No, it most certainly is. It's just fun to watch the arguments that somehow it isn't.
ACA Running Thread
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No, it most certainly is. It's just fun to watch the arguments that somehow it isn't.
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Kathleen Sebelius basically warned Congress today that the stats on number of enrollments so far is far lower than anyone could possibly believe. She's doing a Wellman-esque job of lowering the bar right now, in anticipation of the stats going public in a few days.
ONW
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Ch, two questions:
When the insurance companies are forced to cancel plans, they are losing revenue correct?
What percentage of health insurance policies does an insurance company assume and hence accept will be revenue negative over time?
When the insurance companies are forced to cancel plans, they are losing revenue correct?
What percentage of health insurance policies does an insurance company assume and hence accept will be revenue negative over time?
http://www.nationalreview.com/article/363189/conservative-alternative-obamacare-nina-owcharenko
CH, could you check this out and provide some input?
CH, could you check this out and provide some input?
Deacon923
Scooter Banks
Nothing in this article excuses the underlying problems with ACA or the exchanges, but I do wonder how much of the public discontent it being caused by bullshit like this.
http://readersupportednews.org/news-section2/313-17/20258-how-insurers-are-hiding-obamacare-benefits-from-customers
http://readersupportednews.org/news-section2/313-17/20258-how-insurers-are-hiding-obamacare-benefits-from-customers
Deacon923
Scooter Banks
I am not CH but I read the article and the abstract and will provide my reaction.
this outline has been around for years. some of the ideas were part of McCain's plan in 2008. There are some very, very good ideas in there, no question. But there is a huge glaring omission. This plan basically does nothing at all to help people who make too much for Medicaid but don't have employer-provided insurance and can't afford to buy their own. There are two items in the Heritage plan that kind of pay lip service to this issue, but neither are adequate or even serious:
1) Tax equity - remove employee exclusion and give everyone and equal tax credit, but must be revenue neutral. From a general tax policy perspective this is certainly a good idea, but unless you use it to redistribute some wealth to uninsured poor people in a pretty serious way it is not going to get many more people insured. This would probably help on the margins with people like small business owners (typical Heritage target) but little or nothing for part time uninsured Wal-Mart stockers (not a typical Heritage constituent). Most of the people who are uninsured already don't make enough to pay any income taxes anyway, so a credit does nothing for them unless it's refundable like the EITC. That might help by putting cash in their pockets, but I don't think you can do that without new revenue from somewhere. At the very least, the people who get employer-provided insurance are going to be paying more tax to pay for the refundable tax credit for the others. And, the abstract does not specifically say it's refundable, so they may not even mean a refundable tax credit.
2) they throw out some nebulous suggestion to "encourage" the states to do a better job with Medicaid and offer state-level insurance premium assistance. Yeah, sure. Like the deep Southern states with the most poor uninsured blacks are really going to raise taxes to offer more assistance to their residents. Give me a freaking break. Of course what they really mean is privatize Medicaid, so instead of "government waste" we can siphon off taxpayer money to private stockholder profits.
On the whole, this plan would probably improve the insurance markets and probably bring down cost with increased competition. There are certainly some great ideas. For example, we should absolutely get rid of anticompetitive certificate of need laws, and I see little downside in getting rid of state level mandates and insurance regulation to remove barriers to interstate competition (you'd have to set up a federal regulator in their place, which I doubt Heritage would like). But I have serious doubts that the net impact of increased competition would bring down the cost of insurance enough to allow the currently uninsured to afford it without subsidies, or drag health cost inflation down to the rate of general inflation.
They lose revenue if they dont simply switch the policies to compliant ones...I dont think a lot of these cancels were financially based.
Id guess 15% or 20% or so of policies are stinkers. 5% of policies drive 50% of the costs. There are some really sick people out there who drive a lot of the costs.
Overall, insurers make 3-5% margins on a book.
Deacon923
Scooter Banks
meanwhile, the medical device makers run at something like a 20% profit margin but their lobbyists have convinced most of Congress that the medical device tax is a "job killer".
ONW
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Thanks man
bmoneydeac
Butts - Jessica Biel's in particular
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I've said it before on this thread but I've worked with a med device manufacturer that makes over 50% net profit and they are a pretty niche player in the industry (60MM or so in sales). That's unheard of in any other area of manufacturing.
http://www.usatoday.com/story/news/nation/2013/11/06/aca-young-and-healthy-premiums-mental-health/3326533/
"The Obama administration estimates that 2.7 million people between the ages of 18 and 30 need to buy health insurance through the federal and state marketplaces to offset the health care needs of older Americans buying insurance as required by the Affordable Care Act. But while those younger Americans may not have physical ailments, they are more likely to have mental health issues that will now be treated the same as physical problems because of the law."
"The Obama administration estimates that 2.7 million people between the ages of 18 and 30 need to buy health insurance through the federal and state marketplaces to offset the health care needs of older Americans buying insurance as required by the Affordable Care Act. But while those younger Americans may not have physical ailments, they are more likely to have mental health issues that will now be treated the same as physical problems because of the law."
http://www.reuters.com/article/2013/11/06/us-humana-exchanges-idUSBRE9A50P620131106
"A top U.S. health insurer gave the first detailed view of how the problem-plagued rollout of President Barack Obama's signature healthcare law is affecting the industry, saying on Wednesday it had cut its enrollment forecasts by at least a half and expected the government to delay the sign-up deadline."
"A top U.S. health insurer gave the first detailed view of how the problem-plagued rollout of President Barack Obama's signature healthcare law is affecting the industry, saying on Wednesday it had cut its enrollment forecasts by at least a half and expected the government to delay the sign-up deadline."
http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_PRE_EXISTING_ANXIETY?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2013-11-06-15-35-26
"Hundreds of thousands of people across the country with pre-existing chronic conditions such as cancer, heart failure or kidney disease who are covered through high risk-insurance pools will see their coverage dissolve by year's end.
They are supposed to gain regular coverage under the Affordable Care Act, which requires insurers to cover those with severe medical problems. But many of them have had trouble signing up for health insurance through the exchanges and could find themselves without coverage in January if they don't meet a Dec. 15 deadline to enroll..."
"Hundreds of thousands of people across the country with pre-existing chronic conditions such as cancer, heart failure or kidney disease who are covered through high risk-insurance pools will see their coverage dissolve by year's end.
They are supposed to gain regular coverage under the Affordable Care Act, which requires insurers to cover those with severe medical problems. But many of them have had trouble signing up for health insurance through the exchanges and could find themselves without coverage in January if they don't meet a Dec. 15 deadline to enroll..."
dot com
Well-known member
So I was talking with some administrators this morning in a meeting and I thought I share some ACA side effects of how Medicare is going to save money (I haven't verified these and may be misremembering):
-Medicare only pays many situations if you're in a hospital bed for at least 2 days. In order to get the reimbursement, hospitals will artificially extend a stay "for observation". These situations will typically carry higher copays, pushing cost to the patient.
-Medicare pays flat fees for many "very sick" services/patients, (I'm just making this for example up) for example, Leukemia treatment might be reimbursed $10k but the actual treatment may involve a very long length of stay for which the hospital would get no additional money. Would there be incentive to withhold lifesaving treatment due to monetary concerns?
If anyone can prove/disprove that'd be great. I didn't have any luck 5-min researching the two day thing.
-Medicare only pays many situations if you're in a hospital bed for at least 2 days. In order to get the reimbursement, hospitals will artificially extend a stay "for observation". These situations will typically carry higher copays, pushing cost to the patient.
-Medicare pays flat fees for many "very sick" services/patients, (I'm just making this for example up) for example, Leukemia treatment might be reimbursed $10k but the actual treatment may involve a very long length of stay for which the hospital would get no additional money. Would there be incentive to withhold lifesaving treatment due to monetary concerns?
If anyone can prove/disprove that'd be great. I didn't have any luck 5-min researching the two day thing.
Think you're referring to the new "two midnight's" rule. If a patient's stay is less than the rule states, it is considered "observation" and Medicare payment is made under Part B instead of Part A. Part B pays less and has higher deductibles.
The second part of your question is probably about the hospital DRG payment system. If the treatment for a set of diagnoses averages $15,000, the hospital gets paid that amount. If they can treat and discharge for less than that, the hospital gets to keep the difference. If it costs more, they eat it.
The two rules are somewhat related in that hospitals are now penalized if they have too many patients who return to the hospital within 30 days of discharge. Previously, a hospital had a financial incentive to discharge early (often to a skilled nursing facility). If the patient had a qualifying 3 night hospital stay, the nursing facility would be eager to accept the admission in order to capture Medicare A reimbursement. Part A in a SNF pays full for 20 days and with a co-insurance deduction for days 21-100. If a patient has Medicaid backup, the SNF might not be interested in keeping the patient after 20 days and look for a reason to discharge back to the hospital. If the patient has private pay back-up, the patient might want to go home on day 21 to avoid the copay. Depending on the quality of home care, or lack thereof, the patient often ends up back in the hospital within the 30 day window.
To avoid the 30 day re-admission penalties, some hospitals keep patients who return within 30 days on "observation" for several days because observation days don't count for the 30 day re-admission rule. I believe the new "two midnight's" rule is designed to encourage hospitals to make better decisions on admissions and discharges.
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dot com
Well-known member
Excellent, thank you.
Keeping patients on an observation status beyond two days screws up discharge planning if the patient is heading for a SNF. Observation days are not counted towards the required 3 day hospital stay for Medicare A payment to the SNF. Patients without Part A days are much harder to place.
Some background on SNF reimbursement - SNF's make good money (20% margin) on Part A patients. There is also a tremendous savings to Medicare as 10 years ago most of those patients stayed in the hospital. Snf's lose money (about $20 per patient day) on Medicaid patients and make a little on Private Pay, although there aren't too many of them. Overall profit for SNF's is around 6-7% before taxes. There are new rules for "dual eligible's" (having both Medicare and Medicaid) which automatically switches payment from Medicare to Medicaid on day 21, meaning the SNF loses any financial benefit for the co-insurance days (qualifying days 21-100). In any event, SNF's are under pressure to discharge from Part A as quickly as possible. Medicare reviews SNF claims very closely and isn't bashful about charging a SNF with fraud.
Some background on SNF reimbursement - SNF's make good money (20% margin) on Part A patients. There is also a tremendous savings to Medicare as 10 years ago most of those patients stayed in the hospital. Snf's lose money (about $20 per patient day) on Medicaid patients and make a little on Private Pay, although there aren't too many of them. Overall profit for SNF's is around 6-7% before taxes. There are new rules for "dual eligible's" (having both Medicare and Medicaid) which automatically switches payment from Medicare to Medicaid on day 21, meaning the SNF loses any financial benefit for the co-insurance days (qualifying days 21-100). In any event, SNF's are under pressure to discharge from Part A as quickly as possible. Medicare reviews SNF claims very closely and isn't bashful about charging a SNF with fraud.
"The government's top health technology guru has stepped down from his role leading the Centers for Medicare and Medicaid Services through the implementation of the Affordable Care Act..."
http://www.usatoday.com/story/news/nation/2013/11/06/cms-tech-head-leaves/3456505/
http://www.usatoday.com/story/news/nation/2013/11/06/cms-tech-head-leaves/3456505/
923, thanks for the reply. STILL waiting on you, CH!
I agree with a lot of what you say. I always thought that the way to corral the young healthies and the gap (between medicaid and affordability) people was to offer a refundable health care credit. if you dont get ins, you don't get the $$. It seems to have worked for the EITC that you alluded to.
Lastly, this seems much more affordable, and easy to implement that the monstrosity that we currently are going through.