ACA Running Thread

awaken said:

Agreed. This is why health insurance should be like home, life, auto insurance and separate from employment. Of course they're linked today due to government interference - so, yay government!

My daughter's kindergarten teacher was married to a tire mechanic. Two young kids making their way in the world. Since she had good insurance through the State, they decided for him to roll off his insurance and on to hers. His term ended in July, and he would be effective on her insurance in October. What could happen to a healthy young male between July and October, right? He got diagnosed with an aggressive brain tumor that needed immediate surgery. Could not wait until October. Waiting would cost him his sight. He could have the surgery done at Duke or fly in the doctor who invented this special kind of surgery from Japan. They went with surgery at Duke, and he survived just fine. I imagine his medical bills were a healthy six figures if not seven. I have no idea how a teacher and mechanic could ever pay this. We attended a spaghetti dinner the school held for them, but while a nice gesture, it had to be a drop in the bucket. We moved away, and this was at least twelve years ago, so I don't know how their story ends.

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Kentucky’s Medicaid administration costs jumped more than 40% after implementing work requirements , a new report from Fitch Ratings shows. Those costs were incurred before a federal judge ruled against Kentucky’s Medicaid work requirements last month, dealing the effort at least a temporary blow.

“In its biennial budget, Kentucky’s Medicaid administration costs increased more than 40%, or $35 million, from prior biennium to $116 million, which Fitch partially attributes to implementing Medicaid work requirements,” Eric Kim, the lead analyst for Fitch on the report, “Medicaid Waiver Actions Limit U.S. States’ Cost Controls,” wrote. “In addition to systems development and ongoing monitoring for the roughly 200,000 Medicaid enrollees, Kentucky estimates could be subject to the work requirements and could also contribute to the higher administration costs.”

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Blue Cross and Blue Shield of North Carolina said Tuesday that it is requesting permission from the N.C. Department of Insurance to lower premium rates by an average 4.1 percent for individuals signing up for 2019 coverage on the federal health-insurance exchange.

The insurer stressed that the reduction could have been up to 15 percent if not for the uncertainty about the future of the Affordable Care Act, commonly known as “Obamacare.”

For example, the Trump administration drastically cut funding for publicizing the ACA enrollment period, which begins Nov. 1 and is likely to run through Dec. 15.

Blue Cross estimates it will cover more than 475,000 North Carolinians with exchange plans next year.

Blue Cross hinted on July 13 that a rate cut was possible when it confirmed its plans to cover all 100 counties for the 2019 exchange.

Nonetheless, the reduction represents the first rate decrease in Blue Cross of North Carolina’s history since entering the current individual market in 1993....

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...Blue Cross said in its actuarial memo to the federal Centers for Medicare and Medicaid Services that "due to destabilizing federal health policy, we expect the individual market to contract significantly in 2019."

The insurer said the repeal of the individual mandate "removes much of the incentive for healthy, unsubsidized individuals to purchase coverage."

The expansion of short term limited duration health plans "is expected to magnify this effect, as it will provide an option for those healthy, unsubsidized members that value health insurance coverage."

"Repeated attempts by Congress to repeal the ACA is likely to reduce consumer confidence in the program and may exacerbate these effects."...

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Deacon923 said:

Even when people have skin in the game via high deductibles, and even when the healthcare they need could be shopped for a lower price, they don't/won't shop for care. Instead they do whatever their doctor tells them. https://theincidentaleconomist.com/wordpress/shopping-for-health-care-simply-doesnt-work/

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On graduation, most medical students swear some version of the ancient Hippocratic oath — a promise to act morally in their role as physicians. Human nature being what it is, some will break their promise. But we still expect those who provide health care to behave more ethically than the average member of society.

When it comes to how political figures deal with health care, however, we’ve come to expect the opposite, at least on one side of the aisle. It often seems as if Republican politicians have secretly sworn a Hypocrite’s oath — a promise to mislead voters to the best of their ability, to claim to support the very protections for the sick they’re actively working to undermine.

To see what I mean, consider the case of Josh Hawley of Missouri, who is running for the Senate against Claire McCaskill.

Hawley is one of 20 state attorneys general who have brought a lawsuit attempting to repeal a key provision of the Affordable Care Act — the provision that protects people with pre-existing medical conditions, by requiring that insurance companies cover everyone of similar age at the same rate regardless of medical history. Kill that provision, and millions of vulnerable Americans will lose their insurance.

But here’s the thing: Protecting coverage for pre-existing conditions is overwhelmingly popular, commanding majority support even among Republicans. And McCaskill has been hammering Hawley over his role in that lawsuit.

So Hawley has responded with ads claiming that he, too, wants to protect those with pre-existing conditions, as supposedly shown by his support for a bill that purports to provide such protection.

I have to say, you almost have to admire the sheer brazenness of the dishonesty here. For the bill Hawley touts is a fraud: It’s full of loopholes allowing insurers to discriminate in ways that would end up making essential health care unaffordable for those who need it most. For example, while it would require that they offer insurance to, say, cancer patients, it would allow them to sell policies that don’t cover cancer treatment — which would mean that policies that did cover such treatment would become prohibitively expensive.

And the fraudulence of this bill aside, even serious, nonfraudulent regulation of insurance companies isn’t enough in itself to provide affordable coverage for pre-existing conditions. If that’s all you do, those who sign up for coverage will be a lot sicker than those who don’t, which means a bad risk pool, which means high premiums. That was New York’s experience: Before the A.C.A., it had strong regulations on insurers, but high premiums meant that only people with health problems bought insurance on the individual market (as opposed to getting it from their employers), and this in turn kept premiums high.

To make regulation work, you have to back it up with incentives for healthy people to sign up, including subsidies that help lower-income families afford insurance. In other words, if you really want to make essential care available for pre-existing conditions while continuing to rely on private insurance companies, you need a system that looks a lot like … Obamacare. Indeed, New York premiums dropped in half when the A.C.A. went into effect.

Hence the Hypocrite’s oath. Republicans hate the idea of guaranteeing that all Americans receive essential health care, and they really, really hate the taxes on high incomes that help pay for Obamacare subsidies. And you can imagine an alternative political universe in which the G.O.P. openly admitted its true goals, justifying them on the basis of economic freedom, or something.

But in this universe, Republicans have decided that they must conceal their intention of taking health care away from those who need it most. So they’re doing what Hawley is doing: resorting to a combination of sabotage and smoke screen. On one side, they’re hacking away at the edges of the Affordable Care Act in the hope that it will implode. On the other, they’re pretending to want the very things — like guaranteed coverage of pre-existing conditions — they’re trying to destroy.

By the way, this is why many Democrats are talking about Medicare for all. Obamacare was a market-friendly health insurance reform designed in part to mollify conservatives; their response was scorched-earth opposition, followed by a series of attempts to exploit public confusion about how the Affordable Care Act works and what it will take to sustain it. So there’s something to be said for a simpler system that would be harder to game politically.

For one has to admit that the G.O.P.’s cynical strategy is working to some extent. True, polls show that Democrats hold a large edge over Republicans on the question of which party people trust more on health care. But that gap would surely be even bigger if more voters realized what the G.O.P. is actually trying to do.

So let’s be clear about this: If you or anyone you care about suffers from a pre-existing medical condition, Republicans are trying to take away your insurance. If they claim otherwise, they’re lying.

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PhDeac said:

Republicans can’t kill ACA but they can torture it.

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