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ACA Running Thread

CHDeac said:
20M at it high water mark out of 330M (my stats may be a little off) The way people bitched about it, you would have thought it hit everyone in the country hard.

For the most part, it helped some lower income Americans and those that had trouble getting insurance due to their health. Thats a good thing.

Counterpoint?
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That $20M seems way low. Is that just the newly insured? The bill had a positive impact on a ton of people who already had insurance as well (and a negative impact on a fair many others).
 
CHDeac said:
Lots of people claim harm who have large group insurance. Thats total BS IMHO.
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I know my costs for my large group plan have gone up tremendously since ACA was passed. I don’t know how you call that BS.
 
RChildress107 said:
That $20M seems way low. Is that just the newly insured? The bill had a positive impact on a ton of people who already had insurance as well (and a negative impact on a fair many others).
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The people enrolled on exchanges, increase to Medicaid (some were already eligible pre ACA and didnt know it) and the up to 26 group folks. In NC, the U65 market was ~400k pre ACA and jumped to 600k now so all of it wasn't from the uninsured. Some shifts as groups dropped. Of course, the uninsured rate dropped almost in half. So thats good.

I think the other benefits were largely window dressing. Most plans had all the ESBs covered. In the 25 years I've worked in the payer space, we've had fewer than 10 people hit their lifetime max.

All good things, just not all that big a deal for many people.

My point is sorta the inverse. Lots of bitching where there were little to no impacts.
 
DistrictDeacon said:
I know my costs for my large group plan have gone up tremendously since ACA was passed. I don’t know how you call that BS.
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BS because it likely has nothing to do with the ACA and more likely a function of your groups claims experience and medical trend on things like speciality drug. Now, if your group is under 50, there were some impacts.
 
CHDeac said:
BS because it likely has nothing to do with the ACA and more likely a function of your groups claims experience and medical trend on things like speciality drug. Now, if your group is under 50, there were some impacts.
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The removal of lifetime maxima has no doubt contributed to the prevalence of very expensive orphan specialty drugs. Agreed this impacts an extremely low percentage of the population but it does drive trend to some (relatively small) degree.

The largest, by far, negative impact to large employer group plans would come from the one component that keeps getting kicked down the road - the excise tax for high-cost plans, which if implemented would eventually kill employer sponsored healthcare.
 
thatguy2016 said:
The removal of lifetime maxima has no doubt contributed to the prevalence of very expensive orphan specialty drugs. Agreed this impacts an extremely low percentage of the population but it does drive trend to some (relatively small) degree.

The largest, by far, negative impact to large employer group plans would come from the one component that keeps getting kicked down the road - the excise tax for high-cost plans, which if implemented would eventually kill employer sponsored healthcare.
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Totally agree with the Cadillac tax. Designed very poorly. I doubt it ever gets implemented.
 
We were in the individual Marketplace under ACA and our premium increases were insane and the increase in deductibles and lowering of benefits pretty much coincided with the premium increases. The last three years we switched over to a small business group and our premiums have hardly increased at all since then and our deductibles are back down to pre aca levels. It turned the individual Marketplace into a high-risk pool whether you should have been there or not and if you didn't qualify for the subsidies you just got reemed.
 
CHDeac said:
Carriers had to adjust networks and align with systems. Those that went alone were often left out in the cold and slowly withered.

Ironically, Primary Care is where all the new value based excitement (and $$$) is these days.
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A lot of realignment was already happening before ACA.



Anyhow, I work (now, for about 8 years) in a hospital environment. And I routinely hear folks bitching about the ACA as if it’s responsible for every perceived problem with healthcare. Nursing staffing too stretched—damn Obamacare! Etc.

Just a lot of misunderstanding mostly.

Sure the ACA was not enough and flawed. But it was a decent attempt to get most everyone insured under better insurance. If it had been supported in bipartisan fashion it was a very adequate platform that could have been adjusted over time to accomplish a lot of good.
 
Looking For ACA Health Insurance For 2019? Here's What To Expect

But the shopping and buying experience will vary widely, depending on where people live.
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Nonetheless...

"Every place in America — no matter where you live — the subsidies are there today and people should check and find out if they're eligible for them," Lee says.

In February 2018, nearly 90 percent of people who had insurance through an exchange qualified for subsidies.

The average premium for a benchmark policy for a 27-year-old is about $405 per month, according to the Department of Health and Human Services. But because of subsidies, the average price a 27-year-old will actually pay is $140 per month.
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Uggg, was looking at the individual market in the event I take advantage of tax reform and become self-employed. A small network blue shield platinum HMO through small group coverage is $380 with a $1,700 OOP max. Most similar plan on the individual marketplace is same platinum HMO with same carrier OOP Max of $3,600 (but the rest is the same), but a monthly premium of almost double, $690. What a mess.
 
palmab03 said:
Uggg, was looking at the individual market in the event I take advantage of tax reform and become self-employed. A small network blue shield platinum HMO through small group coverage is $380 with a $1,700 OOP max. Most similar plan on the individual marketplace is same platinum HMO with same carrier OOP Max of $3,600 (but the rest is the same), but a monthly premium of almost double, $690. What a mess.
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Lol
 
 
https://theintercept.com/2018/11/20/medicare-for-all-healthcare-industry/

"NOW THAT THE midterms are finally over, the battle against “Medicare for All” that has been quietly waged throughout the year is poised to take center stage.
Internal strategy documents obtained by The Intercept and Documented reveal the strategy that private health care interests plan to use to influence Democratic Party messaging and stymie the momentum toward achieving universal health care coverage..."
 
Health Insurance companies running equipment racket and spying on their clients via CPAP machines "monitoring compliance"
https://www.propublica.org/article/you-snooze-you-lose-insurers-make-the-old-adage-literally-true

Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook


"...When his doctor prescribed a CPAP, the company that supplied his device, At Home Medical, told him he needed to rent the device for $104 a month for 15 months. The company told him the cost of the CPAP was $2,400.
Levy said he wouldn’t have worried about the cost if his insurance had paid it. But Levy’s plan required him to reach a $5,000 deductible before his insurance plan paid a dime. So Levy looked online and discovered the machine actually cost about $500.
Levy said he called At Home Medical to ask if he could avoid the rental fee and pay $500 up front for the machine, and a company representative said no. “I’m being overcharged simply because I have insurance,” Levy recalled protesting..."
 
myDeaconmyhand said:
Health Insurance companies running equipment racket and spying on their clients via CPAP machines "monitoring compliance"
https://www.propublica.org/article/you-snooze-you-lose-insurers-make-the-old-adage-literally-true

Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook


"...When his doctor prescribed a CPAP, the company that supplied his device, At Home Medical, told him he needed to rent the device for $104 a month for 15 months. The company told him the cost of the CPAP was $2,400.
Levy said he wouldn’t have worried about the cost if his insurance had paid it. But Levy’s plan required him to reach a $5,000 deductible before his insurance plan paid a dime. So Levy looked online and discovered the machine actually cost about $500.
Levy said he called At Home Medical to ask if he could avoid the rental fee and pay $500 up front for the machine, and a company representative said no. “I’m being overcharged simply because I have insurance,” Levy recalled protesting..."
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Medical usury. This time by the insurance company. There ought to be a law....
 
Hopefully those 14 Dem controlled states can come up with workable systems and eventually develop a framework for what a national plan would look like.

More Democrats need to run on the successes of blue states and say they will work to do the same in their state.
 
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