Congress may stick country with Obamacare, opt out themselves due to high cost

[Wrangor]

This is going to be the No Child Left Behind of Obamas legacy. Great intentions and terrible product. The only possible good result is that this legislation will be so terrible that both sides will be forced to come up with something better. The health insurance sequester so to speak.

 

[SkinsNDeacs]

This is going to be the No Child Left Behind of Obamas legacy. Great intentions and terrible product. The only possible good result is that this legislation will be so terrible that both sides will be forced to come up with something better. The health insurance sequester so to speak.

The only difference is President Obama and the Dems own this 100%. At least President Bush had bi-partisan support for NCLB.

 

[RJKarl]

Tell the 1-2M 21-26 yos who stayed on their parents' insurance how bad it is.

Tell the millions of seniors who have already benefitted from the "doughnut-hole" rule to save thousands how bad it is.

Tell the people who would have already gone bankrupt due to medical bills how bad it is.

Tell the people who have pre-existing conditions and can't get insurance how bad it will be.

My bad, it's awful because the healthcare industry and GOP have staked their existence on brainwashing people to have such knee jerk reactions.

 

[CHDeac]

I suspect the worries around the ACA have less to do with the freebies outlined above versus the costs and unintended consequences of what hits in 2014.

To start, the new taxes will kick in 1.1. A conservative estimate is 7.5% of premium. This includes ~8 new taxes that will be passed on to groups and individual consumers starting 1.1.

We also need to look at the increased costs coming from new mandated benefits and minimum benefit levels also coming 1.1. There are a lot of groups and individuals who only want to offer catastrophic coverage (still good coverage, just not good enough under the ACA) that is no longer legal. Many of these folks will leave the pool. But theres the mandate right? Maybe. In year 1, its $95 or 1% of income (with caps by the way). This will keep healthy people out of the pool and drive up costs further. And then we will have the big increase from all the underwriting changes. Lets not fool ourselves. The uninsured come with higher costs.

So costs are going up. A lot. And groups will dump, esp. sick groups (some in the administration suggest the opposite which is insane) which will pout a ton of pressure on subsidies and costs even more. Rather than allow employers staying in, the feds have banned employer funding of individual coverage. Really?

We continue to hear about the CBO projections but this is the same CBO that said the federal high risk pools would have enough funds to make it to 2014 (they didn't). And its the same CBO that priced the long term care product which was quickly dumped.

A cost shit storm is coming. And we need to be worried about that.

Then there is the implementation challenge. There have been 25,000 pages of regs issued on a 2000 page law. I sit on a weekly CCIO call on federal exchange implementation. They are way behind. They haven't even begun testing. Heck, specs aren't even done. But before we can test the exchanges, they have to approve products. And the product templates don't work. Oooops.

So, a bad law (with some good features) is being implemented poorly and costly. But lets only talk about the freebies we put in early. Its a mess but its the law and its coming. So watch out.

But Im just a brainwashed right wind ideologue...

 

[Wrangor]

I suspect the worries around the ACA have less to do with the freebies outlined above versus the costs and unintended consequences of what hits in 2014.

To start, the new taxes will kick in 1.1. A conservative estimate is 7.5% of premium. This includes ~8 new taxes that will be passed on to groups and individual consumers starting 1.1.

We also need to look at the increased costs coming from new mandated benefits and minimum benefit levels also coming 1.1. There are a lot of groups and individuals who only want to offer catastrophic coverage (still good coverage, just not good enough under the ACA) that is no longer legal. Many of these folks will leave the pool. But theres the mandate right? Maybe. In year 1, its $95 or 1% of income (with caps by the way). This will keep healthy people out of the pool and drive up costs further. And then we will have the big increase from all the underwriting changes. Lets not fool ourselves. The uninsured come with higher costs.

So costs are going up. A lot. And groups will dump, esp. sick groups (some in the administration suggest the opposite which is insane) which will pout a ton of pressure on subsidies and costs even more. Rather than allow employers staying in, the feds have banned employer funding of individual coverage. Really?

We continue to hear about the CBO projections but this is the same CBO that said the federal high risk pools would have enough funds to make it to 2014 (they didn't). And its the same CBO that priced the long term care product which was quickly dumped.

A cost shit storm is coming. And we need to be worried about that.

Then there is the implementation challenge. There have been 25,000 pages of regs issued on a 2000 page law. I sit on a weekly CCIO call on federal exchange implementation. They are way behind. They haven't even begun testing. Heck, specs aren't even done. But before we can test the exchanges, they have to approve products. And the product templates don't work. Oooops.

So, a bad law (with some good features) is being implemented poorly and costly. But lets only talk about the freebies we put in early. Its a mess but its the law and its coming. So watch out.

But Im just a brainwashed right wind ideologue...

/end thread. Could not agree more. I like the intent. The application is horrible, which is why I compared it to NCLB. We will go to single payer from this because this law will bankrupt he country. I am not sure why they didn't just do that is the first place. They had the votes to do what they wanted.

 

[PhDeac]

They didn't have single payer support from enough Dems.

They compromised and got no votes from it. Poor strategy. Horrible way to use political capital.

 

[Wrangor]

That is the craziest part. The reason we don't have single payer and instead have this debacle of a bill is because of Dems with a weak stomach.

 

[deacondamo]

rj defends 24-26 yo losers is a great tag. That is all.

 

[OGBDeacon07]

They didn't have single payer support from enough Dems.

They compromised and got no votes from it. Poor strategy. Horrible way to use political capital.

Nailed it.

 

[RJKarl]

Single payer was never going to pass at that time. However, had we listened to the Republicans, I would have bet significantly that President Hillary Clinton would have had 80+ votes for single payer by 2020.

 

[PhDeac]

That is the craziest part. The reason we don't have single payer and instead have this debacle of a bill is because of Dems with a weak stomach.

It's not a weak stomach if its not what they wanted.

Tackling health care was an overreach and the Dems should have cut their losses and regrouped with some smaller targeted initiatives.

 

[Sgt Hulka]

the areas where healthcare quality has improved greatly and costs have dropped dramatically are the only areas of healthcare that the gov't does not participate.

Cosmetic Surgery and Lasik Surgery.

15 years ago, Lasik cost $2-3k/eye. Now, there are new techniques that make the surgery safer and more effective, yet the price has dropped to between 500-1,000/eye.

the same holds true for facelifts, breast augmetation, vericose vein surgery, etc.

If the gov't would get out of healthcare, quality would improve and costs would drop. However, it is too late for that. Therefore, we should have a minimum govt coverage for the poor (the real poor, not a couple making $80k/yr which is what obamacare classifies as medicaid eligible) and everyone else is on their own to buy health ins. That way, the 24-26 YO that rj is so fond of, can buy their own health ins for really cheap and people who want health insurance as real insurance (insurance against catastrophic issues) can buy that...people that want a pre paid health policy can get that, etc.

With Obamacare, you can not buy a catastrophic care policy, you can not opt out of pre natal care, etc. That is ridiculous.

It is a horrible bill, that was ill conceived and implemented poorly and will evelntually bankrupt the country.

 

[PhDeac]

Obamacare is just going to get scapegoated for problems already apparent in health care.

 

[Manmythlegend]

Told ya so!

 

[SkinsNDeacs]

Obamacare is just going to get scapegoated for problems already apparent in health care.

As well it should...it was sold as a fix to those problems. If your car has a broken transmission and you take it to the mechanic to fix he gets scapegoated if he charges you but does not fix it (and probably made it worse).

 

[2&2 Slider To Leyritz]

As well it should...it was sold as a fix to those problems. If your car has a broken transmission and you take it to the mechanic to fix he gets scapegoated if he charges you but does not fix it (and probably made it worse).

Agreed. Obamacare is the [Redacted] of healthcare.

 

[CHDeac]

As well it should...it was sold as a fix to those problems. If your car has a broken transmission and you take it to the mechanic to fix he gets scapegoated if he charges you but does not fix it (and probably made it worse).

Exactly. There were a ton of promises made with this bill and we need to measure the outcomes and then evaluate it. Shouldn't be hard to do.

I even think I remember that the ACA was supposed to be part of the foundation of fixing our economy.....Or so was said to the american people in an address before Congress.

 

[PhDeac]

As well it should...it was sold as a fix to those problems. If your car has a broken transmission and you take it to the mechanic to fix he gets scapegoated if he charges you but does not fix it (and probably made it worse).

Right and that's fine. But Obamacare didn't create those problems. We don't have high health care costs because of Obamacare.

Hulka, those elective surgeries aren't covered by most private insurance plans either, right?

So your point isn't anti-government. It's pro out of pocket.

 

[CHDeac]

Right and that's fine. But Obamacare didn't create those problems. We don't have high health care costs because of Obamacare.

Hulka, those elective surgeries aren't covered by most private insurance plans either, right?

So your point isn't anti-government. It's pro out of pocket.

Hulka's broader point is a good one. When people see how much health care really costs, and pay for it themselves, costs and utilization adjust. We certainly can't compare LASIK to chemo directly, but, a system that creates cost transparency has a better chance of lowering costs than does a system that gives away contraceptives.

We need to create transparency and incentives to help lower trend. The ACA does neither.

 

[SkinsNDeacs]

Hulka's broader point is a good one. When people see how much health care really costs, and pay for it themselves, costs and utilization adjust. We certainly can't compare LASIK to chemo directly, but, a system that creates cost transparency has a better chance of lowering costs than does a system that gives away contraceptives.

We need to create transparency and incentives to help lower trend. The ACA does neither.

Absolutely!

Cost is so far removed from care in our system there is NO CHANCE we will ever lower costs in a real way that will not drastically effect service. I have always said that the best system would be mandatory high premium "disaster" insurance that would protect against life changing medical costs. Then the rest is paid by health savings accounts. Costs would drastically come down over night and in turn solve a lot of this nations health care problems would be solved. That is a Fairly drastic change from where we are so I don't how we get there but that is what government officials get paid for.