The Health Care Debate

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Re: The Health Care Debate

Postby flyingember » Thu Nov 05, 2015 2:29 pm

There's no such thing as "regular" ACA coverage.

There's just a marketplace for private companies providing a bunch of different products, which vary by state. In this case some of the companies trying to do the same were running as a nonprofit.

In the end some companies didn't have the right business model and they were backed with government loans. Now there's less companies competing.

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Re: The Health Care Debate

Postby grovester » Thu Nov 05, 2015 2:40 pm

Thanks for understanding for me. People who were utilizing the co-ops can now opt for a plan in the ACA market place, just like "regular" folks.

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Re: The Health Care Debate

Postby aknowledgeableperson » Mon Nov 16, 2015 11:28 pm

http://www.msn.com/en-us/money/insuranc ... li=AAa0dzB
"First, the administration revealed that enrollments for Obamacare next year will barely hit 10 million, far below previous projections.
Then last week, the consulting firm of McKinsey & Company estimated that premiums for policies under the Affordable Care Act, also known as Obamacare, were going up substantially in 2016. For instance, the median rate increase for the lowest priced, highly popular “Silver” plan will rise by 11 percent – compared to just a seven percent increase in 2015.
...
Now there are troubling reports that consumers will be facing soaring out-of-pocket costs for deductibles next year – increases that in many cases will neutralize the benefits of their health care plans or discourage some from purchasing coverage.
“That these deductibles are so high is clearly one of the reasons people aren’t buying a plan—they simply don’t see themselves getting anything for the money,” Robert Laszewski, president of Health Policy & Strategy Associates, a business and policy consultant, said in a newsletter on Monday."

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Re: The Health Care Debate

Postby flyingember » Tue Nov 17, 2015 9:26 am

Dropping enrollment numbers actually makes sense. It's going to correspond to employment numbers. As I recall when you can get employer coverage you have to.
http://data.bls.gov/timeseries/LNS14000000

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Re: The Health Care Debate

Postby shinatoo » Tue Nov 17, 2015 9:37 am

I read that yesterday. Obviously written with a anti ACA slant. Deductibles went up 11%, rates went up 5-15%. Sucks but still better than the 20-30% a year increases before the ACA. Also, how much is your deductible if you don't have access to health insurance?

I work for a successful company, my deductible has never been less than $4000.

You want to risk it, pay the fine and go without insurance, fine. Hope you don't need an appendectomy, mine was almost $40k.
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grovester
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Re: The Health Care Debate

Postby grovester » Tue Nov 17, 2015 10:37 am

It's also important to note that even if something is below your deductible you still get all the discounts and write offs that wouldn't be available without insurance.

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Re: The Health Care Debate

Postby AllThingsKC » Tue Nov 17, 2015 11:37 am

shinatoo wrote:You want to risk it, pay the fine and go without insurance, fine. Hope you don't need an appendectomy, mine was almost $40k.


Aren't preexisting conditions covered by ACA? If so, couldn't somebody just pay the fine, wait until they have something wrong, then still qualify for insurance under ACA?

That's been my understanding of it. But I could be mistaken or something may have changed since the time I believed that to be true.
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Re: The Health Care Debate

Postby droopy » Tue Nov 17, 2015 12:06 pm

AllThingsKC wrote:
shinatoo wrote:You want to risk it, pay the fine and go without insurance, fine. Hope you don't need an appendectomy, mine was almost $40k.


Aren't preexisting conditions covered by ACA? If so, couldn't somebody just pay the fine, wait until they have something wrong, then still qualify for insurance under ACA?

That's been my understanding of it. But I could be mistaken or something may have changed since the time I believed that to be true.


Yes, but you can't enroll at anytime during the year. If your heart attack, cancer, etc happens when you're uncovered and it isn't the enrollment period you're paying that entire bill (or more likely declaring bankruptcy) until the next enrollment period comes around.

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Re: The Health Care Debate

Postby aknowledgeableperson » Wed Nov 18, 2015 11:43 pm

http://www.msn.com/en-us/money/smallbus ... li=BBieTUX

"When LaRonda Hunter opened a Fantastic Sams hair salon 10 years ago in Saginaw, Tex., a suburb of Fort Worth, she envisioned it as the first of what would eventually be a small regional collection of salons. As her sales grew, so did her business, which now encompasses four locations — but her plans for a fifth salon are frozen, perhaps permanently.
Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer their workers health insurance or face financial penalties that can exceed $2,000 per employee. Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company’s profit and the five-figure salary she pays herself from it, she said.
“The margins are not big enough within our industry to support it,” she said. “It’s not that I don’t want to — I love my employees, and I want to do everything I can for them — but the numbers just don’t work.”
...
For some business owners on the edge of the cutoff, the mandate is forcing them to weigh very carefully the price of growing bigger.
“There’s kind of a deer-in-headlights moment for those who say, ‘I have this new potential client, but if I bring them on, I have to hire five additional people,’” said Philip P. Noftsinger, the payroll unit president at CBIZ, a financial services provider for businesses. “They’re really trying to assess how much the 50th employee is going to cost.”
Nearly all large companies provide health care benefits, but only 54 percent of businesses with three to 49 workers offered coverage to their workers this year, according to an analysis by the Kaiser Family Foundation. Paying even a portion of the cost can be expensive. The average annual premium for workers at small companies currently tops $6,100 for individual insurance and $16,600 for family coverage.
That premium is typically shared between the employer and employee. Businesses that fall under the health care law’s mandate are required to offer their workers “affordable” insurance, which the law defines as individual coverage that costs less than 9.5 percent of the employee’s household income. (Because employers do not know how much money their workers’ relatives make, their options for compliance include basing their calculation on only their own employees’ wages.) For a full-time, minimum-wage employee making $14,500 a year, an employer offering an average-price individual plan would have to pay around $4,700 a year.
Added to that cost are the administrative requirements. Starting this year, all companies with 50 or more full-time workers — even those not yet required to offer health benefits — must file a set of new tax forms with the Internal Revenue Service that provide details on employee head count and any health insurance offered. Gathering the data requires meticulous record-keeping.
“These are some of the most complex informational returns we’ve ever seen,” said Roger Prince, a tax lawyer with the consulting firm Berry Dunn in Portland, Me.
...
The health care law defines a full-time-equivalent employee as someone who works an average of 30 or more hours a week — and the hours worked by some part-time employees count toward the calculation.
...
Tony Lamb has 700 franchisees for Kona Ice, his shaved-ice truck business, but his corporate staff in Florence, Ky., has only 44 full-time-equivalent positions. It took an outside consultant to confirm that number; his internal accountant’s calculation came up with 42.
Kona Ice offers a retirement plan, profit-sharing and other perks, but no health benefits — and one of Mr. Lamb’s concerns about expanding is the salaries that he priced accordingly.
“I said, ‘Instead of paying you $50,000 and $15,000 in health care, I’ll pay you $65,000,’” he said. “You can’t go back on people and change the rules. No one wants a pay cut. I think it’s a very big deterrent to growth.”
Some owners who began offering insurance this year to comply with the new law have been surprised by how few employees purchased it. Participation rates as low as 1 or 2 percent are not uncommon in industries like restaurants and retailing, in which employees making close to the minimum wage may struggle to afford the premiums."

Of course someone said above:
"Dropping enrollment numbers actually makes sense. It's going to correspond to employment numbers. As I recall when you can get employer coverage you have to."
However, according to the article:
"Without the mandate, the law’s creators feared, companies would be tempted to cancel their insurance benefits and encourage all of their employees to move to the online marketplace exchanges created by the law, where many low- and middle-income workers qualify for government subsidies. Those who are offered insurance through their jobs are ineligible to collect subsidies if they instead choose to buy coverage through the exchanges."
So with an employer provided health insurance option and a participation rate of 1 to 2% for a number of jobs it would appear that many workers are indeed opting to go bare.

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grovester
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Re: The Health Care Debate

Postby grovester » Thu Nov 19, 2015 9:19 am

The pre ACA would be worse. Not only would she not offer her employees insurance, the employees couldn't afford insurance on the open market.

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Re: The Health Care Debate

Postby aknowledgeableperson » Thu Nov 19, 2015 9:40 am

Pre or post, doesn't make much difference.
Just wondering, how much money do you think these hairdressers make a year? If the employees couldn't afford insurance on the open market before ACA and she expands and has to offer health insurance the employees cannot receive an ACA subsidy if they turn down the employer provided coverage. Which appears what 98 to 99% of the workers in the service industry do, turn down the employer provided coverage. Therefore, still can't afford open market health insurance.

And the choice of not using a government run exchange does have a consequence for those exchanges.
http://www.forbes.com/sites/brucejapsen ... ix&ref=yfp
"UnitedHealth Group UNH +2.56%, in a surprising announcement, said this morning it has revised its profit expectations for the rest of the year due to what it called a “deterioration” of its individual commercial insurance offerings on government-run exchanges under the Affordable Care Act and offered no commitment it would stay in the business beyond next year.
The nation’s largest health insurer said it was “evaluating the viability of the insurance exchange product segment,” pulling back on its marketing efforts for individual exchange products for next year and “will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017.” The insurer sells individual plans on public exchanges in 24 states and covers more than a half million Americans in these plans.
UnitedHealth had been among the more cautious in offering coverage to individuals on the exchanges, entering only a handful of markets in 2014, the first year such coverage became available. The company expanded for this year and only recently said it would expand its offerings in nearly a dozen more states for 2016. But this morning, it said the business has deteriorated and it expects a reduction in earnings for the fourth quarter of this year of $425 million, or 26 cents per share “driven by 2015 and 2016 exchange product pressure.”
Just last month, UnitedHealth president and chief financial officer David Wichmann touted growth for the individual commercial business, saying “we continue to expect exchanges to develop and mature over time into a strong viable growth market for us.”
But UnitedHealth and other insurers need more Americans to come into the public exchanges because the patients that are signing up for coverage are sicker, making a “higher overall risk pool,” insurance executives say. It’s a key reason many Americans are seeing rate increases of 10 percent or more across the country on public exchanges."

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grovester
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Re: The Health Care Debate

Postby grovester » Thu Nov 19, 2015 10:30 am

Not sure why you're assuming they'd turn down employer coverage. Too expensive? There are exceptions for that.

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Re: The Health Care Debate

Postby aknowledgeableperson » Thu Nov 19, 2015 12:08 pm

Just look at the numbers in the article. 1 to 2%. Think that pretty much assumes they would turn down employer coverage.

No answer to the question about how much they make?

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Re: The Health Care Debate

Postby grovester » Thu Nov 19, 2015 12:12 pm

No idea. I'd imagine there is a big tipping component.

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Re: The Health Care Debate

Postby aknowledgeableperson » Thu Nov 19, 2015 8:17 pm

From a few different sources the median is around $27,000 but the average varies from $22,000 to $25,000. Good but not great. Two factors that seem to influence the numbers where they are (big difference state-by-state) and if they are an employee or independent and rent their space from a shop owner.

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Re: The Health Care Debate

Postby shinatoo » Thu Nov 19, 2015 9:45 pm

Just got my plan from my employer. My benefits stayed the same and my rates went up 1.03%. First time in memory it hasn't increased in double digits.
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Re: The Health Care Debate

Postby mean » Sun Nov 29, 2015 9:02 am

My premium dropped a bit. Same coverage as far as I can tell, although I haven't read up on everything. I have been told this is impossible, because Obamacare was supposed to make everything more expensive and destroy the economy so that Saudi princes could take over and implement sharia law in the US, so I guess I should verify that my copay hasn't gone nuts. You know, just in case.

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Re: The Health Care Debate

Postby aknowledgeableperson » Wed Aug 17, 2016 10:43 am

http://www.msn.com/en-us/money/healthca ... li=BBnb7Kz

"Aetna said it will exit 11 of the 15 states where it offers coverage through the Affordable Care Act, widely known as Obamacare. That affects about 80 percent of its customers covered through insurance marketplaces.

The marketplaces, known as insurance exchanges, were created to provide coverage for Americans who cannot get affordable health benefits through a job. A key aspect of the health-care law, the marketplaces allow people to purchase insurance online with subsidies based on their income."


" Earlier this month, Humana said it will cut back its participation on the exchanges from 15 states to 11. On an earnings call in July, UnitedHealth Group chief executive Stephen Hemsley announced that his company plans to remain on “three or fewer exchange markets.”

In a reversal of expectations, Anthem said it is projecting mid-single-digit losses on the individual plans it sells on the exchanges for 2016. And Cigna has said that it is losing money on the exchanges, although the insurer is planning to expand its marketplace presence to three new states in 2017.

The health-care law is likely to prompt another heated political battle, regardless of which party wins the White House and control of Congress in November.


"There are many possible policy remedies, but the main issues have to do with the risk pool — the balance between healthy people and sick people with higher health-care expenses. Many insurers have noted that people who have signed up for health insurance on the marketplaces are sicker, putting greater demands on the system.

“You have here a situation which all of us who care about the exchanges have to worry about,” said Zeke Emanuel, who served as a top White House health policy adviser during Obama’s first term and is now vice provost for global initiatives at the University of Pennsylvania. “There is a problem with the risk pool. There is a problem with the numbers of people signing up.”

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Re: The Health Care Debate

Postby bobbyhawks » Wed Aug 17, 2016 2:01 pm

I'm on Obamacare. I love that I can change plans every year, but I do have to do some research. The good thing is that I don't have to roll over and accept whatever BS my employer provides me (since I'm self-employed, so maybe I do?) regarding prices going up and negotiated rates being higher etc. I think one of the problems is that, within your price range, there tends to be a clear winner for your specific needs and not a number of options to choose from based on customer loyalty, etc. This could mean that poorly constructed plans are only attracting people with specific higher risk profiles. Also, I think the plans have been constructed to sell to large employee pools and not to individual people. Individual people have a completely different set of priorities than employers do looking out for a group of people. This could mean that a large part of the problem is that this history of the way healthcare has been sold is working against the current marketplace structure. In my opinion, everyone should have a choice and should not be held hostage by their employer, but that is another matter.

Also as an aside, the website now works great and reminds me automatically every year to renew my health/dental. It is extremely user friendly compared to other medical-related websites I have seen for doctors and employers. The information is much easier to sift through and is pretty transparent.

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Re: The Health Care Debate

Postby grovester » Wed Aug 17, 2016 3:28 pm

When our company first dropped their plan, they brought in a broker to help the employees through the enrollment process. The brokers pitch was, if you don't need the subsidies you don't need to sign up for Obamacare, we offer the same policies outside the ACA for the same rate. I assumed the broker got a better commission.

I wonder how many people this would add up to, and does it make the ACA pools more expensive?


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