system that requires consumers to create password-protected accounts before buying health insurance on the federal exchange.

Did they build the part that Foos said was the original culprit or am I misremembering?

Yeah. Different article, but I thought I read the same thing.

"This company messed it up. But don't worry. We've hired a company to fix it. Spoiler alert! It's the same company."

 

[Mystery Achiever]

So, they picked QSS as the firm to oversee the fixes.

http://www.nytimes.com/2013/10/26/us/politics/general-contractor-named-to-fix-health-web-site.html?_r=0

Quality Software Services already performs several major roles in the federal insurance marketplace. It built a “data services hub,” or pipeline, that transmits data back and forth between federal and state insurance exchanges and federal agencies, including the Social Security Administration, the Internal Revenue Service and the Department of Homeland Security.

The company also developed an “identity management” tool used as part of a registration system that requires consumers to create password-protected accounts before buying health insurance on the federal exchange.

Did they build the part that Foos said was the original culprit or am I misremembering?

They are a unit of United Healthcare and apparently raised (unheeded) concerns along the way that there were problems. I didn't hear/read anything on the identity mgmt. issue.

"That contractor is UnitedHealth Group subsidiary QSSI, which has already built the site's federal data hub, a core function that unlike the rest of HealthCare.gov is said to be working as designed. QSSI's appointment is a clear slap in the face both to CGI Federal, which was the primary contractor in building HealthCare.gov..."

http://www.cnbc.com/id/101128768

 

[Ramsay Hunt Experience]

Just following up on my dispute over matty's interpretation of the AHIP white paper, here is AHIP itself on the importance of the link between reform measures and the individual mandate. AHIP opposes some elements of the ACA. It thinks that the ACA restricts age banding too much (a 60 year old can only be charged 3X a 25 year old under the ACA). But AHIP itself, the very group that commissioned the study posted, is clearly in favor of the mandate.

http://www.ahipcoverage.com/2013/10/25/what-they-are-saying-the-link-between-market-reforms-and-the-mandate/

This is a really obvious point with just a moment's reflection. It is true that the ACA allows some who generate higher health costs into the individual market. But it also compels (in theory, a stiffer penalty may be needed) many more healthy low heath care cost individuals into the market. Or to put it another way, the people who are bearing the biggest premium increases, are the people who weren't paying premiums before. The very people that we're upset at for not purchasing insurance before they got sick.

Which is why the CBO and just about every economist I've looked at predicts premiums to drop at comparable levels. There may be an overall individual premium raise reflecting higher benefit policies (which is what the CBO predicts), but that is a modest rise. Nothing like the absurd 80% or some other ridiculous number I"m seeing in this thread.. In Massachusetts, premiums (which are either the highest or second highest in the nation depending on what you look at, this is true) have dropped extensively EVEN while benefit levels have increased.

In any case, I've lost track of how many times the posted white paper mentioned that the problem with GI and Community Rating were that they didn't account for adding healthy customers to the insured pool. I just don't see how anyone can read that paper and come to the conclusion that matty is coming to.

I invite anyone to take a look at AHIP's survey of insurance plans from 2009. Take a look at the state premiums. Then play around on Kaiser's subsidy calculator. It's instructive. Because you'll begin to figure out what inputs are needed to really see any significant price increase. First, you need to be in the individual market. Then you almost need to be unsubsidized. I can play around a bit and make some young people in the 9.5% subsidy range maybe come out a bit over the 2009 premium, but it's almost impossible to see anything like a real rate increase until you hit the unsubsidized area. And because of the tighter age banding in the ACA a lot of that is eaten up for older people because they're only paying 3 times the young person's rate instead of 5 times.

 

[Foosball God]

So, they picked QSS as the firm to oversee the fixes.

http://www.nytimes.com/2013/10/26/us/politics/general-contractor-named-to-fix-health-web-site.html?_r=0

Quality Software Services already performs several major roles in the federal insurance marketplace. It built a “data services hub,” or pipeline, that transmits data back and forth between federal and state insurance exchanges and federal agencies, including the Social Security Administration, the Internal Revenue Service and the Department of Homeland Security.

The company also developed an “identity management” tool used as part of a registration system that requires consumers to create password-protected accounts before buying health insurance on the federal exchange.

Did they build the part that Foos said was the original culprit or am I misremembering?

Yes they did.

 

[SacramentoBob]

Is anyone going to report their experience getting insurance via the ACA?

 

[MaxThreshold]

Is anyone going to report their experience getting insurance via the ACA?

Check back at the end of November when the website goes live.

 

[matttyl]

Here's the ACA situation I was dealing with this morning. I have a current health insurance client who has had their policy only since October of 2010 (meaning they aren't "grandfathered" and need to change their plan). He's 58, she's 62. They bought the plan when he came off his previous employer's group plan, and they got average health rating on a plan with a $10k "family" deductible. There is no individual deductible as it's an HDHP, so they can hit that $10k by either one of them individually, or by each having $5k, or anything where they combine to hit $10k. They pay $493 a month for that plan, and very much like it as they also utilize a HSA for the "small stuff".

As noted above, they can not keep that plan in 2014, and at their renewal (October) will need to change it. He thought, though, that because they are older, ACA compliant plans would be less expensive than his current plan. That is not so, as the cheapest plan available to them next year would be $944 a month (and it's their only HSA compatible option) - and come with a $12k family deductible (which is obviously $2k more than they have now). If nothing else, that's $451 more per month, or over $5,400 more a year for this couple. Also note that rate is for if they start in January, it will likely be even more come next October.

Source - http://www.ehealthinsurance.com/ehi/ifp/individual-family-health-insurance!goToScreen?allid=eHe29411&referer=http%3A%2F%2Fwww.ehealthinsurance.com%2Fehi%2Fifp%2Findividual-family-health-insurance!goToScreen%3Fallid%3DeHe29411%26sourcePage%3D%26edit%3Dtrue%26ajax%3Dtrue%26screenName%3Dbest-sellers&sourcePage=&edit=true&ajax=true&screenName=best-sellers

Now, as for a subsidy, that's where it gets interesting. He's a small business owner, so he doesn't fully know what he'll make in 2013, much less how to answer the question of what he'll make in 2014 (which is what a subsidy is based on). I pointed him to the KFF subsidy calculator. If they make $62k total next year, they are subsidy eligible for about $7,700 - knocking the cost down to $5,890 (which would still be higher than what he's paying now, but not by much).

Source - http://kff.org/interactive/subsidy-calculator/#state=va&zip=22030&income-type=dollars&income=62000&employer-coverage=0&people=2&alternate-plan-family=individual&adult-count=2&adults%5B0%5D%5Bage%5D=58&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=61&adults%5B1%5D%5Btobacco%5D=0&child-count=0&child-tobacco=0

If, however, he makes just $100 more - or $62,100 in 2014, his subsidy would be $0. Leaving him to pay the full price of whatever plan he picks - which for the "2nd cheapest silver plan" would be 21.87% of his income.

Source - http://kff.org/interactive/subsidy-calculator/#state=va&zip=22030&income-type=dollars&income=62100&employer-coverage=0&people=2&alternate-plan-family=individual&adult-count=2&adults%5B0%5D%5Bage%5D=58&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=61&adults%5B1%5D%5Btobacco%5D=0&child-count=0&child-tobacco=0

That absolutely floored him - and he told me flat out that he'd just drop his coverage all together because they can't afford to potentially pay 21.87% of his income for coverage. I can't say that I blame him. Also, if he says that he'll earn $62k or less, and get that subsidy of ~$7,700 a month, but then when he files he actually made $62,100 or more - he'll owe all that money back that he was subsidized. Yeah, that will go over well.

If this doesn't help a couple age 58 and 62....who does it help? As I said before, all this will do is lead to a whole new group of people who are going to be uninsured because they can't afford these new higher prices for "ACA compliant" plans.

 

[Black Box]

So, they picked QSS as the firm to oversee the fixes.

http://www.nytimes.com/2013/10/26/us/politics/general-contractor-named-to-fix-health-web-site.html?_r=0

Quality Software Services already performs several major roles in the federal insurance marketplace. It built a “data services hub,” or pipeline, that transmits data back and forth between federal and state insurance exchanges and federal agencies, including the Social Security Administration, the Internal Revenue Service and the Department of Homeland Security.

The company also developed an “identity management” tool used as part of a registration system that requires consumers to create password-protected accounts before buying health insurance on the federal exchange.

Did they build the part that Foos said was the original culprit or am I misremembering?

Yes they did.

Oof.

 

[BassNBrew]

Well I still can't shop for a plan. I called the marketplace (and while they are good at answering the phone) they don't have any answers other than try again during non-peak times or log out and log back in, call us again if that doesn't work. When I asked if anyone had been able to enroll in a plan that lives in NC, she couldn't answer. She did say the goods news is that I'm one of the few people who have been accepted and gotten this far.

6 weeks and I'll be going for the ranks of the insured to the uninsured. If my ex- wife takes me to court for not having coverage for our son, can I subpoena Obama to the hearing or can he claim executive priviledge?

 

[matttyl]

Well I still can't shop for a plan. I called the marketplace (and while they are good at answering the phone) they don't have any answers other than try again during non-peak times or log out and log back in, call us again if that doesn't work. When I asked if anyone had been able to enroll in a plan that lives in NC, she couldn't answer. She did say the goods news is that I'm one of the few people who have been accepted and gotten this far.

6 weeks and I'll be going for the ranks of the insured to the uninsured. If my ex- wife takes me to court for not having coverage for our son, can I subpoena Obama to the hearing or can he claim executive priviledge?

I'm actually interested in this answer. Lots of people are "forced" by the courts to obtain coverage for children, or ex spouses. People have been promised the ability to obtain health insurance come 1/1/14. If they can't, who's to blame? What happens if someone gets in a car wreck on their way home from a New Year's party on some icy road and the coverage hasn't gone through the system yet? Can they hold someone liable?

 

[BassNBrew]

Trying at odd hours as suggested.

30 mins ago - Error

System error. Please re-try your action. If you continue to get this error, please contact the Administrator.

Now - Enrollment incompete, resume enrollment <click>...You are not enrolled yet. Work at your own pace (LOL). Review your application details <click>...Back to the first screen, Enrollment incomplete, resume enrollment.

29 days down, 46 to go.

 

[Jojo the circus boy]

Trying at odd hours as suggested.

30 mins ago - Error

System error. Please re-try your action. If you continue to get this error, please contact the Administrator.

Now - Enrollment incompete, resume enrollment <click>...You are not enrolled yet. Work at your own pace (LOL). Review your application details <click>...Back to the first screen, Enrollment incomplete, resume enrollment.

29 days down, 46 to go.

I've had the best luck at like 5 or 6AM EST. When you try it now, you are still competing with Left Coast clicks.