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ACA Running Thread

There are a lot of questionable statements in that article. Just to take a couple:

1. "Short-term policies, which were limited under the Obama administration to three months maximum and no renewals, would be expanded under Trump to last up to a year." The 90-day guideline went into effect on April 1st, 2017. The "no renewals" piece is also misleading. Customers can sign up for multiple consecutive 90-day plans right now, up to 360 days, not technically a "renewal" I guess since they do it all at once.

2. "The economically rational response for the healthy in that segment would be to pay $100 or less a month in premiums and barely use any services over the course of the year. The danger, of course, is that anyone can get hit by a bus or find themselves holding an unexpected cancer diagnoses. Then they're screwed." Why exactly would they be 'screwed'? They are probably better off with a short term plan in those two examples for a variety of reasons, unless their claims exceeded a few million dollars during the calendar year.
 
Because the coverage is not regulated as an ACA compliant plan—the short-term plans are cheaper for a reason: typicaly don’t cover nearly as much, exclude coverage for preexisting conditions, imposed maximum coverage amounts, etc. So if you get sick, when you roll into your next short-term plan they can exclude coverage for your new illness.

It’s just another of many ways to degrade the viability of ACA compliant plans. Thus are their costs/premiums skyrocketing.
 
ConnorEl said:
Because the coverage is not regulated as an ACA compliant plan—the short-term plans are cheaper for a reason: typicaly don’t cover nearly as much, exclude coverage for preexisting conditions, imposed maximum coverage amounts, etc. So if you get sick, when you roll into your next short-term plan they can exclude coverage for your new illness.

It’s just another of many ways to degrade the viability of ACA compliant plans. Thus are their costs/premiums skyrocketing.
Click to expand...

Right, but if you were approved for the plan then the examples of getting hit by a bus, or diagnosed with cancer would be covered just fine (up to typically 2 million), and you would have the plan up until you could get back into an ACA plan if you were going to be ineligible from that point forward.

My main issue is on the "Short-term policies, which were limited under the Obama administration". The 360 day short term plans were available from day 1 of the ACA rollout until April of last year. And since that time customers have just been buying multiple 90-day short term plans at once so they do not have to go back through underwriting if they get cancer/etc. This article is written in a way where the reader would likely think the 360 day limit is something completely new that hasn't been impacting premiums on the ACA side from the start.
 
After a year of the White House (and GOP in general) screaming from the hilltops that the ACA was in a death spiral, the White House quietly releases a report from the Council of Economic Advisors that says, well actually, the insurers are doing just fine.

Health insurance companies initially struggled to make a profit in the post-ACA individual and
small group markets. Insurers were unsure how to price insurance with the new ACA
requirements such as, guaranteed-issue modified community rating, and an expansive
minimum essential benefits requirement. They underpriced their products relative to their
enrollees’ health risks. Many insurers left the market altogether. But the remaining insurers,
despite the expiration over a year ago (2016) of the reinsurance and risk corridors programs
which were meant to financially protect insurers, have started to make higher profits again
(McCue & Hall 2017). Figure 2 shows that, after narrowing in the initial years of ACA
implementation, the gap between individual market premiums and claims payments was
much higher in 2017 than pre-ACA. As of 2017, most Blue Cross Blue Shield regional insurers,
the main insurers left in the ACA-compliant individual and small group markets, have better
profit margins than during the initial years of offering plans in marketplaces and have returned
to pre-ACA profitability (Farrah 2018).
Click to expand...

https://www.whitehouse.gov/wp-content/uploads/2018/03/The-Profitability-of-Health-Insurance-Companies.pdf
 
https://jamanetwork.com/journals/jama/article-abstract/2674671?redirect=true

Conclusions and Relevance The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions.
 
tiltdeac said:
After a year of the White House (and GOP in general) screaming from the hilltops that the ACA was in a death spiral, the White House quietly releases a report from the Council of Economic Advisors that says, well actually, the insurers are doing just fine.



https://www.whitehouse.gov/wp-content/uploads/2018/03/The-Profitability-of-Health-Insurance-Companies.pdf
Click to expand...

Of course the margins are better now that carriers have years of actuarial data to use when setting premium rates. However, the increased rates have eliminated most people earning between 400%-600+% of the Federal Poverty Level from being able to afford an insurance plan.
 
LCDeacon said:
Of course the margins are better now that carriers have years of actuarial data to use when setting premium rates. However, the increased rates have eliminated most people earning between 400%-600+% of the Federal Poverty Level from being able to afford an insurance plan.
Click to expand...

Sure. That's an entirely different problem though. The whole death spiral talk was essentially that premiums were going to continue to spike, insurers would all leave the market, and the market would implode on it's own. It's clear that that was false, and the spike in 2017 was a one time correction for the risk pool. The markets are stable, not spiraling.

No question a big problem, maybe the biggest problem, with the ACA is unaffordability for people over the 400% threshold, and that needs to be addressed. I'm not sure what the best solution is. Some combination of additional subsidies made available for patients >400% FPL + reinsurance?
 
Example 1000 of why our current system is garbage

https://www.vox.com/2018/5/1/17261488/er-expensive-medical-bill

She didn’t get treated at the ER. But she got a $5,751 bill anyway.

Vox’s emergency room database shows that patients can face steep bills even when they decline treatment.
On October 19, 2016, Jessica Pell fainted and hit her head on a nearby table, cutting her ear. She went to the emergency room at Hoboken University Medical Center, where she was given an ice pack. She received no other treatment. She never received any diagnosis. But a bill arrived in the mail for $5,751.
“It’s for the ice pack and the bandage,” Pell said of the fee. “That is the only tangible thing they could bill me for.”
Pell’s experience is not unique. Submissions to Vox’s ER database project found multiple examples of ERs charging patients hundreds or even thousands of dollars for walking through the door. Some never got past the waiting room. Some were triaged, but none received treatment from a doctor.
Pell left the ER when she discovered the plastic surgeon who would see her was out of network for her insurance. She decided to go to an in-network facility instead. She thought this was a smart way to avoid the costly fees that came with seeing a provider that wasn’t included in her health plan.
“I decided to decline treatment because I can’t really afford any surprise bills right now,” she said. “The bill I’d probably incur would not be worth saving my ear, which was sad but a choice I had to make.”
Pell’s health insurance plan paid the hospital $862, what it deemed a “reasonable and appropriate” fee for the services the hospital paid. That left Pell with a $4,989 bill that she received on February 28.
 
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Providers are gouging. We need a medical usury law.

In another thread, rj was saying that medical providers often wreck people's credit. These types of charges seen in the vox article and Time magazine's A Bitter Pill article put people in unnecessary financial hardship. If they cannot pay, they get sent to collection agency. That's how unscrupulous providers have become - they'd rather sell "debt" of inflated, BS charges for ten cents on the dollar and ruiin someone's credit than negotiate a reasonable rate.
 
We need a much better regulated health care system.

Everyone needs a way to have needed care provided without truly undue financial hardship.

People need to vote for (reward) politicians (if we can find them) that advocate for reasonable solutions, not politicians who champion inflammatory, demagogic, or empty sloganism.

And, based especially on the last decade...that means we need to vote for very few Republicans.
 
Group to submit 60,000 signatures for Medicaid expansion in Idaho. Here's what's next.

Months of gathering signatures by volunteers for the Reclaim Idaho group has come down to this.

The group's organizers, who are aiming to expand Medicaid and provide health care to 62,000 uninsured Idahoans through their Medicaid for Idaho petition drive, plan to submit today and Tuesday more than 60,000 signatures they've gathered to get the measure on the November ballot.

County clerks now have until June 30 to validate the 60,000 signatures. All petitions must be submitted to the Secretary of State's Office on July 6. Volunteers and supporters are planning a large celebration at the Idaho State Capitol when that happens, according to the press release.

If the measure qualifies for the ballot, voters statewide would decide its fate at the general election Nov. 6.
Click to expand...
 
myDeaconmyhand said:
Example 1000 of why our current system is garbage

https://www.vox.com/2018/5/1/17261488/er-expensive-medical-bill

She didn’t get treated at the ER. But she got a $5,751 bill anyway.

Vox’s emergency room database shows that patients can face steep bills even when they decline treatment.
On October 19, 2016, Jessica Pell fainted and hit her head on a nearby table, cutting her ear. She went to the emergency room at Hoboken University Medical Center, where she was given an ice pack. She received no other treatment. She never received any diagnosis. But a bill arrived in the mail for $5,751.
“It’s for the ice pack and the bandage,” Pell said of the fee. “That is the only tangible thing they could bill me for.”
Pell’s experience is not unique. Submissions to Vox’s ER database project found multiple examples of ERs charging patients hundreds or even thousands of dollars for walking through the door. Some never got past the waiting room. Some were triaged, but none received treatment from a doctor.
Pell left the ER when she discovered the plastic surgeon who would see her was out of network for her insurance. She decided to go to an in-network facility instead. She thought this was a smart way to avoid the costly fees that came with seeing a provider that wasn’t included in her health plan.
“I decided to decline treatment because I can’t really afford any surprise bills right now,” she said. “The bill I’d probably incur would not be worth saving my ear, which was sad but a choice I had to make.”
Pell’s health insurance plan paid the hospital $862, what it deemed a “reasonable and appropriate” fee for the services the hospital paid. That left Pell with a $4,989 bill that she received on February 28.
Click to expand...

sounds like the $3k bill my wife got for visiting the ER for a burn on her hand; nurse wrapped in gauze and said take some advil and sent her home.
 
60 Minutes with a good piece on drug pricing:

https://www.cbsnews.com/news/the-problem-with-prescription-drug-prices/

The underlying problem we have with prescription drugs in this country is that every single actor has the potential to make money when drug prices go up. Remember that for drugs that doctors give to their patients, they make more money when they give expensive drugs than less expensive drugs. It's true of hospitals, too. It's true of pharmacies as well. And so this ever-expanding pie is serving everyone.
 
awaken said:
Providers are gouging. We need a medical usury law.

In another thread, rj was saying that medical providers often wreck people's credit. These types of charges seen in the vox article and Time magazine's A Bitter Pill article put people in unnecessary financial hardship. If they cannot pay, they get sent to collection agency. That's how unscrupulous providers have become - they'd rather sell "debt" of inflated, BS charges for ten cents on the dollar and ruiin someone's credit than negotiate a reasonable rate.
Click to expand...

In addition to the outrageous pricing, people on the other end often get screwed. My friend has me several instances of people's credit getting fucked without them knowing. The most egregious I have personally was a guy who was perfect on everything else, but he had three medical charge-offs. They totaled $22. I would make a massive bet he had no idea he had those bills.

The collection agency had zero incentive to call him or contact him in any way and doesn't care how they harm people. I would say collection agencies probably have a floor amount to go after and don't bother with people under that number. After a certain period, it goes from being a "collection" on your credit to "charge-off" which is far worse.
 
thatguy2016 said:
60 Minutes with a good piece on drug pricing:

https://www.cbsnews.com/news/the-problem-with-prescription-drug-prices/

The underlying problem we have with prescription drugs in this country is that every single actor has the potential to make money when drug prices go up. Remember that for drugs that doctors give to their patients, they make more money when they give expensive drugs than less expensive drugs. It's true of hospitals, too. It's true of pharmacies as well. And so this ever-expanding pie is serving everyone.
Click to expand...

That was a depressing segment. Fuck the drug manufacturers, middle men and providers who do this shit.
 
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ConnorEl said:
People need to vote for (reward) politicians (if we can find them) that advocate for reasonable solutions, not politicians who champion inflammatory, demagogic, or empty sloganism.
Click to expand...

Empty sloganism like "Yes, we can" and "If you like your doctor, you can keep your doctor"?
 
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