OBAMA/TRUMPCARE MEGATHREAD

[StrangeSox]

Right, now the "catastrophic" plans have high premiums too.

 

f*** you, healthy young people.

Now the "catastrophic" plans don't exist because of the mandatory minimum coverage regulations.

 

Again, this is deliberately and explicitly how the bill was structured and written. Low-premium, questionably-useful catastrophic plans go away and everyone is mandated to be covered by a plan that meets the mandatory minimum. For an overwhelming majority of people, this will be essentially unchanged as their employer-provided plans or their Medicare/Medicaid/VA plans already meet the mandatory minimums or will need minor changes. Premiums change for plans every year, so more analysis would need to be done to show that, on aggregate, Obamacare is driving up premiums for already-conforming plans.

 

The goal was to get coverage expanded using 1) Medicaid expansion, which was seriously gutted by the SC decision and then the decisions by many state governors to reject the expansion and 2) creating community rating plans with no pre-existing condition exclusions with premium supports while expanding the insurance policy buyer pool with the mandate such that many currently healthy people who would otherwise go without will now be buying plans (or paying the penalty).

 

Obama's rhetoric in speeches may have been dishonest, misleading or understating the potential impact ("if you like your plan, you can keep it" really would need several caveats to be accurate), but the elimination of catastrophic plans and the expansion of the insurance pool to include more young, healthy people was the central premise of how non-Medicaid coverage was going to be expanded. They wanted to work with market-based solutions in the current insurance market with a few significant changes (pre-existing, lifetime caps, community ratings) and this is about the only way to go about it. There were other, more-progressive and likely much better choices out there, but this is the path that was chosen and it is an improvement over the pre-ACA system, though that's a pretty low hurdle.

[Jenksismyhero]

It makes no sense to me that a health young person who doesn't use health care as often needs to pay MORE for coverage. If anything, they should pay the least amount out of anyone.

[Soxbadger]

They are notoriously the weakest voting block, of course it makes sense.

 

Politicians are in the business of being re-elected, not fixing problems.

[illinilaw08]

It makes no sense to me that a health young person who doesn't use health care as often needs to pay MORE for coverage. If anything, they should pay the least amount out of anyone.

 

They still do pay the least. They just pay more than before so others pay less.

 

The ACA changes are hitting my pocketbook as well (I will miss catastrophe plans...), but I agree with SS that the new system is a better system than pre-ACA healthcare. I would have preferred single payor to the ACA but that's not happening any time soon.

[StrangeSox]

It makes no sense to me that a health young person who doesn't use health care as often needs to pay MORE for coverage. If anything, they should pay the least amount out of anyone.

Community rating. Individual underwriting is eliminated.

 

eta: to expand on that and what illini said above, people within the same geographical area and age group are given a "community rating" and must be offered the same price for an insurance plan regardless of any pre-existing conditions (with notable exceptions, like using tobacco). So a young person is going to pay less than an older person for the same plan, but a 24yo person with chronic asthma and a couple of other previous health issues will pay the same price as some 24yo who's never been sick in their life. That healthy 24yo is going to pay more so that the sick can pay less. But the idea is that there are many, many more healthy people than there are sick people who will be added to the insurance risk pools, so the cost of one sick person is spread out over many healthy people. Again, this is the explicit design of the program from day 1, not any sort of surprise. I'll turn it over to the healthcare/economics blog, The Incidental Economist:

 

http://theincidentaleconomist.com/wordpres...al-mandate-too/

 

On the other hand, I don’t care how many times you email me or tweet me to say that President Obama “lied” when he said you could keep your plan if you like it. I immediately recognized that was untrue when he said it. I called him out on that. I did that because I thought it was important to highlight the policy of the ACA and explain that there were many mini-med plans and the like that were going away no matter how much people liked them. And then I moved on. Austin recently wrote on how it was indefensible again.

 

This “mistake” is on the administration, not the policy. It’s how the ACA was supposed to function, and it’s unfortunate that the President got it wrong. But that’s on the people who said it, not the ACA. If there are any members of Congress who voted for the law because they believed that to be true, then they have a gripe. If there are any voters who voted for the President because they believed that to be true, then they have a gripe. Everyone else wouldn’t have changed their behavior much. Could they hate (or love) the law more?

 

 

http://theincidentaleconomist.com/wordpres...-obama-edition/

 

Let’s start with “if you like your plan you can keep it.” This is never, uniformly true. Plans change every year, even in the years before Obamacare was conceived. The truth is, if you like your plan, there’s a good chance it will change. That’s just as true, if not more so, under Obamacare. I do not endorse or defend this statement.

 

What Obama might have more plausibly have said is that Obamacare makes only minor or modest changes to coverage for the vast majority of Americans. Where it makes the biggest change is for the minority of Americans who cannot obtain affordable coverage today. That I could defend, though I am sure others would still contest it.

 

Next, what about family premiums falling by $2,500? Sorry, no. OK, maybe — maybe maybe — adjusted for benefits, accounting for subsidies, and relative to the counterfactual trend, it might, possibly be true. But this is not how most reasonable Americans would interpret the statement. What’s true is that, in absolute terms, health care gets more expensive every year. Bending the cost curve is not reducing the absolute level of cost. And it remains to be seen if and how much Obamacare will bend that curve. I do not endorse or defend this statement.

 

What Obama might have said is that health plans will offer more benefits with fewer loopholes. Though this is not costless, costs will be shared in an equitable manner, with subsidies for low-income individuals and higher taxes for those who can afford them. Meanwhile, the law will attempt to slow the growth of health costs, but more is likely needed on that front. That I could defend, though I am sure others would still contest it.

 

Obama said some foolish things. That does not mean I, as a supporter of the law (with acknowledgement of its trade-offs and limitations) need to accept them. Nor do you. Let’s debate things we actually disagree about, not waste time arguing over silly things we both should reject. Meanwhile, President Obama and his surrogates, please stop saying these things. They sound foolish because, under reasonable interpretations, they are.

 

 

Edited October 30, 2013 by StrangeSox

[CrimsonWeltall]

Now the "catastrophic" plans don't exist because of the mandatory minimum coverage regulations.

 

They do still exist, just with some qualifications: https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

 

For me, one of these catastrophic plans costs nearly double what my old plan (roughly silver level) was costing. So, I can pay way more to get way less.

 

Again, this is deliberately and explicitly how the bill was structured and written. Low-premium, questionably-useful catastrophic plans go away

 

And so have many low-premium, very useful plans.

[StrangeSox]

So, if those low-premium, useful plans met the minimum requirements (or were very close, only requiring minor changes), why are the insurance companies no long offering them? It's a legitimate question.

[Jenksismyhero]

So, if those low-premium, useful plans met the minimum requirements (or were very close, only requiring minor changes), why are the insurance companies no long offering them? It's a legitimate question.

 

Probably so they can afford to pay the costs of people with pre-existing stuff. I'm sure it has to do with their bottom line.

[StrangeSox]

Probably so they can afford to pay the costs of people with pre-existing stuff. I'm sure it has to do with their bottom line.

If those plans were profitable before, then the only reason to cancel them would be to push people into even-more-profitable plans using the mandate as leverage.

[Jenksismyhero]

If those plans were profitable before, then the only reason to cancel them would be to push people into even-more-profitable plans using the mandate as leverage.

 

But the even-more-profitable-plans might be to offset the costs of adding in the mid-20's crowd and people with pre-existing conditions. My understanding is the insurance game is pretty competitive. There are a number of big companies out there that want an employer to do business with them. I doubt they just raise prices and/or change coverage just to make more money. In principle anyway. I'm sure they do to offset new costs or recoup losses from a prior year.

[StrangeSox]

They're going to try to maximize profits at all times--that's their job. Whether or not that have to offset new costs (community rating, guaranteed issue) or not, I don't see why they wouldn't go with the business model that pushes more people into higher-profit products. This shift could easily be a result of the incentives from Obamacare (individual mandate, new coverage minimums), but they're always going to try to have the highest possible prices with the lowest possible expenditures. Every business trying to turn a profit does that.

 

Adding in the (mostly healthy) mid-20's crowd isn't an additional cost, it's the big windfall that's supposed to allow these companies to remain profitable (or in the case of 'non-profits,' still make enough money to pay their staff as if they were for-profit).

 

If you want to expand coverage to people with pre-existing conditions and go with community ratings so that it's reasonably affordable for them while still working within the existing US health insurance market, I don't see a good way around what the ACA is basically trying to do.

[CrimsonWeltall]

So, if those low-premium, useful plans met the minimum requirements (or were very close, only requiring minor changes), why are the insurance companies no long offering them? It's a legitimate question.

 

Because now they're stuck insuring unhealthy customers that they're going to take a loss on. They have to offset that somehow.

[StrangeSox]

Because now they're stuck insuring unhealthy customers that they're going to take a loss on. They have to offset that somehow.

 

But they can only do that because they have the leverage of the mandate, right? Otherwise, why wouldn't they be selling you the more-expensive plan before? Taking on more losses might be a motivator to really try to maximize your profitability, but BCBS wasn't sitting around not investigating how to maximize their market share and profits prior to community rating/guaranteed issue. They just didn't have the leverage/excuse to drop these less-profitable plans and only offer the more-profitable plans without all of the substantial changes in the market going on over the next couple of months.

[StrangeSox]

By the way, I think this just continues to demonstrate why relying on private insurance to ensure health care access to every American (if you agree with that goal) is a really clumsy and inefficient way to do it, and that at a minimum some sort of public option if not single-payer would have been a much easier solution.

[StrangeSox]

Also, if anybody is curious about dynamics of COBRA insurance and how the ACA may affect that whole market, this was posted at another forum by someone who works in the insurance industry:

 

In most states, there is some degree of declination available in the individual market. So if an individual applies, and has a health condition the company doesn't want to be responsible for, the company can basically say "get f***ed" and refuse to sell them a policy*.

 

COBRA is required at the federal level to be offered to employees leaving an employer sponsored health insurance plan for qualifying reasons (I'm not sure what all the reasons are). I believe, but am not certain, that you are charged the full amount that the employer pays for your coverage - both your contribution and what the employer would have paid had you still been employed.

 

*Most* of the time, employer coverage is more generous in coverage than what you find in the private market. Even if it isn't, depending on your company, there are often other services rolled into their price - reporting from the insurer to the employer on their overall performance, special handling of claims, and other special stuff that large employers get that individuals don't care about most of the time. Additionally, large employers are often experience rated, so if they've got unusually healthy people their costs will we lower, and if they've got unusually sick people their costs will be higher. On average, employer groups tend to have members that are sicker than the individual market. The end result is usually that the cost-per-person for employer coverage is higher than it is in the private market.

 

At this point, it becomes something of a game-theory problem. If the employee or someone in their family is ill, or needs medical care, they're less likely to apply for private insurance because they believe they will be declined. Is they are healthy, they are more likely to apply, because they believe they will be accepted. So for the most part, the only people who take COBRA are those who believe they will be unable to get private coverage.

 

Since the people who elect COBRA over private insurance contribute to the experience of the employer group, there's a bit of a cycle. If the majority of people who stay on COBRA are sicker than the average employee, then they end up driving up the risk level of the whole group... which affects the price that the employer pays, and in turn increases the cost of the COBRA plan. Since the people who decline COBRA coverage tend to be healthier people, their leaving removes some healthier people from the pool that the employer has, and puts them into the private market instead (adding to the overall healthiness of the private market).

 

This contributes to the divide in cost between employer coverage and private coverage. Of course, if you're actively employed, you don't usually see the whole cost. Most employers, especially larger ones, contribute a fair bit toward that cost, and the employees are only responsible for a small bit of it.

 

Of course, this dynamic will change with ACA. Since nobody can be declined coverage in the private market, most people won't take COBRA (assuming they have at least a decent HR person to explain some of this crap to them). They'll go straight into the private market, where the costs are probably lower, and where they might have access to a subsidy. Over time, this will probably lead to the average cost per person being much closer in the two risk pools, although there will probably still be some differences due to different kinds of administrative services for employers.

 

Given enough time, and ignoring all the other factors that influence it, it should theoretically result in the private market prices being higher than they are today, and the employer market prices being lower. Not necessarily a great thing, if your employer contributes a lot to your coverage, as it will make it seem as if the private market is a LOT more expensive than employer coverage. But there are a huge number of moving parts in this ball game... and lots of political issues involved... so who knows where it will eventually end up.

[CrimsonWeltall]

But they can only do that because they have the leverage of the mandate, right? Otherwise, why wouldn't they be selling you the more-expensive plan before? Taking on more losses might be a motivator to really try to maximize your profitability, but BCBS wasn't sitting around not investigating how to maximize their market share and profits prior to community rating/guaranteed issue. They just didn't have the leverage/excuse to drop these less-profitable plans and only offer the more-profitable plans without all of the substantial changes in the market going on over the next couple of months.

 

They didn't have any leverage because I would have switched to another insurer if they had arbitrarily quadrupled my rate. Now, every insurer is facing new costs and jacking up their prices accordingly. I can't bolt to someone else.

[Cknolls]

The website has never crashed. Lol you mutant..

[Y2HH]

Health insurance is also a very low profit margin business, contrary to popular belief.

[Jake]

I hope people begin to see that healthcare should be universally available, which would make a single payer system the main alternative for reform. My main fear about single payer is that we'll entrust it to the state governments like Canada has, which would be a grave mistake. No Republican governor would ever run something with so much cost in a way that doesn't screw poor people while the Rs that don't intentionally screw the poor along with the Ds will mismanage it to hell anyway. It needs federal oversight and, more importantly, uniform policies, protections, and services

Edited October 31, 2013 by Jake

[StrangeSox]

The website has never crashed. Lol you mutant..

so does anyone know what this post is referring to?

[Jenksismyhero]

so does anyone know what this post is referring to?

 

http://news.yahoo.com/healthcare-gov-suffe...-181641521.html

 

Sebelius testified that the site had never crashed, and at the exact same time she was testifying the system crashed. I have to believe it has "crashed" before too. It was a dumb thing to say. Add it to the list.

[StrangeSox]

Fox News’ Greta Van Susteren Out-Journalisms CBS News on Florida Woman’s Junk Insurance

 

I think every story I've seen with actual details about the plans and premiums so far has ended up exactly like this.

 

“Your $54 a month policy is a pretty, you know, bare bones policy, “Greta said. “Why do you want to keep that one, except for the price? Maybe you can get something better with a subsidy?”

 

“Well, I know it doesn’t cover lengthy hospital stays,” Barrette replied, adding “It’s perfect for what I want. I get co-pays for doctor visits and prescriptions. So it suffices what I need. Also, the price isn’t too bad either.”

 

Her $54 plan actually doesn’t have copays for doctor visits and prescriptions. It pays $50 toward covered doctor’s visits, Dianne pays the rest, and $15 toward prescriptions, Dianne pays the rest. As for hospitalization, Greta again went where CBS did not, and actually asked about it.

 

“Well, does it pay for any hospitalization, the current policy you have?” Greta asked.

 

“Again, I’m a little confused about it,” Barrette answered. “I have been reading over and over the policies, and it appears that it does cover some outpatient, but when you go through the booklet they sent, it would say refer to this, refer to it but then refer back to… it was very confusing.”

 

Actually, it doesn’t cover any hospital stays, unless Dianne suffers complications from pregnancy. Then, it pays fifty bucks. It doesn’t cover any outpatient care, except for mammography, osteoporosis screening, diabetes self-management, and complications from pregnancy. For that handful of services, the plan pays $50, and Dianne pays the rest.

Edited October 31, 2013 by StrangeSox

[Jenksismyhero]

They didn't have any leverage because I would have switched to another insurer if they had arbitrarily quadrupled my rate. Now, every insurer is facing new costs and jacking up their prices accordingly. I can't bolt to someone else.

 

This. SS I'm not sure how you're not seeing this. My wife's health insurance has changed companies I think three times in the last 6-7 years. CIGNA, AETNA and BCBS. And luckily the costs have been roughly the same each year, which means someone in their HR department calls around every year to get the best price. Now all the insurance companies can jack up the prices and blame it on these requirements. Before they had to operate within that fine line that the market would tolerate.

 

 

[Jake]

Yikes. She'd be f***ed if she ever wanted to see a doctor or actually got sick. I take a medicine that is $400/month without insurance; I'd never get by on something like that.

[StrangeSox]

This. SS I'm not sure how you're not seeing this. My wife's health insurance has changed companies I think three times in the last 6-7 years. CIGNA, AETNA and BCBS. And luckily the costs have been roughly the same each year, which means someone in their HR department calls around every year to get the best price. Now all the insurance companies can jack up the prices and blame it on these requirements. Before they had to operate within that fine line that the market would tolerate.

No, not "this." Are you really under the impression that health insurance premiums have, in aggregate, held steady over the past 6-7 years? People have been seeing substantial yearly increases (5-15% or more) for a while now. If insurance companies are using ACA as an excuse to extract even more rents from the rest of the economy, well, that's even more damning evidence against their existence.

 

 

edit: steadily increasing health care costs are a major impetus behind the PPACA in the first place. Now, it will be interesting to see what happens with prices over the next several years (though I think we've already started to see a reduction in premium increases in the last few years?), and it could very well be that Obamacare is a poorly designed policy. And, undoubtedly, some portion of people are going to be stuck paying more for "better" plans that they won't actually use because they won't need healthcare. But, really, every story I've seen that's had even a minimal amount of detail, with the exception of Crimon's claimed cost increases, has turned out to be vastly overstated or just ridiculously incorrect.

 

edit2: as a kicker, my premiums for my pretty awesome, relatively inexpensive plan are dropping by 1% this year! Obamacare works!!!

Edited October 31, 2013 by StrangeSox