Politics Obamacare

edited, never mind me...

 

We either need true single payer or make the market truly competitive. The obamacare, hybrid, is going to fail. The trends are clear. Younger healthier people are not signing up in the needed numbers to make the system affordable and sustainable. Enjoy your coverage while you can. Dramatic premium increases are around the corner, each year those enrolled will be older and sicker - the structure has to change.

This may surprise you, but i am in obamacare. I just turned 55 and I have some preexisting conditions and I have going to have a hip replacement done later this year - my net costs are lower. Fundamentally, I think it is wrong for me to be subsidized by young healthy people in their 20's and 30's, knowing that the current system is going to fail and they will incur their costs when they are my age and the costs of older sicker people now. We can fix the system, we can lower the costs, we can address the needs of everyone. We need to objectively start addressing the problems. I do not understand why that is a problem!

 

The 2014 enrollment rate for young people was higher than projected.

And, to make the market "truly competitive" puts insurance company profits over patient care.

Nearly every prediction by opponents has been wrong . Only by manipulating data and adding in ideological-based projections can they make their case on future trends.

And I agree that the ACA needs fixes; most are relatively minor. Unfortunately, Republicans in Congress (and those running for 2016) are not interested in fixes but, after six years, still have no viable alternative.

 

The CBO for 2015 projected about 12 million enrolled. HHS's projection was about 9 million and they hit about 10 million. In March the CBO reduced their 2015 - 2025 projection by 8 million. Depending on the number you are correct, but I am too....however...

Look at the rate filings by insurance companies and the reasons they list as justification. Given, they may ask for increases that will not be approved, i.e. asking for 30% and perhaps getting 20% - we are still looking at significant premium increases. Also, understand we are still in the period with guaranteed bailouts for the insurance companies if they need them.

In addition, if you look closely at the rate filings you will find many are proposing deductible increases along with the premium increases. some with a $5,000 deductible going to a $6,500 deductible - that is a 30% increase.

Currently there is a threshold in the law that requires a specific minimum percentage of premium goes to patient care. Increasing competition is as simple as starting with allowing consumers to buy across state lines. I can consumer goods across state lines. I can bank across state lines. Buy life insurance. Work, vacation....why not be able to compare and shop for health insurance?

 

Have you looked at the rate filings? In how many states and which insurance companies? Are you only looking at plans that have an older, unhealthier experience base? That is the usual trick of opponents.

I agree that rates will likely increase more than last year, in part, because insurance companies now have more than one year of rating experience with the millions of newly insured.

But, given the rate approval process, premium increases are still likely to be in single digits, on average, with more options (more providers and more plans in more states).

And cost shifting to higher deductibles is not a new phenomenon or directly related to ACA; it started in the early 00s. What is new are the medical loss ratios so that at least most of premiums (80-85% ) are spent on patient care as opposed to administrative costs and profit when pre-ACA, that MLR for many insurance companies was closer to th 60% range than th 80% range.

Selling across state lines might have some benefit for the healthiness consumers but only IF all ACA federal regulations on insurance companies are kept in place. That is certainly not the intent of Republican proposals that include selling across state lines where it is nothing more than a race to the bottom for insurance companies to set up domicile in least regulated states with the least patient benefits and least consumer protections.

 

I have health insurance through the Federal Exchange, I am not an opponent of my insurance coverage. Your issues are not clear to me. Are you really concerned with me giving you a detailed list of what I have read? The issues I point out are general in nature, and it seems to me that we should address these issues.

...and with a year of rating experience (meaning premiums collected minus costs) what doe this information tell us?

Do you seriously believe this? Government officials and insurance companies can manipulate the system to give a false number or to hide some of the increases - the crafting of the law creates a system that actually backboards the costs - why not have an adult conversation and address what seems to be obvious. Do you believe we have the proper balance of younger healthier people in the system compared to older unhealthier people? Do you appreciate the importance of this balance long-term? The system will collapse if this balance is not established. Have you talked to younger healthier people who have made the choice to go without coverage to understand what their issues are? have you done any of your own research outside of reading the administration's talking points?

...the point was to fix the system!

Race to the bottom??? What bottom? How about what my intent for my bottom line. I want the best I can afford at the lowest cost! If a California carrier has that and North Carolina does not - who are who to say I can not have the option of choice? I know how the current law is drafted - but you make no logical argument for it not to be changed - other than protecting insurance companies! You ignore the minimum coverage requirements by law. You ignore the minimum ratio of premiums collected to benefits to be paid directly on behalf of the insured. What bottom are you talking about?

 

You said "if you look closely at the rate filings..." I am asking how closely you looked.

Reading a news article that hardly provides a detailed picture of rate filings for next year's rates does not tell the full story. Are extraordinary rate increase requests across the board or for certain level plans? And are those the plans that experience would demonstrate has older, less healthy workers, including lots of smokers?

One thing it tell us , and insurance companies, are that the right wing prediction that predominantly unhealthy people would sign up for plans was wrong. And, as a result, insurance companies that sat out the first year as a result of uncertain experiences, are now jumping in, with more plans at each level in many of the insurance exchanges....i.e. more competition.

See above on why more insurance companies are entering the exchanges. In addition, there are still two areas where rate discrimination is allowed.....age (can charge max of 3X as opposed to pre-ACA 5x for those between 50-64, and smokers.

Fixes dont happen overnight. Premium increases for this year were lower, on average, than annual increases pre-ACA, While ER visits may be static (old habits are hard to break), the $40+ billion/yr of uncompensated costs as a result of people going to ER is down because many of those now have insurance that covers the cost.

Nearly every right wing prediction has been wrong. And, yes, I would expect the 2016 rates to be a bit higher, but again, lower than pre-ACA. Cost reduction is a longer term effort that requires retooling the system much more with alternative delivery systems like Accountable Care Organizations, many of which are in pilot projects.

The ACA will allow interstate compacts BUT with the provision that all ACA regulations carry over from state-to-state. That is much preferred for me than putting regulatory control back in the hands of state insurance commissions, many of which are nothing more than an extension of the industry.
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The most interesting issue to come is the Supreme Court decision this month on the subsidies, a case that should have never reached the Court given that it was simply a technical error in the drafting of the law ("state" was intended to apply to the federal exchange as well as the 17 state exchanges).

But, if the conservative majority on the Court decide that the subsidies on the federal exchange are unconstitutional, the Republicans in Congress, not Obama, will be on the hook.

The fix is easy...a one sentence amendment, but if the Republicans, in their unwavering interest in seeing the ACA fail, will not support such an amendment, they will be responsible for 6+ million losing their affordable insurance!

 

Yes. NC Blue Cross Blue Shield is asking for a 25.7% increase for individual coverage under 65 in the ACA. Are you saying you don't believe it? Look yourself.

The detailed filings are difficult to gain access to for the general public - I have some contacts in the industry. For the general public what you will mostly find are summaries and/or reports in the media. If you don't do your own homework (i.e. - calling the state insurance dept. and asking - if you are motivated to see the detail) I can not help you.

In NC the ACA rate increased 13% from 2014 t0 2015. Above historic averages year over year.

We will see.

 

Several factors to consider:

NC had fewer insurers (2) on the insurance exchange than most states (ave of 5)

Average premium subsidies on ACA plans in NC was in the $300 range.

benchmark silver plan in NC:
6.4 % increase before subsidy, 0.8% decrease after subsidy

benchmark bronze plan in NC
9.1% increase before subsidy; 0.7 decrease after subsidy

Analysis of 2015 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces | The Henry J. Kaiser Family Foundation

 

I have seen different studies with different methodologies that allow people to arrive at various conclusions regarding rate increases. I suspect what you cite is based on one specific plan, for a 40 year-old male non-smoker. For the average consumer the system is complicated - total cost sharing subsidies are based on silver plans - this is where there is the greatest incentive to get enrollments. Not intuitive is that bronze plans, lowest premiums, are the most costly. Platinum plans are priced in a manner as to make them less appealing. So, the question is how do we calculate premium increases? I would suggest we look at total premium dollars collected per insured per plan and adjusting rates in terms of constant out of pocket costs. It is easy for an individual to calculate because they they can total their premium and project total out of pocket costs to get a true value for a year over year increase. My NC totals were in the neighborhood of 15% for 2015.

 

I would suggest you look for a different plan next open enrollment; you are likely to have a few more options.

And I would suggest that the Republicans in Congress come up with a constructive fix if the Supreme Court strikes down the subsidies and constructive amendments to improve the law overall because it is here to stay. More than 50 votes to repeal is nothing more than pandering to the base and avoiding having to acknowledge that they do not have a better alternative.

At least until the country wakes up and demands a single payer system.

 

If the Republicans don't have an immediate fix the minute the SC knocks down the subsidies and I mean the next day, that go into effect the minute the subsidies go away, then they are screwed.
It had better be as good a plan as the current one.
I have no hope that it will be better but I demand that it be comparable.
Otherwise there will be people in the streets like you wouldn't believe.

 

My posts have focused on the large increases expected in 2016 - a general discussion, applicable to all interested. Your suggestion that I had not read rate proposals lead us down the path of issues specific to NC. I don't need your help. I think I know this subject better than most.

Now it a republican party problem? The fix they want is repeal and start over!

If your party wants it, why don't they do something about it? I know your answer - If not for those mean ol' Republicans...
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The legislation was crafted specifically to encourage states to establish their own exchanges so the people in those state exchanges would qualify for subsidy. From the very beginning it was known some States would not set up their own exchange and that the legislation was poorly written and a total mess - not likely to be constitutional. Democrats never pushed any type of fix when they controlled either the House or the Senate. And the President certainly has never done anything to fix the law or improve it. And now, what about Clinton - she is not talking. What a coward.

 

The Dems don't need a plan, Hillary doesn't need to speak up, you know why?
They didn't bring the stupid damned lawsuit, that even many of the Republicans are admitting was a bad idea.
As to repeal, most of the mainstream Republicans have given up that pipedream.
It's only the fringe who still nurse that little bundle of crazy.
Yeah, many of the states screwed up implementation.
The red states that didn't take the matching Medicare funds are the best examples.

 

I do not agree. I believe law makers need to get legislation passed consistent with their intent. At best they were careless. This should not be acceptable. Given the potential impact of the ruling I think every one running for President and every one currently in Congress and the Administration needs to state how the issue is to be addressed. I understand grid lock, but grid lock in the face of a train wreck is beyond what we should tolerate - from either party - Clinton included.

 

The intent was clear, even Republicans in Congress know that. And, if the Supreme Court, strikes down the subsidies on the federal exchange, the fix is simple. A one sentence technical amendment.

If the Republican majority want to include several other minor proposals (e.g. tax on medical devices) that will not change the overall intent of the law, there would likely be bi-partisan support, including from Obama.

But that is not their intent. Once again, they will attempt to kill the ACA and they will fail and be held accountable if 6+ million individuals and working families lose their affordable health care.

 

It should not have had to come to this, but screw Hobby Lobby and others with their "religious objections" to including no co-pay birth control in employee health plans.

And $1.4 billion saved on birth control....not bad!