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ACA Running Thread

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".

It's not a job killer. It is a tax hike that will be paid for by the consumers.
 
It's not a job killer. It is a tax hike that will be paid for by the consumers.

Maybe. All taxes on businesses are ultimately paid by real people, whether the customers or the owners. That said no tax hike is passed on to the consumer with 100% efficiency, and the degree to which it is passed on depends on price elasticity in the market. Hard to tell what will happen in the medical device market, if insurance companies and Medicare do a better job holding the line on device reimbursement, then more of that hike will come out of profit margin to ownership.
 
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.

Not sure I understand how that would work in this context. If you are luring young healthies into the pool by giving them a refundable credit of what they pay for the insurance, then you are giving them free insurance. That does the opposite of the intended goal: it gets more potential patients into the system without also bringing their money into the system. Recognize that the system is only looking for the healthies' money, not the healthies themselves as patients.
 
Not sure I understand how that would work in this context. If you are luring young healthies into the pool by giving them a refundable credit of what they pay for the insurance, then you are giving them free insurance. That does the opposite of the intended goal: it gets more potential patients into the system without also bringing their money into the system. Recognize that the system is only looking for the healthies' money, not the healthies themselves as patients.

The private insurance companies don't care whether the healthies' (I like that word, BTW) premiums come out of their pockets or out of the government's pockets. At all. Either way it increases money coming into the pool. Maybe I am misunderstanding your post.
 
The private insurance companies don't care whether the healthies' (I like that word, BTW) premiums come out of their pockets or out of the government's pockets. At all. Either way it increases money coming into the pool. Maybe I am misunderstanding your post.

I may be misunderstanding Hulka's post, but as I read it the healthie would get a refundable credit back from the government for buying insurance as an enticement into the pool. So healthie pays a $1,000 premium and gets a $1,000 tax credit from the government. That is not adding any additional private money to the pool, it is just taxpayers subsidizing the pool. If we are going to have taxpayers subsidizing the pool, why would you actively invite the healthies to create more bodies to potentially treat? Just have taxpayer subsidy of the unhealthy.
 
I may be misunderstanding Hulka's post, but as I read it the healthie would get a refundable credit back from the government for buying insurance as an enticement into the pool. So healthie pays a $1,000 premium and gets a $1,000 tax credit from the government. That is not adding any additional private money to the pool, it is just taxpayers subsidizing the pool. If we are going to have taxpayers subsidizing the pool, why would you actively invite the healthies to create more bodies to potentially treat? Just have taxpayer subsidy of the unhealthy.

I did a poor job of outlining the details. So, here goes. The healthies that make bank probably already have ins because they can afford iit or work for a company that provides it. The ones that are waiters, etc, don't have it and even though they can afford it, choose not to have it because it is an expense they don't want or think they need.

This would be an income based credit (where a lot of the healthies would qualify-and they are qualifying for subsidies under obamacare). This law is going to cost the government trillions of dollars. If we are going to spend that money it is more efficient to do it directly rather than set up the obamacare infrastructure to distribute funds/monitor stuff.

I hope that helps understand my point.
 

Ive been swamped the past few days. Lots of ACA things in the hopper and lots of contingency planning going on.

I only read the article so its was pretty high level stuff. A few cursory thoughts...

-I am a huge fan of state high risk pools. You can do a lot with these product & rate wise. I think it was a wasted opportunity to throw them away w/ the ACA. They can really help get people enrolled while keeping non high risk pools rates lower.

-I do think we need innovation, crazy innovation actually, in Medicaid as the traditional FFS model just doesn't work well, IMHO. That being said, I haven't a clue what their patient centered Medicaid plan is. Im one of these crazies that thinks we can get innovation in the managed medicaid space but its a tough nut to crack. Would love to incent states to pilot, test, innovate.

-I think we need to change the tax treatment of employer sponsored insurance. I think its crazy that this is tax free in the employer space. This leads to over insurance which I think drives higher costs. It sounds like they were arguing something different.

-Low income people need access to premium assistance and I don't think tax credits as they laid out will get us there. I think the ACAs tax credits are ok in theory (advanceable, sliding based on income) but way too complicated and way to skewed to cover older people. My biggest issue is they are indexed to premium and since insurance costs increase faster than wages, its a disaster waiting to happen.

-It is missing transparency. We need to create cost transparency in this space with providers.

-It was also missing Medicare reforms. I think we need to overhaul how we pay docs in this space using some of the innovation from private payors in outcomes, cost/ quality data, etc.
 
CH,
Quite a few states are trying Managed Care with their Medicaid programs with very mixed results. Just remember, Medicaid pays me about 55 cents on the dollar of charges, how much more managed can you get and with my overhead running about 50% it won't take much more cutting to drop me out of the system. This is general in NC. It doesn't make since to me that the state can run the program with a 5% expense ratio, 95% going to patient care and a private insurance company with an expense ratio of 13% can provide more patient care dollars. Simple math says insurance company cannot provide better result.
 
CH,
Quite a few states are trying Managed Care with their Medicaid programs with very mixed results. Just remember, Medicaid pays me about 55 cents on the dollar of charges, how much more managed can you get and with my overhead running about 50% it won't take much more cutting to drop me out of the system. This is general in NC. It doesn't make since to me that the state can run the program with a 5% expense ratio, 95% going to patient care and a private insurance company with an expense ratio of 13% can provide more patient care dollars. Simple math says insurance company cannot provide better result.

They can't. But to the current NC governor and general assembly, that 5% expense ratio is "government waste" but the 13% is, I don't know, job creation or something.
 
923,
There is a great deal of pushback at this point on the plan to privatize the NC medicaid program, especially in light of the findings in that NC Health News article. The light is being let in but the General Assembly has the final word and there are quite a few very dark spaces in that group.
 
If you cut out the middlemen of insurance companies like we basically did with auto insurance and all but completely did with travel agents, premiums would definitely come down.
 
If you cut out the middlemen of insurance companies like we basically did with auto insurance and all but completely did with travel agents, premiums would definitely come down.

Commissions loads are about 3% of premium and are going down as trend goes up. So this is flat out wrong.
 
It's not just commissions. You have management costs, marketing costs and other costs.
 
CH,
Quite a few states are trying Managed Care with their Medicaid programs with very mixed results. Just remember, Medicaid pays me about 55 cents on the dollar of charges, how much more managed can you get and with my overhead running about 50% it won't take much more cutting to drop me out of the system. This is general in NC. It doesn't make since to me that the state can run the program with a 5% expense ratio, 95% going to patient care and a private insurance company with an expense ratio of 13% can provide more patient care dollars. Simple math says insurance company cannot provide better result.

Yeah, its not about reimbursement. Its about the lack of innovation in managing care. Our delivery system isn't designed around someone who makes 11000 a year, may live alone, has mental health or substance abuse issues or not have a car.

We need innovation in outreach, education, incentives and integration in Medicaid. I'm not sure the current public model does this consistently well.
 
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