ACA Running Thread

[ConnorEl]

Only three providers up to now? Or on the exchange? Or both?

Are some providers in NC or elsewhere at risk for significant losses due to the ACA? Conversely, will some be likely winners?

Just wondering.

 

[ConnorEl]

Don't you agree that the new law makes that more likely, since the biggest deterrent of all has been removed? When you take away the preexisting condition denial, you'd have to ratchet the penalty above the cost of insurance premiums to draw the attention of a rational actor, no? I get what you mean about open enrollments...but those people are already running the risks you say that they might later choose to avoid. Why would they change when you've dulled the teeth on the saw of deterrence?

Sure, I see what you're saying. I still think guaranteed issuance is desirable. And I'm pretty sure that over time the idea is to make it work out so that most everybody ends up insured. By "choice" as the carrots/sticks are adjusted.

 

[CHDeac]

CH, question for you (I don't know exactly what you do but obviously you're in the health insurance industry in some way).

If someone is forced out of a non-complying (if that's the right term) plan with insurance company A and onto an ACA exchange plan with insurance company B, I guess this is a loss for company "A".

What's the situation in NC and more broadly...are most companies in the position of "A" also on the exchanges? Or not?

In most cases, they are. Insurers spend a lot of effort trying to explain how to stay with A. Insurers actually mapped people to the closest ACA compliant plan they could with a call to action of "check to see if you are subsidy eligible". If they do nothing, they auto renew them so there is no gap in coverage.

BTW, NC now has 2 exchange carriers as one dropped. BCBSNC and Coventry. BCBSNC is in all 100 counties, Coventry in 39.

 

[CHDeac]

I hear you, and that is very good post.

I think the mandate will push a greater percentage of those young people into buying the insurance, and getting something, over paying the penalty and getting nothing. For the first time it's now a case where you're going to lay out some money one way or the other. I feel confident that the majority of those people will want something back in return, especially when it's the also sensible thing to do. The mandate should spur rational behavior, I think.

That seems like a glitch that would fixed be made by a sensible bipartisan agreement, if were lived under a government that could function properly.

A strong mandate will. The year 1 mandate coupled with all the issues may not. I'm work in marketing/enrollment and we get folks excited to buy but they cant enroll. So off they go....Hopefully we will find them again but there's nothing like getting them to sign up right then and there.

 

[Deacon923]

Are we supposed to be cheering about all the people supposedly getting better deals under the ACA simply because the taxpayers are subsidizing a portion (and in some cases, all) of the bill? Color me unimpressed.

getting more people insured is something to cheer, but the math is never going to add up on the cost of the subsidies like the Democrats claimed it would. They'll never collect the projected amount of penalties, and half the taxes and other revenue passed to fund it (like the medical device tax) are going to get repealed under the weight of various industry lobbies.

 

[EatLeadCommie]

getting more people insured is something to cheer, but the math is never going to add up on the cost of the subsidies like the Democrats claimed it would. They'll never collect the projected amount of penalties, and half the taxes and other revenue passed to fund it (like the medical device tax) are going to get repealed under the weight of various industry lobbies.

The math never added up in the first place. 10 years of taxes and penalties to pay for 7 years of the ACA. Might work for CBO budget tricks, but not in the real world. When you take away the stuff you mentioned, it gets even worse.

 

[Deacon923]

exactly. they already quietly scuttled the Ted Kennedy long term care insurance plan, which was a big part of gaming the CBO since all the revenue was to be received in the first 10 years with all the payouts coming in the second ten years.

 

[ArlingtonDeac]

Well, the GOP is going to have to construct an HC reform platform. Because there's no going back.

http://www.washingtonpost.com/blogs...01/the-gop-push-for-obamacare-repeal-is-dead/

 

[CHDeac]

Not sure if this was posted but the small group exchange was delayed indefinitely. Was slated to go live on 10.1 was delayed to 11.1 And now tbd.

IMHO the SHOP was going to have no impact on the market at all so not a big deal but indicative of all the issues with the ACA.

 

[CHDeac]

getting more people insured is something to cheer, but the math is never going to add up on the cost of the subsidies like the Democrats claimed it would. They'll never collect the projected amount of penalties, and half the taxes and other revenue passed to fund it (like the medical device tax) are going to get repealed under the weight of various industry lobbies.

This is a great post. At some point the exchange will work in some fashion, a lot of people will get enrolled and folks will realize the ACA plans won't kill you.

But the cost issues will remain. Based on the structure of the bill I predict the cbo estimates will be nothing more than a fleeting memory at which point we will have 3 entitlement programs to reform.

But hey we are all dead in the long run.

 

[jhmd2000]

Sure, I see what you're saying. I still think guaranteed issuance is desirable. And I'm pretty sure that over time the idea is to make it work out so that most everybody ends up insured. By "choice" as the carrots/sticks are adjusted.

If the goal is to get everyone who needs insurance the insurance they need, then young people should be able to buy policies that suit their needs, like low premium, high deductible hedges against catastrophic loss (the very ones they now can't. Of course.). The idea that we're going to make young people out-insure their needs to help subsidize other people who couldn't afford the insurance they need is naked paternalism. It's fine if that's what you're into, but a) it requires a very regressive penalty that I doubt the PTB have the stomach to make work in the first place and b) runs more than a little counter to my own personal belief system that people should be left free to make their own choices about their own lives. So...other than the fact that it isn't going to work and undermines fundamental notions of individual liberty, I think it's a great idea.

Mainly, I'm growing weary of old people asking for young people to pay their way through life. My generation has to compete with the rest of the world without the fifty year head start that the current retirees had coming out of World War II. As BKF will tell you, college is more expensive now, the manufacturing base has found friendlier employment environments, jobs have dried up and wealth is concentrated in a bunch of old people hording it while cashing the social security and medicare checks that working people are paying. Now "our" plan is to ask that subset of working people that are employed that after pissing away the social security and medicare dollars that they'll never see again, service dual student loans in the twin income trap ("Hey, this daycare sure is convenient and affordable." - No one ever) to reach further into their threadbare pockets and overpay for insurance they don't need so that other people get more free stuff, under the coercive threat of a tax penalty if they don't...did I get that right? That's the plan? Oh, well, then no thanks.

Our health care problems are quantity-based. We need more doctors and clinics. I'd rather see money be used to increase supply than subsidize greater demand on the existing system. This plan doesn't even begin to address what is actually wrong with our system.

 

[EatLeadCommie]

Good post, jhmd. I'd like to see some kind of patent reform too to shorten the monopoly Big Pharma has on the dope they make. Not a popular opinion, I know, among conservative minded people, but it's not like they're going to just quit making drugs. Besides, the NIH funds a helluva lot of the research that eventually results in many of these drugs, or at least leads to the advancements that lead to the creation of the drugs. And in an increasingly global world where the Chinese and others scoff at our patented products, it would seem to me that the American is the one who ends up getting fleeced.

 

[Deacon923]

Agree with elc. I am not sure who signed america up to subsidize big pharma profits for the benefit of the rest of the globe.

Sent from my DROID RAZR using Tapatalk

 

[PhDeac]

Nice point by ELC. There's probably a lot of old regulations like that that don't take into account innovation, technology, and globalization.

 

[ConnorEl]

Simple supply/demand doesn't readily or fully apply to healthcare. Hasn't for a long time. See Kenneth Arrow, Paul Krugman, etc. And, speaking as someone working as a provider in the industry for more than 25 years, they are largely correct.

We are all in this together. It's not, or shouldn't be, the older folks vs the younger. Or the poorer vs the richer. We ought to figure out and work towards a system that serves our collective and individual needs reasonably well. Bare naked market forces will never, have never, done this.

 

[ConnorEl]

CH, why so few carriers on the NC exchange? Are these really the only folks offering individual plans up to this point? I don't know, but I do know that in the past few years I had to purchase on the individual market and did so not via BC/BS or Coventry. So are some carriers that did supply now not able to on the exchange? Or what???

I assume all this varies state to state. And I'm wondering if there are places where some large/national companies are in a position to lose out under the exchanges??? Or not?

 

[09deaconX]

CHDeac, I just sent you a PM - please check your inbox.

 

[SkinsNDeacs]

I must say...for such a heated topic that has little to no real discussion in the "real world" this thread has been very informative and well reasoned for the most part.

 

[Deacfreak07]

I must say...for such a heated topic that has little to no real discussion in the "real world" this thread has been very informative and well reasoned for the most part.

I just checked this thread for the first time in a while and was a little stunned to see reasonable discourse. Kudos, politico posters, kudos.

 

[jhmd2000]

here are two thoughts I own.
1) Obamacare is going to cost much more than projected and have many unanticipated, mostly bad, consequences.
2) That said, where in the world are you getting this line: "removing meaningful choice and increasing costs for twenty-five million people"? Some costs are going up, some are going down, and millions of people now have a choice to get health insurance (and outside of NC, a choice of several different plans and providers) where before they had one choice - be uninsured and go to the ER for everything. This line is just as much of an oversimplification and head-in-the-sand refusal to admit reality as the Obamabot failure to admit that the "you can keep it" promise was broken.

Here is a relatively "fair and balanced" article on the subject. http://nation.time.com/2013/10/28/the-bright-side-of-obamacares-broken-promise/

It seems that 25 million is a bit low after all. Forbes would like you to nearly quadruple it: http://www.forbes.com/sites/theapot...e-to-keep-their-health-plans-under-obamacare/