ACA Running Thread

[PhDeac]

Link?

Sorry.

[h=1]You've Been Duped[/h] The Affordable Care Act isn't raising your premiums. Republicans are.
https://www.usnews.com/opinion/poli...aised-your-health-care-premiums-not-obamacare


Op-Ed [h=1]Obamacare is only 'exploding' in red states[/h]
http://www.latimes.com/opinion/op-ed/la-oe-baker-obamacare-red-state-20170713-story.html

When he talks about his efforts to repeal the Affordable Care Act, President Trump almost always asserts that Obamacare is “exploding.” Republican members of Congress make similar claims, insisting that Obamacare is unsustainable—and that they therefore have no choice but to “repeal and replace” it.


There is some basis for this argument. More than 1,300 counties only have one insurer in their exchanges, meaning there is no competition. But there is a nuance that Republicans willfully ignore: This is a problem of their own creation that is largely confined to red states.

Where Republican governors have sought to sabotage the program, they have largely succeeded. Where Democratic governors have tried to make the ACA work, they too have largely succeeded.
Here are the basic numbers. In states with Republican governors, more than 40 million people live in counties with only one insurer. In states with Democratic governors, there are 10.7 million people who live in such counties.


The difference is far more dramatic if we exclude North Carolina from the Democratic list. While North Carolina does now have a Democratic governor, it had a Republican governor until January, and even now the Legislature is overwhelmingly Republican.
Not counting North Carolina, only 2.1 million people in Democratic states live in counties without competition. Put another way, if someone lives in a state with a Democratic governor other than North Carolina, they have a 1.8% probability of only having a single insurer in their exchange. If they live in a state with a Republican governor, there is a 20.7% probability of the same.

There are two main ways in which Republican governors have been effective in sabotaging Obamacare in their states. The first and most important was by refusing to expand Medicaid.
...
The other issue is the extent to which states took the initiative to promote Obamacare. Less healthy people generally don’t have to be prodded to buy insurance, since they know they need it. The issue is whether more healthy people buy into the system. Insurers are going to lose money if all the people they insure have serious health problems.

 

[tiltdeac]

LOL

 

[CHDeac]

Why are we paying insurers off to lower the out of pockets for lower income members when we have Medicaid which is designed to take care of lower income members?

This also doesn't seem to jive with the actuarial math of only 5-8% of people in any given year reaching an out of pocket maximum. Changing that number to reduce it shouldn't result in a 19% rise in premiums for all.

It doesn't jive because the "pay off" applies to a lot of benefits like deductibles, copays, coinsurance as well as total OOP maximums. Lets remember the CSRs are part of the law and insurers are required to offer them, just as the Feds are required to pay insurers back for these "free" upgrades. And the Rs are using a loophole, a questionable one at that, to threaten to stop funding these. BS politics at its best.

Are you arguing people under 250% shoudl all be on Medicaid (250% FPL is where the CSRs kick in)? Im pretty sure that might bankrupt a lot of hospitals and is just bad overall policy IMHO. Medicaid is a program designed for poor kids and pregnant women and some elderly. Its not the chassis I would bild reform around.

 

[CHDeac]

I don't think it's true that the best doctors don't take medicaid, but it's a difficult thing to prove. I can point to recent large survey data (LINK) to suggest that patients access to and satisfaction with the care they get with Medicaid is quite good, which is one measure. True comparative outcomes research is difficult because the patient populations are so fundamentally different, but we shouldn't just assume it is worse than private insurance (LINK). I work at a well known "top" hospital, and we certainly take Medicaid (I'm also on salary and it makes no difference to my income the number of patients I see or the insurance mix). That said, what CH said about private insurance subsidizing Medicaid is true. Private insurances pay us at higher rates (not just than Medicare/Medicaid, but they pay us significantly more for the same service than they pay the other large hospital system in the city because we are the better brand). As a department, if our payer mix is significantly different than projections (a higher percentage of Medicaid patients for example) we would not meet our budget, and if everyone paid Medicaid rates, we'd have to adjust our practice and I'd make less money. It wouldn't be a big deal for a specialist like me, but for some of the less well compensated doctors (pediatricians, family medicine docs), that would be difficult.



Fair. Everything I've read seems to suggest that overhead is either comparable to or lower than private insurance, but exactly how those audits are done I don't know.



I think it's completely fine to allow the states freedom to administer health care if that is deemed more efficient, as long as certain minimum standards of care and coverage were met. "Let states deal with it" can result in states electing not to expand Medicaid resulting in 3 million people without insurance, for example.

Good post. Its interesting to look at payer mix when assessing care. Those with a larger Medcaid mix would tend to be lower in overall quality as measured by the different groups that look at these things. Medicaid serves an important role but again, not sure I would design a system around it.

 

[CHDeac]

[h=1]You've Been Duped[/h] The Affordable Care Act isn't raising your premiums. Republicans are.




Thoughts?

Spot on. That being said, the design the Dems came up with was inherently going to spike costs and did so more than a lot of experts thought, thus why so many insurers lost $ in the first 3 years.

The courts will eventually settle the risk corridors suits and I woul expect the insurers to get their $. Most of the early results point to this. And the feds themselves admit they owe it.

Of course the Part D program, a Republican law passed in 2003, had a (wait for it) risk corridor program. Oooops.

If the corridors werent part of the program originally, I doubt many insurers would have even participated. This stop gap was a main reason we entered the market.

 

[PhDeac]

http://www.politico.com/story/2017/...o-defer-obamacare-repeal-vote-240596?cmpid=sf

The Senate will "defer" consideration of its attempt to repeal and replace Obamacare, said Senate Majority Leader Mitch McConnell on Saturday night. The announcement follows Sen. John McCain's surgery that will keep him away from Washington next week. The bill has two GOP senators in opposition already and likely would have failed to advance with McCain's absence.

 

[2&2 Slider To Leyritz]

Good post. Its interesting to look at payer mix when assessing care. Those with a larger Medcaid mix would tend to be lower in overall quality as measured by the different groups that look at these things. Medicaid serves an important role but again, not sure I would design a system around it.

We didn't need to design a system around it, we needed to use it to address the ~10% or so that Obamacare was supposed to address (in actuality quite less, if you ignored the healthy younger population that could have afforded insurance but just chose not to). But Obama FUBARed the entire system, so here we are.

 

[RJKarl]

Spot on. That being said, the design the Dems came up with was inherently going to spike costs and did so more than a lot of experts thought, thus why so many insurers lost $ in the first 3 years.

The courts will eventually settle the risk corridors suits and I woul expect the insurers to get their $. Most of the early results point to this. And the feds themselves admit they owe it.

Of course the Part D program, a Republican law passed in 2003, had a (wait for it) risk corridor program. Oooops.

If the corridors werent part of the program originally, I doubt many insurers would have even participated. This stop gap was a main reason we entered the market.

And the Part D scam has wasted hundreds of billions of dollars due to their fascist non-competitive bidding part of the law. It is totally outrageous, un-American, anti-capitalistic to bar the government from negotiating the lowest prices for prescriptions that can be had anywhere in the world.

It is an abomination that the biggest purchaser of many drugs pays more than smaller purchasers. There is no excuse for this.

 

[ONW]

Why are we paying insurers off to lower the out of pockets for lower income members when we have Medicaid which is designed to take care of lower income members?

This also doesn't seem to jive with the actuarial math of only 5-8% of people in any given year reaching an out of pocket maximum. Changing that number to reduce it shouldn't result in a 19% rise in premiums for all.

When those 5-8% of people reach their maximum, the insurance companies keep paying the bills, and that is being built into everyone's premiums.

 

[dartsndeacs]

[/B]

It doesn't jive because the "pay off" applies to a lot of benefits like deductibles, copays, coinsurance as well as total OOP maximums. Lets remember the CSRs are part of the law and insurers are required to offer them, just as the Feds are required to pay insurers back for these "free" upgrades. And the Rs are using a loophole, a questionable one at that, to threaten to stop funding these. BS politics at its best.

Are you arguing people under 250% shoudl all be on Medicaid (250% FPL is where the CSRs kick in)? Im pretty sure that might bankrupt a lot of hospitals and is just bad overall policy IMHO. Medicaid is a program designed for poor kids and pregnant women and some elderly. Its not the chassis I would bild reform around.

We have like 80 million people on medicaid. Do we really have many more than that being under 250% of poverty?

 

[dartsndeacs]

When those 5-8% of people reach their maximum, the insurance companies keep paying the bills, and that is being built into everyone's premiums.

Yes, but what is causing the high premiums are the few people that the insurance companies are paying millions of dollars in medical costs for. Changing the out of pocket maximum one way or another a few thousand dollars shouldn't result in drastic premium changes for all, since only a small amount of people hit that maximum, and it's only changed a few thousand dollars.

 

[ONW]

Yes, but what is causing the high premiums are the few people that the insurance companies are paying millions of dollars in medical costs for. Changing the out of pocket maximum one way or another a few thousand dollars shouldn't result in drastic premium changes for all, since only a small amount of people hit that maximum, and it's only changed a few thousand dollars.

So I have a million dollar surgery, I max out at 10K instead of 5K, someone is still eating 990K.

 

[dartsndeacs]

So I have a million dollar surgery, I max out at 10K instead of 5K, someone is still eating 990K.

Yes, but it stated that the removal of the subsidies on the out of pocket max is what's driving up the premiums. As you point out, someone is still eating 990k, so the removal of those subsidies should not affect the premiums much at all. That's my point.

 

[dartsndeacs]

It doesn't jive because the "pay off" applies to a lot of benefits like deductibles, copays, coinsurance as well as total OOP maximums.

CH explained it partially, as I read "out of pockets" as "out of pocket maximums"

Still suppose I'm ignorant on just how many poor people and how much damn subsidizing we're doing here. 80 million people on medicare (~25% of our population). Yet our federal government needs to further subsidize to make healthcare have less costs since more than 25% of our population qualifies as needing assistance?

Almost seems like we need to focus on Making America Great Again.

 

[dartsndeacs]

32% of American families at 200% of poverty level. Unreal.

 

[myDeaconmyhand]

32% of American families at 200% of poverty level. Unreal.

We could start by removing the complicated poverty aspect of the plan and just implement a single payer system.

 

[CHDeac]

CH explained it partially, as I read "out of pockets" as "out of pocket maximums"

Still suppose I'm ignorant on just how many poor people and how much damn subsidizing we're doing here. 80 million people on medicare (~25% of our population). Yet our federal government needs to further subsidize to make healthcare have less costs since more than 25% of our population qualifies as needing assistance?

Almost seems like we need to focus on Making America Great Again.

What % of Americans are covered under the ACA, not including Medicaid expansion? 5% or so? And of these, Id estimate 70% are under 250% of the FPL. So this impacts about 3.5% of the population? I think Medicaid is 20%, Medicare is around 15% while the employer market is around 50%. I'm not sure I'd call Medicare subsidized as a lot of people paid into since the mid 1960s. So maybe 1 in 4 are on a heavily subsidized health plan?

Id still argue enrolling adult working men on Medicaid is a bad idea and keeping them in the ACA or employer market is much preferred. Medicaid is designed around poor women and children. I also fret at the idea of Medicare for all as its designed for Srs. It would be bad to do that IMHO.

 

[CHDeac]

And the Part D scam has wasted hundreds of billions of dollars due to their fascist non-competitive bidding part of the law. It is totally outrageous, un-American, anti-capitalistic to bar the government from negotiating the lowest prices for prescriptions that can be had anywhere in the world.

It is an abomination that the biggest purchaser of many drugs pays more than smaller purchasers. There is no excuse for this.

So not that easy. That being said, Part D in its current form is well under CBO projections. Yet everyone hates it ex for the people on it.

 

[PhDeac]

McCain's surgery may be more serious than previously thought.
https://www.nytimes.com/2017/07/16/health/john-mccain-blood-clot-recovery.html

Interesting parallel to Democrats losing Ted Kennedy's 60th vote for ACA.

 

[dartsndeacs]

So not that easy. That being said, Part D in its current form is well under CBO projections. Yet everyone hates it ex for the people on it.

I can confirm there's no major issue with medicare and all its supplements. The two owners of my company I just moved them on it, saved half compared to what they'd pay on the private market, and they're getting better coverage. they both have enough money to get the best coverage there is. Medicare (and the full range of supplements) is it.

I do get concerned reading things like medicaid can negotiate 40% the costs that medicare does..... But medicare ain't got many issues from the user's perspective.