The Health Care Debate

Come here to talk about topics that are not related to development, or even Kansas City.
bobbyhawks
Bryant Building
Bryant Building
Posts: 3735
Joined: Mon Dec 04, 2006 1:19 pm

Re: The Health Care Debate

Postby bobbyhawks » Wed Aug 17, 2016 5:00 pm

grovester wrote: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?

Good question. I don't know, but I use the ACA marketplace because it is more straightforward than going through a broker. If I was told there was a pool of much better plans, a much better price, or another compelling reason to look outside of the marketplace, I'd look into it, but I have confidence the plans offered through the marketplace have minimum coverage and other regulatory requirements. Perhaps I'm just naive and lazy, but its really simple and still gives me options, just like going through Kayak.com instead of using a travel agent's word cuts out the bias. I'm okay with limiting my search to the options available, and there are still gold and platinum rated plans on the ACA. It's not like they only offer poverty-level plans. My current plan is better than what I had with my previous employer, just that I have no subsidy as I did with my employer paying half. I think that is part of the sticker shock for some is they don't realize the dollar value of the benefits they previously received.

I've gone through a broker before, and they basically just gave me a single option and I had to take their word for it. I have no idea if it was the best option or an upsell for a kickback deal. The experience was very much like my auto insurance. I get something mailed to my house that says it's what I owe, and I hope the random agent my family has used for a long time is giving me a decent deal (which is a cycle I have fallen into and have accepted - need to break that btw). It's why people don't use travel agents anymore unless it is someone they really trust or they don't care about saving money. Seeing all of the prices in one place and comparing the information makes me feel like I have more control and makes me more informed about my choice.

User avatar
grovester
Hotel President
Hotel President
Posts: 3489
Joined: Thu Mar 13, 2008 7:30 pm
Location: KC Metro

Re: The Health Care Debate

Postby grovester » Wed Aug 17, 2016 6:40 pm

I agree with you 100%. I am on the ACA now. But I wonder how many companies like ours have numerous "healthy" people who aren't in the ACA, but could be just as easily.

bobbyhawks
Bryant Building
Bryant Building
Posts: 3735
Joined: Mon Dec 04, 2006 1:19 pm

Re: The Health Care Debate

Postby bobbyhawks » Thu Aug 18, 2016 9:57 am

http://www.nbcnews.com/business/consumer/aetna-threatened-quit-obamacare-if-u-s-blocked-humana-merger-n633456

So, yeah, there's this... Double win! You get to blame/hurt Obamacare AND get your merger approved!

flyingember
One Park Place
One Park Place
Posts: 6016
Joined: Tue Jul 17, 2012 7:54 am

Re: The Health Care Debate

Postby flyingember » Thu Aug 18, 2016 10:37 am

bobbyhawks wrote:http://www.nbcnews.com/business/consumer/aetna-threatened-quit-obamacare-if-u-s-blocked-humana-merger-n633456

So, yeah, there's this... Double win! You get to blame/hurt Obamacare AND get your merger approved!


They clearly missed the point that if they keep saying it's not possible to have a near universal health insurance system on the private market with free market capitalism involvement they're selling moving to a universal government run system.

They're saying their business model doesn't work unless they can exclude people from coverage. Which is likely true. It seems to me that the result is going to be medicaid/Medicaid merging into a plan all people in the country have. This would be part of your federal tax bill relative to your pay and a bill that couldn't be deducted away. People too low income to pay federal taxes would pay some minimal amount, much like the private exchanges do.

The basic idea is preventative, necessary and lifesaving care would be universal. If you have a SSN number and matching ID or a valid Visa you are covered in all doctor's offices in the country for any basic service. This would be a fine place to encourage being in the country legally. You become official today and you're covered tomorrow. (Of course not all doctors would do all procedures like today.)

Experimental work would still be covered with equally strict eligibility to today, but you couldn't just go to any doctor for this. Approved trial people would be covered. The treatment program would need to be approved by a medical board to go mainstream.

Non-necessary medical care would be out of pocket or paid by private insurance. And if the government has a 15% deductible private insurance could cover all/most of this gap.

So you will end up with a minimum level of care all documented individuals get, everyone pays, and there's still a market to get better coverage than that.

aknowledgeableperson
City Center Square
City Center Square
Posts: 12188
Joined: Thu Mar 11, 2004 10:31 pm

Re: The Health Care Debate

Postby aknowledgeableperson » Thu Aug 18, 2016 4:54 pm

If the feds, both Dem and GOP, were really interested in providing health care then the costs that an individual/family would incur would be a tax credit instead of an itemized deduction.

User avatar
grovester
Hotel President
Hotel President
Posts: 3489
Joined: Thu Mar 13, 2008 7:30 pm
Location: KC Metro

Re: The Health Care Debate

Postby grovester » Thu Aug 18, 2016 5:22 pm

aknowledgeableperson wrote:If the feds, both Dem and GOP, were really interested in providing health care then the costs that an individual/family would incur would be a tax credit instead of an itemized deduction.


It is for the self-employed.

aknowledgeableperson
City Center Square
City Center Square
Posts: 12188
Joined: Thu Mar 11, 2004 10:31 pm

Re: The Health Care Debate

Postby aknowledgeableperson » Wed Aug 24, 2016 8:06 pm

"While Tennessee residents suffered Obamacare premium sticker shock this year, with increases as high as 36 percent, those rates will pale by comparison to those that received final state approval for the coming year: BlueCross BlueShield of Tennessee was granted a jaw-dropping 62 percent average increase; Cigna was given a 46 percent average increase and Humana was granted a 44.3 percent average increase."

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

bobbyhawks
Bryant Building
Bryant Building
Posts: 3735
Joined: Mon Dec 04, 2006 1:19 pm

Re: The Health Care Debate

Postby bobbyhawks » Thu Aug 25, 2016 12:09 pm

aknowledgeableperson wrote:"While Tennessee residents suffered Obamacare premium sticker shock this year, with increases as high as 36 percent, those rates will pale by comparison to those that received final state approval for the coming year: BlueCross BlueShield of Tennessee was granted a jaw-dropping 62 percent average increase; Cigna was given a 46 percent average increase and Humana was granted a 44.3 percent average increase."

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

So, these companies wildly misjudged the market and had an initial price point that was not realistic. Is that necessarily the fault of the ACA? 62% sounds impressive, but do we know from what to what and how that relates to equivalent states? Also, I wonder what the oversight is on these companies asking for such increases (what is the burden of proof in justifying the added costs or in verifying the loss claims?). Utilities have to go through a pretty rigorous process of getting approved for rate increases, including a pretty in-depth evaluation of all of the investments and costs that directly benefit the customer. I'm not aware of how the Insurance Commissioner verifies such information.

I took a job for very little money out of school due to my lack of experience in the field. When I found out what others around me were making, and after I'd gained some experience, my bosses tried to tell me that an 11% raise was an excellent raise. Going from "severely underpaid to only slightly less severely underpaid" was a different headline than "11% Raise!" A 62% increase is only meaningful if we know other information that describes how this number compares to the monthly fees paid by people outside of the exchanges. I haven't seen anyone yet compare a plan secured for a company to an equivalent plan on the ACA marketplace. Companies not liking the markets is very different from "they aren't working." It is clear that the big names are not fans of the ACA currently. Theoretically, there is zero reason for them to pull out of the marketplace if they are granted an appropriate fee increase. Either there is a number that will make them profitable, or they are just trying to sabotage a system they think will not be as beneficial to them as the old system.

swid
Strip mall
Strip mall
Posts: 263
Joined: Wed Jul 10, 2013 8:29 pm
Location: Financial District

Re: The Health Care Debate

Postby swid » Thu Aug 25, 2016 12:28 pm

Given that there's a strong correlation between "the % more on health care the US spends than the average other developed countries do" and "the % of overall health care spending in the US captured by insurance companies" (about 20%, in both cases), the cynic in me is inclined to lean towards sabotage on the part of insurance companies, as they should have already absorbed the majority of the pre-ACA uninsured population 3-4 years ago. I can't imagine that their actuaries would have wildly underestimated how much it would end up costing to insure this population, either.

That cynic also notes that it wouldn't hurt to make those price spikes be especially egregious in an election year, but that's just me.

bobbyhawks
Bryant Building
Bryant Building
Posts: 3735
Joined: Mon Dec 04, 2006 1:19 pm

Re: The Health Care Debate

Postby bobbyhawks » Thu Aug 25, 2016 2:00 pm

swid wrote:I can't imagine that their actuaries would have wildly underestimated how much it would end up costing to insure this population, either.

That cynic also notes that it wouldn't hurt to make those price spikes be especially egregious in an election year, but that's just me.

This. I've actually helped input data for such actuarial tables in a long-ago internship. These companies can easily input all actual losses correlated to demographics and model/project the expected losses vs. any hypothetical insurance plan. The fluctuations from future reality should not be significant (at least not in a one year span). That they would so unexpectedly be off and require an immediate 62% increase is either indicative of total ineptitude, factors in the industry that are not solely the cause of the ACA, or a gaming of the system.

shinatoo
Oak Tower
Oak Tower
Posts: 5919
Joined: Wed Jan 19, 2005 3:20 pm
Location: Lee's Summit

Re: The Health Care Debate

Postby shinatoo » Thu Aug 25, 2016 2:18 pm

What insurers are saying is that their estimates are off because fewer healthy people are signing up than expected. Opting to just pay the much lower penalty.

Insurers want this to work because it gives them more customers. What they are pushing for is higher penalties for failure to enroll.
Quocunque Jeceris Stabit

User avatar
grovester
Hotel President
Hotel President
Posts: 3489
Joined: Thu Mar 13, 2008 7:30 pm
Location: KC Metro

Re: The Health Care Debate

Postby grovester » Thu Aug 25, 2016 2:51 pm

That wouldn't catch the people in our companies situation. Healthy, wealthy (not eligible for subsidies) who are enrolled in non-ACA individual plans.

There has to be an angle the insurers are playing in this situation, probably having to do with the profit caps on ACA plans.

pash
Bryant Building
Bryant Building
Posts: 3801
Joined: Sun Feb 20, 2011 2:47 am

Re: The Health Care Debate

Postby pash » Thu Aug 25, 2016 3:04 pm

.
Last edited by pash on Tue Feb 14, 2017 8:03 pm, edited 1 time in total.

User avatar
grovester
Hotel President
Hotel President
Posts: 3489
Joined: Thu Mar 13, 2008 7:30 pm
Location: KC Metro

Re: The Health Care Debate

Postby grovester » Thu Aug 25, 2016 3:49 pm

Meh, any expected cost reductions by the ACA were going to be realized long term, not year to year. "Bending the arc" and all that.

Getting the uninsured on the program and out of the emergency room, preventing bankruptcies from illness and paving the way for single payer were the real goals.

pash
Bryant Building
Bryant Building
Posts: 3801
Joined: Sun Feb 20, 2011 2:47 am

Re: The Health Care Debate

Postby pash » Thu Aug 25, 2016 4:18 pm

.
Last edited by pash on Tue Feb 14, 2017 8:01 pm, edited 1 time in total.

User avatar
grovester
Hotel President
Hotel President
Posts: 3489
Joined: Thu Mar 13, 2008 7:30 pm
Location: KC Metro

Re: The Health Care Debate

Postby grovester » Thu Aug 25, 2016 4:49 pm

Well the aforementioned push out of emergency rooms and into regular appointments would cost less. Insured populations are generally healthier over time, so they cost less. People actually having meaningful deductibles means more critical use of their healthcare resources.

There are also a bunch of wonky medicare reforms that I won't try to explain, ACOs, readmission penalties, etc.

I'll admit, these are big picture goals, anything tough and game-changing (single-payer) wasn't going to happen with the first version of the ACA and congress wasn't going to let the normal improvement process happen under Obama's watch.

pash
Bryant Building
Bryant Building
Posts: 3801
Joined: Sun Feb 20, 2011 2:47 am

Re: The Health Care Debate

Postby pash » Thu Aug 25, 2016 8:17 pm

.
Last edited by pash on Tue Feb 14, 2017 8:01 pm, edited 1 time in total.

User avatar
grovester
Hotel President
Hotel President
Posts: 3489
Joined: Thu Mar 13, 2008 7:30 pm
Location: KC Metro

Re: The Health Care Debate

Postby grovester » Thu Aug 25, 2016 9:27 pm

I would argue that the climate in 2008 would not allow the ACA to address the problems you mention. In normal legislative times the ACA would be tweaked over the ensuing 8 years.

As for the newly insured using it excessively, there certainly would be a catch up period. Again, long term.

pash
Bryant Building
Bryant Building
Posts: 3801
Joined: Sun Feb 20, 2011 2:47 am

Re: The Health Care Debate

Postby pash » Thu Aug 25, 2016 10:06 pm

.
Last edited by pash on Tue Feb 14, 2017 7:58 pm, edited 1 time in total.

aknowledgeableperson
City Center Square
City Center Square
Posts: 12188
Joined: Thu Mar 11, 2004 10:31 pm

Re: The Health Care Debate

Postby aknowledgeableperson » Thu Aug 25, 2016 10:10 pm

The ACA was a political hack job from the beginning. Even within the Dem ranks there were too many compromises made to get the votes that in the end all that can be said is "We got something accomplished." And that accomplishment was getting a bill passed. That bill didn't come close to fixing the problem and in some cases made the problem worse.

I don't know what the overall solution would be. Right now I am not completely sold on the idea of Medicare-for-all but I am close to saying that is a major part of the solution. Private insurance companies could still be involved in tie-in programs and such, much like they are now. One major problem that needs to be fixed are drug costs. If other countries can have them and the drug companies comply then why not here.


Return to “General Discussion”

Who is online

Users browsing this forum: No registered users and 2 guests