Politics Obamacare

The graphic is very pretty, but fails to prove your point.

 

Putting comparisons aside, the most important point is that the cost of the plans on the Exchanges are coming in lower than projected.

 

If you dont qualify a subsidy, it probably wont work for you.

 

I have read CBO reports, they are all based on assumptions - at least they tend to outline thier assumptions. I have not read the PWC report, only what you cited. The flaws I pointed out are correct - at the very least PWC and the author of what you cited needed to outline the flaws in what they are reporting. The comparisons like those you often cite are inherently incorrect. The basis of insurance premiums are costs. At best we should consider current ACA premiums as estimates - if low at some point in time actual costs will be a factor. It is possible to have initial premiums that are inaccurate and artificially low - this is what I suspect. Do you suspect the current premiums are right on target or high?

One reason I like anecdotal information is to compare it to various studies. Regarding Medicare Advantage or Medigap Plans we can look at real world results over time and actually verify if the Heritage Foundation is correct. In some studies, like the PWC study comparing an average of options to an average of actual selections, we can never verify the truth without doing a separate independent study. But, the short answer is, yes there are virtually always flaws - honest requires an acknowledgement and understanding of those flaws.
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Not sure I understand your point here or how it contradicts what I wrote. 2 in 10 select Bronze, that is relatively low compared to 6 in 10 selecting silver. Based on my review of what was available to me, I am not sure why anyone would select a Bronze plan, given uncertainty, I do not see how the Bronze plan will be cost effective considering, premiums, co-pays, deductibles and other costs compared to Silver. For a bit more premium the benefits are far greater with Silver. If I were to do comparisons I would base them on Silver Plans as a baseline. Either way making the selection is not an easy one, because of the challenges in comparing not only the premiums but the other cost factors.
--- merged: Jan 31, 2014 at 6:23 PM ---

Costs or premiums? We are certainly sophisticated enough to know that business/government/any entity can establish initial low prices/premiums knowing big adjustment can be made later. Meaning initial prices/premiums are held artificially low to serve a purpose of some kind. I wonder what would the motivations there are with the ACA to keep initial premiums low outside of honest miscalculations? If costs are actually going to go down I would be optimistic regarding lower premiums. My fear is that in 2015 either the government will pay large sums to cover insurance company losses or premiums will go up dramatically. This thread may be around in a year, it will be interesting to revisit it.

Normally it is illegal for insurance companies to collude on premiums - is it illegal if insurance companies collude with government on premiums? Probably not. I would love to see reporting on how ACA initial premiums were determined - there should be actuarial data. I wonder if government official told insurance carriers to come in at a certain range of premiums for the various plans? Perhaps we need a study.

 

Ace...the difference between the PWC study and Heritage studies is that the former is based on real data of actual costs of plans in the Exchanges as opposed to projections by Heritage using a model based solely on a most expensive outcome. At least the CBO, when it projects, uses three or more different scenarios, the difference being that CBO has no agenda and Heritage does.

And as to anecdotes, another recent one, from the Republican response to Obama's State of the Union, citing a huge increase in cost to an individual whose plan was dropped, was immediately debunked by multiple sources.

The bottom line is the ACA is working, not as well it could or should, but far better than you, Sarah "death panels" Palin, the Heritage Foundation and Republican members of Congress are suggesting with their biased studies and faulty/debunked anecdotes.

As I noted before, the country would be better served if the anti-ACA crowd would take a more constructive approach to make the law better rather than to continue to demagogue it with baseless misrepresentations and faulty studies with an agenda.

But I dont expect you are interested in offering anything constructive to improve the law so carry on as a self-described extremists if it makes you feel better.
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This is a good article on Where Obamacare is Succeeding...and Where it is Falling Short.

Unfortunately, in red states with the highest level of uninsured, the political leaders are more interested in playing politics than addressing the problem.

 

The irony of The Heritage Foundation making doomsday predictions is that the ACA was The Heritage Foundation's idea to start with:



They only started hating it when a Democrat decided to support it.

 

I agree that ACA opponents will spin it like that...the ACA causing job losses.

But that would not be correct. The CBO explicitly states that, “[t]he estimated reduction [in labor] stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor.”

The ACA will in fact give millions of people, particularly those looking for early retirement (before Medicare eligibility), with options for affordable insurance.

That might be me in 10 years.
--- merged: Feb 4, 2014 at 5:55 PM ---
Other findings from the CBO report:

• Current Insurance Exchange premiums are actually 15 percent cheaper than it predicted last year.
• The "risk corridors" or re-insurance that opponents misrepresent as a bailout for insurance companies would save taxpayers $8 billion over the next 10 years. But, Republicans may still hold the next round of debt limit extension hostage until the risk corridor provisions are repealed.

 

I know what it is like to leave a job with health insurance and go into the individual market - many people are unwilling or unable to take the risk for fear of losing coverage and are locked into jobs they may not want. I also know what it is like to leave the individual market in one state and obtain coverage in another state. Again, many people are unwilling or unable to take the risk for fear of losing coverage. This has been a major problem in the health insurance market, especially for people between about 40 and 65. We needed a fix. I supported market based solutions including allowing the purchase of health insurance across state lines and provisions of transferring coverage from employer based plans to individual plans with no penalty.

Here, with the ACA the issue to me is who pays for people having the luxury of forgoing available insurance for the opportunity to reduce hours, change jobs, move from one state to another, or dropping out of the work force. I think it is wrong for a middle aged adults to be subsidized, in particular, in any way by young tax paying/premium paying working people.

How does this work - I want to do oil paintings on the beach - can you young folks pay for my health insurance? Perhaps I can give you a discount - I will plan on selling my stuff at the Santa Barbara art shows on the weekends. If this Obamacare works out give me about a year - look for the dude the locals call Ace.

Santa Barbara Arts and Craft Show

 

Maybe I'm misunderstanding, but isn't all commercial healthcare for people who need it 'subsidized' by the people who don't? I usually just watch this thread and learn from those of you who have more knowledge than me debating back and forth. But it seems to me that any insurance company would fail if the only patients they carried were those that were consistently ill. I'm not seeing what you mean by younger, healthier people subsidizing those who are older or need more care. Could you explain please.

 

I find it a bit two-faced that conservatives who bitch about "job lock" and "freedom of choice" immediately starting whining (and lying) about the fact that the CBO report stated that the ACA, in effect, provides an out from said job lock and more choices w/o facing concerns of affordable health care.
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Mission accomplished with ACA.

 

The issue is that people like my Aunt who lost her job @ 60 will be covered by the state's medicaid expansion now, instead of going without insurance. She doesn't have much money or assets. I think there might be a few guys at my job who will choose to retire a few years early since they have plenty of money, yet will be able to get health insurance outside of the company until they qualify for Medicare.

Now, the problem to the greater economy and something that is both good and bad is that abled bodied people don't have to work at a job to be able to get decent healthcare. They can take years off in-between jobs if they have big savings accounts. They can start their own businesses or just not be quite as desperate to find a new job after losing one if they have savings. Or at least they won't have to worry about getting sick or having an accident while in between jobs and getting hit with a big bill. Now, how likely this situation will happen is another question. I don't think there are too many people out there like that, but it could be close to 0.5%-0.75% of the population.

 

I'm not sure I'm seeing the bad.

 

Generally insurance is rated based on risk exposures. Premiums are based on actuarial modeling based on characteristics of rating groups. Life insurance is the easiest way to visualize this - a male, non-smoker of a specific age has a expected life span - actual life span may be different. The policy premium is going to be based on the risk exposure based on actuarial modeling. If the person buys $100,000 of life insurance, the net present value of the stream of premiums would be equal to $100,000 less admin costs and profits. In theory the person will actually pay $100,000 in premiums for $100,000 in insurance coverage - in order to make this work in a low risk manner large numbers of insureds are required for each rating group. If one individual pays less or more, in a free market the insurance company absorbs the costs or benefits. If premiums are too high, smart shoppers will obtain coverage at a lower premium from other companies. If premiums are too low the insurer risks going out of business - regulators review rates and modeling to protect against this

The ACA attempts to manage premiums so that no group pays what some would consider too much. If as a group people 25 years old have actual medical costs of a baseline of 100. People 50 have an actual medical cost baseline of 200. People 60 have an actual medical cost baseline of 400. We would expect people 50 should pay 2x in premiums compared to those 25. Those 60 should pay 4x compared to those 25. If those 25 pay more so that those who are 50 and 60 pay less - they are paying more than they have to pay.

The above is different than those who are 25 paying more today so that they pay less when they are 50 or 60. What the above is doing is putting those who are 25 in a position to pay more now and pay more later - or they might be subsidized by the young when they get old. I do not support young people paying more so older people pay less.

The viability of the ACA should not be based on an assumed need for X number of young healthy people who will pay more into the system than they get back in the form of healthcare benefits.
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My issue is who pays? If a person makes personal choice about work - others should not subsidize the choice in my opinion. The odd part of the ACA is that subsidy is based on income. People can have high wealth and low income - if they work to maintain health insurance and now decide to not work, get an ACA subsidy - personally I have a problem with this. Imagine the guy making about $70,000 supporting a family of 4, mortgage, college expenses, etc. working his ass off so, I can paint pictures of sunsets on the beach with virtually free health care, in part at this guy's expense!

At the very least modify the ACA so that premiums subsidy is not just based on income but also based on available assets and an involuntary loss of a job with health care benefits.

 

I just wonder how other countries with socialized medicine handle this. Does it happen often? What could the state do to prevent this except have some lifetime salary quotas that you would have to meet before you could do this and get subsidized health insurance when you aren't working because you paid into the system for other people when you were working)?

The old system of the poor going to the ER and skipping out on the bill because they had no money was making the other guy pay for it in higher prices for procedures that the guy needed. But, if you wanted to retire early by not having health insurance because you had saved a couple of thousand, they could come after that money if you didn't pay.

I also think that health insurance premiums should take into account how big of an HSA bank account you have. If you save ~$20,000 in an HSA account every 10 years, it isn't crazy to think that you pose a lot less risk to the health insurance company and are basically self-insuring. Other people might need to borrow against that money on paper, but the banks would be able to earn interest on those loans... And having that HSA money would make it possible for you to paint sunsets on the beach knowing you aren't scamming the system, and are still covered if something does go bad.

 

When there is a true single payer system the assumption of having healthcare is a given - society as a whole pays the bill. When there is a free market system the assumption of having healthcare is not a given. Individuals make choices and will opt in and pay. The ACA is a hybrid system - there is the assumption of having healthcare, but society as a whole is not paying the bill. Individuals buying unsubsidized insurance pay. Some pay more, some pay less. Some have good coverage, some have poor coverage. People with incomes of X pay one amount and people who may be $1 over X pay significantly more. The ACA is a convoluted mess, some people can 'game" the system or are put at an advantage over others. If we have a single payer system where every one is treated the same it would be more tolerable to me than the ACA.

We should address the real problem - why does it cost so much? Go to the ER with a broken arm and the cost can be up to $16,000 - why? If we reduced the cost with or without insurance perhaps people could actually pay the bill. The ACA does nothing to actually reduce costs.

Cost of a Broken Arm - Consumer Information and Prices Paid - CostHelper.com

 

Ace...maybe we should go back to Reagan/Republican health care policies:

It was Reagan's Emergency Medical Treatment and Active Labor Act, the law barring hospitals from turning away patients on grounds of their insurance or citizenship that served as a basis for the ACA's ban on insurance discrimination against individuals with preexisting conditions.

It was Reagan who doubled the size of Medicaid over the course of his presidency to pay for all of those new uninsured patients and paved the way for further ACA Medicaid expansion.

And it was Reagan's policy of Medicare reform that set the price that Medicare would pay for hospital admissions rather than reimbursing doctors per cost (Diagnostic Related Groups)...a model for the kind of Medicare payment reform policies in the ACA.

Add earlier Republican (Heritage) proposals for insurance exchanges to provide choice and competition and the individual mandate that are at the foundation of the ACA providing accessible and affordable health insurance to the uninsured, I'm beginning to wonder why I support this right wing health care reform.