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ACA Running Thread

I suspect most employer policies wont be cancelled. They will be updated to cover the new mandates and rating rules. Given the nature of the small group market (rating rules and benefits offered), we will see rate increases but no where near what we see in the individual market. So I don't think its all doom and gloom.

Some small groups will dump no doubt, but most experts, far from all, suspect it to be in the 10-20% range. An evolving strategy is for small groups to keep higher income people on the plan but dump lower income subsidy eligible employees to the exchange.

The other dynamic here is the fact that employers cannot contribute to the purchase of individual insurance so that leaves them to increases wages and lose a lot of the tax benefit of offering insurance. This of course reduces subsidy eligibility.

Plus, there are a lot of employers who believe in the importance of offering coverage (attract talent, keep sick days low, improve productivity, paternalistic).

Nothing surprises me these days in this environment but I think it highly unlikely we will see a mass exodus out of the small group market. Some yes. A lot , no.
 
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Thought this was telling. A timeline of 10 quotes from Sebelius.

10. “As I answered before, congressman, we will be open for open enrollment Oct. 1. We are on track to meet the Oct. 1 deadline.” - Sebelius to Rep. Kevin Brady during a congressional hearing on April 12.

9. “We are on track to flip the switch on Oct. 1 and say to people, 'Come on and sign up.'” - Sebelius in Dallas on July 28.

8. “But it’s sort of a great problem to have. It’s based on the fact that the volume is so high and the interest is so high.” - Sebelius to MSNBC’s Andrea Mitchell on Oct. 1.

7. “I think the volume-related issues are ones that we welcome, frankly.” - Sebelius to CNN’s Wolf Blitzer on Oct. 1.

6. “It started a little rockier than we’d like. It’s better today than it was yesterday.” - Sebelius on "The Daily Show" with Jon Stewart on Oct. 7.

5. “There are people who will pay money. And many of them will pay less than they pay for their cable or their cell phone bill. And God knows we all [love cable.]” - Sebelius on "The Daily Show" on Oct. 7.

4. “Believe me, we had some early glitches. But it’s getting better every day. ” - Sebelius in Pittsburgh, Pennsylvania on Oct. 10.

3. “I am first to say, 'We wish it could have been a lot smoother from Day One.'” - Sebelius in Columbus, Ohio on Oct. 18.

2. “We didn’t have enough testing, specifically for high volumes, for a very complicated project. We had two years and almost no testing,” Sebelius told The Wall Street Journal on Oct. 18.

1. "We had hoped they would have their A-team on the table but I'm talking to CEOs and urging them to make sure we have the talent they have available." - Kathleen Sebelius to CNN's Sanjay Gupta on Oct. 22, when asked about the performance of Healthcare.gov contractors
 
It is absolutely hilarious how much CH has owned RJ on this issue.
 
CHDeac said:
I suspect most employer policies wont be cancelled. They will be updated to cover the new mandates and rating rules. Given the nature of the small group market (rating rules and benefits offered), we will see rate increases but no where near what we see in the individual market. So I don't think its all doom and gloom.

Some small groups will dump no doubt, but most experts, far from all, suspect it to be in the 10-20% range. An evolving strategy is for small groups to keep higher income people on the plan but dump lower income subsidy eligible employees to the exchange.

The other dynamic here is the fact that employers cannot contribute to the purchase of individual insurance so that leaves them to increases wages and lose a lot of the tax benefit of offering insurance. This of course reduces subsidy eligibility.

Plus, there are a lot of employers who believe in the importance of offering coverage (attract talent, keep sick days low, improve productivity, paternalistic).

Nothing surprises me these days in this environment but I think it highly unlikely we will see a mass exodus out of the small group market. Some yes. A lot , no.
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15% out of the small group market. That would equate to about another 5-6 million people who are cancelled and forced into the exchanges. Never mind the number of folks who will see substantial changes in their coverage.

Anyway, here's AETNA's assessment - anecdotal as it may be.

"Aetna has already warned in its marketing materials that dramatic increases in premiums might be in the offing [for the small group market]. “Factors such as essential health benefits, maximum plan deductibles, the application of new taxes and fees and new rating rules will combine to push insurance premiums up substantially for some small businesses,” the insurer said.

In December, Aetna Chief Executive Mark Bertolini said he expects that premiums for individuals or small groups seeking coverage on health insurance exchanges will rise by 20% to 50% in 2014."

Let's say premiums rise 30% on average. Someone is eating that, and it won't be the small business that eats all of it.
 
Aetna is spot on IMHO. That being said, businesses will buy down benefits and shift more costs to employees. And they will shift more costs to people with family coverage. Some employers are dropping spouses coverage too. We will also see a move towards self funding in this segment as it is a way to bypass a lot of the new ACA requirements. This will be great to watch play out.

But I still think a lot of small groups will do enough to keep coverage for another year or two. After that? Who knows.

The original models by the Dems and Obama showed that more small groups would offer. We will see who is right.
 
CHDeac said:
Aetna is spot on IMHO. That being said, businesses will buy down benefits and shift more costs to employees. And they will shift more costs to people with family coverage. Some employers are dropping spouses coverage too. We will also see a move towards self funding in this segment as it is a way to bypass a lot of the new ACA requirements. This will be great to watch play out.

But I still think a lot of small groups will do enough to keep coverage for another year or two. After that? Who knows.

The original models by the Dems and Obama showed that more small groups would offer. We will see who is right.
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Don't businesses already shift HC rate increases to employees via lower compensation?
 
CHDeac said:
I used discretionary to describe non emergency or non critical care. So the cholesterol med example was really aimed at things like generics or the extended release version that formularies don't always control.

When a generic is $25 and the brand is $200 (the allowed amount, not the copay), people should have skin in the game and chose based off true costs. Or when 2 drugs do the same thing and one is lot cheaper. We need to unmask the costs that copays hide. I'm all for people taking these meds if needed, I just want them to see the real costs to make a conscious choice and pay more if it costs more.

On the broken arm...Consumers have choices....ER vs. Urgent Care vs. Ortho Urgent Care....HUGE difference in costs. So arm hirts, do you rush to the ER or find a close ortho? Or wait until the next day?

My crazy idea is we score consumers on their effective use of the system and reward good behaviors and educate poor behaviors.
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OK, that makes it more clear.

I don't think HSAs and HDCPs are bad, and the ACA allows them to continue. Overall though I don't see them as a panacea to reduce health care spending. Check out the link I posted earlier. They create some cost savings around the edges, but the real money is not being spent in the areas that the HSA/HDCP combo can impact. More employers are probably going to take advantage of the HSA/HDCP combos to retard the growth of their health care spend, and that's probably a good thing. I just think they are small potatoes on the cost savings front from a national perspective.
 
Yup. So I dont think this is anything different per se.
 
DeacMan said:
Al Franken admitted yesterday on Minnesota Public Radio that it may be time to delay the individual mandate for a year because the website sucks. That is a sign that hell has indeed frozen over.
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Franken is such a bomb-throwing terrorist racist for even thinking that, much less saying it out loud.
 
DeacLaw05 said:
Franken is such a bomb-throwing terrorist racist for even thinking that, much less saying it out loud.
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You left out that he's trying to open up a third front in the War on Women. The website would be working fine and the Young Invincibles would be flocking to the product they don't want to buy like good little comrades if only Fox News could silenced. Drone strikes for the people with slow internet connections, and this whole thing goes away, amirite?
 
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The bumbled implementation has certainly breathed new life into the Republican party.
 
I think that, more than any other reason, is why Reid sought to change the Senate rules this week. There is real reason to be concerned about control of the chamber come this time next year. Alaska, Montana, South Dakota, Louisiana, Arkansas, North Carolina, Iowa, West Virginia, Colorado, New Mexico and even Michigan are all Democratic seats that are in play. The good news/bad news is that in five of those states Dems are retiring. That is o.k. if the candidate was going to be in a tough fight anyway as the albatros at is Obamacare is off the table. It is bad if the incumbent was really popular.

There are really no Republican seats in play save, perhaps, Georgia.

Control of the Senate is definitely in play right now.
 
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DeacMan said:
I think that, more than any other reason, is why Reid sought to change the Senate rules this week. There is real reason to be concerned about control of the chamber come this time next year. Alaska, Montana, South Dakota, Louisiana, Arkansas, North Carolina, Iowa, West Virginia, Colorado, New Mexico and even Michigan are all Democratic seats that are in play. The good news/bad news is that in five of those states Dems are retiring. That is o.k. if the candidate was going to be in a tough fight anyway as the albatros at is Obamacare is off the table. It is bad if the incumbent was really popular.

There are really no Republican seats in play save, perhaps, Georgia.

Control of the Senate is definitely in play right now.
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So that the new incoming majority would have the previous majority to blame while exercising the rules they enabled? Are you kidding?
 
ONW said:
So that the new incoming majority would have the previous majority to blame while exercising the rules they enabled? Are you kidding?
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Yeah. Doesn't make any sense why they would do this now if the senate was in play. Perhaps it is a Trojan horse? I don't really think the senate is in play but I do think it will tighten up a bit.
 
Wrangor said:
Yeah. Doesn't make any sense why they would do this now if the senate was in play. Perhaps it is a Trojan horse? I don't really think the senate is in play but I do think it will tighten up a bit.
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You give Reid way too much credit!
 
ONW said:
You give Reid way too much credit!
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Do you think the Senate is in play? Need to pick up 6 seats...haven't really seen enough of the individual breakdowns to make much of an opinion. I know that the Democrats have to defend 20 and the Pubs only have to defend 15, so numerically that gives the Pubs somewhat of an edge to make some ground, but I really don't have a lot of in depth insight. You looked into at all yet? I guess it all kind of depends on how ACA shapes out over the next 12 months. If it continues on its current path I think anything is politically possible.
 
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