The Health Care Debate

[grovester]

http://www.nbcnews.com/health/obama-giv ... 2D11591250

Obama to allow insurers to sell crappy policies for another year. Cheap skate insureds allowed to push their excess health care costs on to the public for another year.

[KCMax]

No surprise, Republicans are showing resistance to the bill.

Maybe it is because the House GOP has their own bill.

Their bill would only give insurance companies the option to offer the same plans and get out of the ACA requirements. So some would keep offering the same plans, but others wouldn't.

changlang is right though, the House won't pass anything.

Correction, the House won't pass anything except another failed effort at repealing Obamacare!

This morning, in another conference meeting, Boehner reminded his colleagues about that strategy and explained how bringing the “keep your plan” bill introduced by Representative Fred Upton to the House floor Friday fits into it.

“Remember the strategy for stopping Obamacare we laid out to you back in July. It had two components: Aggressive, coordinated oversight, and targeted legislative strikes aimed at shattering the legislative coalition the president has used to force his law on the nation,” Boehner said, according to a person in the room.

“That plan is being executed as we speak. But none of it will be effective if we aren’t communicating. If we aren’t telling the stories our constituents are sharing, then we’re letting them down. It means we aren’t doing our best to stop this law,” he added.

[chaglang]

Correction, the House won't pass anything except another failed effort at repealing Obamacare!

Force of habit, etc.

[aknowledgeableperson]

Everyone needs to calm down about ACA. Everything will get worked out. This gleeful reaction by many over the technical problems is really just sickening. There is still time for people to enroll, and if things don't get worked out, the enrollment period can be extended.

The only problem is reality. That is political reality. I think that as these proposed changes happen two things will occur. First, the various government insurance exchanges will take a big hit, programs will lose more than expected, and more political fallout will happen. Second, this will be the first step in either a radical overhaul of Obamacare or outright repeal.

[chaglang]

Everyone needs to calm down about ACA. Everything will get worked out. This gleeful reaction by many over the technical problems is really just sickening. There is still time for people to enroll, and if things don't get worked out, the enrollment period can be extended.

The only problem is reality. That is political reality. I think that as these proposed changes happen two things will occur. First, the various government insurance exchanges will take a big hit, programs will lose more than expected, and more political fallout will happen. Second, this will be the first step in either a radical overhaul of Obamacare or outright repeal.

I don't see a path to repeal. Major legislative changes also seem unlikely, given that the House will only pass bills killing the whole program. So the program probably has until 2016 to get things straightened out. What I bet happens is the entire legislative capacity of the US dries up as this standoff goes on for 2 more years.

[FangKC]

Many of these cancelled plans are "junk plans."

http://m.motherjones.com/politics/2013/ ... -insurance

[FangKC]

States that have their own individual state-run health care exchanges seem to be doing okay--like California. If all states had been mandated to offer individual exchanges, the enrollment process probably would have gone much better. Every state has a Medicaid program, so that was probably the logical entity to have handled this task. State Medicaid plans are used to determined eligibility for services based on income, assessing percentage of the poverty level for the family and individual, and family structure. They are also used to contracting with insurance companies and other entities for services.

Not quite sure if true or not. There was a talking head on a news program and the talk was about the numbers, or lack of, and the sign-ups plus the getting the young. The comment, in summary, was many of the sign-ups were for Medicaid coverage, not for the health exchanges or for insurance.

California alone signed up more people than the entire federal health care exchange.

http://www.theatlanticwire.com/politics ... nge/71570/

A good number of people enrolling because of the ACA are going to be eligible for Medicaid because they live in states that have expanded Medicaid eligibility limits and eligibility is at a higher percentage of the poverty level than before.

Many of the uninsured are those that make just above the former federal poverty level eligibility requirements, but not enough income to afford individual insurance policies. You also have to consider that eligibility requirements are different in every state, and have different percentages of the poverty level to determine eligibility.

There will also be those who don't meet new Medicaid eligibility requirements, but will still be eligible for tax credits.

[KCMax]

Everyone needs to calm down about ACA. Everything will get worked out. This gleeful reaction by many over the technical problems is really just sickening. There is still time for people to enroll, and if things don't get worked out, the enrollment period can be extended.

The only problem is reality. That is political reality. I think that as these proposed changes happen two things will occur. First, the various government insurance exchanges will take a big hit, programs will lose more than expected, and more political fallout will happen. Second, this will be the first step in either a radical overhaul of Obamacare or outright repeal.

I don't see a path to repeal. Major legislative changes also seem unlikely, given that the House will only pass bills killing the whole program. So the program probably has until 2016 to get things straightened out. What I bet happens is the entire legislative capacity of the US dries up as this standoff goes on for 2 more years.

Plus people have come to expect pre-existing conditions to be covered, ensuring pretty much a right for everyone to be eligible for insurance. Even Republicans seem to agree on that, so I don't see that getting repealed at least not without some outcry. And I don't see how you require insurance companies to not deny pre-existing conditions and not have a universal mandate to enlarge the pool unless you expect insurance companies to shoulder much bigger costs.

Anyway, the only way to repeal is if the GOP controls the House, 60 votes in the Senate, and the White House. I'm suppose they could defund or destroy the program enough to effectively neuter it if they won 60 votes in the Senate, at least for a few years til the Dems get control back. But full repeal seems like a pipedream.

[aknowledgeableperson]

As a worse case scenario I don't think a complete repeal would take place. As pointed out many of the insurance reforms are acceptable to many. What would be fought over would be the changes made to how health care is accessed and delivered.

[AJoD]

Is the new year-long extension of individuals' ability to keep non-complying plans the key concession that legislators were holding out for during the government shutdown?

I don't follow the nuances of this stuff closely, but it seems like what is happening now is the thing that Obama was unwilling to do before.

[grovester]

The house wanted to delay the individual mandate a year, once they realized they weren't going to be able to repeal it.

[grovester]

Pretty good explanation of why some plans must go.

http://www.slate.com/articles/business/ ... t_was.html

[studentper]

Pretty good explanation of why some plans must go.

http://www.slate.com/articles/business/ ... t_was.html

This is a good explanation of the changes HIPAA made to the insurance market in 1997, but not the ACA.

[KCMax]

Pretty good explanation of why some plans must go.

http://www.slate.com/articles/business/ ... t_was.html

This is a good explanation of the changes HIPAA made to the insurance market in 1997, but not the ACA.

Explain further, not sure I follow. I thought he was talking about the end to companies dropping people for pre-existing conditions. That did not take place with HIPAA, did it?

[studentper]

Pretty good explanation of why some plans must go.

http://www.slate.com/articles/business/ ... t_was.html

This is a good explanation of the changes HIPAA made to the insurance market in 1997, but not the ACA.

Explain further, not sure I follow. I thought he was talking about the end to companies dropping people for pre-existing conditions. That did not take place with HIPAA, did it?

He was talking about rescission.

[grovester]

Well if you click the "insurance rescission" hyper link, it's pretty obvious that it was occurring post 1997. Two aspects of the ACA that seem to address this would be the actual existence of minimum levels of coverage along with the threat of being excluded from the exchanges for egregious behavior.

[studentper]

Well if you click the "insurance rescission" hyper link, it's pretty obvious that it was occurring post 1997. Two aspects of the ACA that seem to address this would be the actual existence of minimum levels of coverage along with the threat of being excluded from the exchanges for egregious behavior.

yes, there are 20 or so examples of insurance companies violating HIPAA, which allowed rescission for only 5 reasons. Two points. These same insurance companies are writing the ACA policies. The ACA didn't change the 5 reasons for rescinding a policy.

[KCMax]

Rescission is only a small part of why these plans should go though, right? Aren't the lifetime and yearly caps and onerous deductibles also reasons they are bad plans that should be scrapped?

[studentper]

Lifetime caps is a good policy reason, but the rational applies to all insurance. Most people's auto insurance has a maximum of $100,000-ish?, but that wouldn't be enough to compensate someone if you wrecked their car, put them in the hospital for a week, and caused them to miss six months of work. Yet the state requirement is $25,000, which might not pay for the car.

The deductibles for the exchange plans are higher and involve copays, which make the yearly max and not the deductible the important number to look at. Thus, my old plan with a $5,000 deductible and 0 copays means my out of pocket yearly medical cost is the premium plus $5,000 (assuming something bad happens, which would be the reason someone buys insurance). Under the ACA, while my deductible could be $100, a 20% copay (and that bad thing happening) means my out of pocket yearly medical cost is the premium plus the yearly max of $6,400. It costs more to pay to protect against a heart attack.

I suppose at some point I (and maybe the Republican party) need to stop being criticizing dicks about the whole thing and offer an idea. If the problem is preexisting conditions, I would suggest eliminating preexisting conditions as a reason for denying coverage, but require a 60, 90, 180 day period where there's no treatment provided unless the person has had continuous coverage. I think the waiting period is more of an encouragement than a $90 tax/penalty to actually purchase insurance. I would let insurance companies charge different rates for sex, age, and some differential based on controllable healthiness (my cholesterol is high. i should either pay more or lower my cholesterol). just my 2 cents.

[KCMax]

The conservative alternative I've heard floated (by pundits, not by politicians) is tax credits for catastrophic coverage (essentially making the premiums free), and making the tax credit for employer-provided care flat, so there is not an incentive to get expensive plans. In theory, employees would be "cost-conscious" and competition would drive down prices.

But there's no mandate, so I would guess the catastrophic coverage would get pretty expensive (on the taxpayer dime), and many people still wouldn't get it, leaving them SOL when they get their hospital bill.