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Obamacare: Obama just straight up lied to you, in your face (4 Viewers)
- Thread starter tommyboy
- Start date
Bottomfeeder Sports
Footballguy
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 issue
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.
The Commish
Footballguy
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 issue
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.
matttyl
Footballguy
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 issue
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.
matttyl
Footballguy
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.
MaxThreshold
Footballguy
timschochet
Footballguy
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"?
BassNBrew
Footballguy
Yes they can do whatever they want. They did in the first place to allow the penalty to stand.
I suspect they will give Congress a 1.5 year window to fix the wording if they strike down the subsidies. That said, I think that's very unlikely to happen. They are going to create chaos that cripples the country and will rule that a typo isn't a reason to strike down legislation.
BassNBrew
Footballguy
BassNBrew
Footballguy
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.
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.
tommyGunZ
Footballguy
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,
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matttyl
Footballguy
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.
The Commish
Footballguy
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.
Democrats screwed the pooch and weren't ballsy enough to go with Obama's plan of a federal insurance plan, so here we are. The point where we have to deal with garbage because politicians chose their jobs over what was right for the country.
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matttyl
Footballguy
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:
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.
BassNBrew
Footballguy
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?
If I could design a plan from the get go I'd probably go back to the old way and add a single payer plan for anyone who like to be involved and base the premium on income. The poor would get free health care paid for by everyone. The insurance companies could set rates and allow membership based on whatever they thought would make them competitive. The guy with a chronic disease that makes $100k would pay a higher premium in the single payer guarantee issue plan, but his expenses wouldn't pollute the insurance company pool.
Bottomfeeder Sports
Footballguy
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).
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.
The Commish
Footballguy
I love that matttyl is determined to get wine out of a rock.
The Commish
Footballguy
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?
Bottomfeeder Sports
Footballguy
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.
Bottomfeeder Sports
Footballguy
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!
The Commish
Footballguy
tommyGunZ
Footballguy
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.
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.
The Commish
Footballguy
matttyl, you're swimming upstream my friend....better to have these conversations with BFS and the like.
matttyl
Footballguy
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?
Bottomfeeder Sports
Footballguy
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).
tommyGunZ
Footballguy
Agreed. BFS has far more patience than I do at this point.
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.
Bottomfeeder Sports
Footballguy
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
Footballguy
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.
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?!).
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BassNBrew
Footballguy
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.
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.
BassNBrew
Footballguy
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.
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?!).
matttyl
Footballguy
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.
BassNBrew
Footballguy
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.
BassNBrew
Footballguy
It was much cheaper the the individual plan I bought after the benefit expired.
The reason COBRA "didn't work" is because when you actually have to pay the real cost of insurance rather than the subsidized cost, you realize it's expensive. When you've likely been coddled your whole life and someone else is usually footing the bill for most of your instance cost you don't have a clue as to how things work in the real world.
tommyGunZ
Footballguy
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.
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.
The Commish
Footballguy
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.
snogger
Footballguy
Tommy.. The issue is you ask for links, we provide said links and we either get 
or .. Not a trusted source..
If the Under-insured rate is not a concern for you.. Then good for you..
Hope you and/or your family never need a 10K+ surgery..
Or maybe a Total Out of Pocket cost of 10k isn't a big deal to you..
or .. Not a trusted source..If the Under-insured rate is not a concern for you.. Then good for you..
Hope you and/or your family never need a 10K+ surgery..
Or maybe a Total Out of Pocket cost of 10k isn't a big deal to you..
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The Commish
Footballguy
What is it you believe you've "tried" exactly?Agreed. BFS has far more patience than I do at this point.
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.
Foosball God
Foos
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.
Bottomfeeder Sports
Footballguy
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'd guess that Small Groups would be the most vulnerable to being unsuspectingly caught in the Cadillac Tax. My very large company has several people that do nothing but work on planning and implementation and coordinating with the administrators of the health coverage options. So they have been planning on the Cadillac Tax for 5 years already making plan design tweaks to avoid or minimize the impact. A small business doesn't have that luxury and I could imagine quite a few designing plans in such a way that the "premium" is under the limit, but the total pretax health care goes over.
I'd think that your small group customers are going to be very dependent on you navigating them through this mine field and that how well agents do will dictate how the news cycles are at that time. I'd think that most economist would count it as an ACA success story if this revenue measure is a total bust at collecting actual revenue as the resulting behavioral change of not running to the doctor for every little thing is also costly. Or, not medically recommended yet alone necessary types of stuff that these plans cover.
Minor Example- Sports medicine has been a big thing this decade in part due to the breaking down of athletic 50 year olds with better than good insurance able to demand surgeries to fix things where a few months rest is actually the medically preferable treatment.
timschochet
Footballguy
I hope you don't leave the thread, tommy. Big fan.
The Commish
Footballguy
snogger
Footballguy
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.
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.
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matttyl
Footballguy
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.
To this point, I don't think that anyone can really make the argument that the ACA has been good for that market overall. Sure there have been winners and losers - but when we look at the overall numbers the average premium has gone up, and will continue to do so (even BFS readily agrees with this as they are still below employer sponsored plan averages). Yes, the new proposals are only that - proposals, but they are also based on actual facts and claims from the market itself - and they are large. You know as well as I do that if they were smaller, you'd be the first one here saying how well the law is working. Well that isn't the case.
I try to have intelligent conversations with you about these topics, and you fail time and time again to bring any real substance to any of it. I've asked you repeatedly to explain yourself about COBRA, and you haven't. I've done the same with other topics of the law and it's implementation and get nothing from you - and the same experience has happened to others here. I'd love to continue to have a conversation about these topics with you here, I really would, but that would require you actually bringing something to the discussion, which you haven't for quite a while.
Bottomfeeder Sports
Footballguy
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.
I don't know where Tommy actually works and I'm not allowed to say where I work, but my guess is that my workplaces pool is at least as dirty as the ACA's. This is because I think there are many more people that have chronic health conditions that keep jobs for the insurance at such employers than there are those that brave going it alone. The ACA will hopefully help with this over time. But the $25K family plans is also because in my case having a rich health plan differentiates my employer from the competition in the positions that are the hardest to recruit talent.
As for "skimming" I've always suspected that large self insured companies inflated the numbers some for tax purposes.
Tau837
Footballguy
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.
I also used it at least one other time when changing jobs. It has worked out great for us.
matttyl
Footballguy
Yup. That's why I thought it was funny when Michigan requested a 10.0% increase, and another state was right at 9.8%.
Tau837
Footballguy
What is it you believe you've "tried" exactly?Agreed. BFS has far more patience than I do at this point.
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.
matttyl
Footballguy
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.
Bottomfeeder Sports
Footballguy
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.
For the individual market it is really a totally new market in many ways. Sure there are those that had long term plans in the past that had their world's changed some a lot. So changes here are expected.
Gotta run.
matttyl
Footballguy
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.
Lets say that happened with your large employer group - how would it go down? The younger and healthier people (who typically have very small or no medical claims) will choose the cheapest plan, and thus the carrier will get the least amount of premium from them - or they would choose to go without coverage all together (until they need it). The older and not so healthy people would all pick the plans with the largest benefits, lowest co-pays, largest networks, and largest drug formularies. True, the carriers are getting more premium money from them, but likely not enough to cover their larger than average claims in return. If they get fixed whatever the need to get fixed (as evidenced from the large number of knee replacements in the ACA individual pools), they can then choose to move to a cheaper plan afterwards.
What I mean is that when each individual makes a plan choice for themselves, it can really negatively affect the entire pool of insured. Example - I have quite a few family clients were only one member has large medical claims. So that one member buys themselves a "gold" or "platinum" plan with the greatest benefits, and the rest of the family who doesn't have large medical claims goes with a Bronze plan. You know those pregnant ladies that I moved to ACA plans last year so they could have maternity coverage? They all picked gold plans knowing they would have a large claim (the delivery). All 3 moved back to bronze plans for the balance of 2015 (still has upfront well-baby care). I just can't see this working out well over the long term when those are the "rules of the pool".
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