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

[Deacon923]

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.

I think something like this would be better than the current system. The one big problem is how do you convince people to get preventive, primary care and manage chronic issues so they don't blow up into bigger issues (diabetes being probably the #1 problem). If all the primary care and chronic management comes out of HSAs, people have an incentive to avoid that spending and not manage their problems until it becomes catastrophic. So in a system like this you'd have to design some kind of carrots and sticks to get people to get regular checkups and manage their 'beetus. Having a "use it or lose it" approach for a part of the HSA might help, maybe combined with a "carrot" of lower rates or rebates at the end of the year if you have met all your prevention and maintenance goals.

 

[PhDeac]

Use it or lose it wouldn't work for mid level emergencies not covered by the disaster insurance.

Perhaps lower disaster premiums for people who have had regular checkups.

 

[2&2 Slider To Leyritz]

Some of the HDHP "catastrophic" plans give you like one general practitioner physical per year so that nobody is fully blindsided by the catastrophic incident. For most people, that is going to be enough to determine that everything looks generally okay or there are some issues on the horizon that the patient needs to start spending money to have checked out or otherwise alter their lifestyle.

 

[2&2 Slider To Leyritz]

Use it or lose it wouldn't work for mid level emergencies not covered by the disaster insurance.

Perhaps lower disaster premiums for people who have had regular checkups.

I would think that most mid-level emergencies are things like broken bones and other physical ailments that people would want to and be more willing to pay to get addressed because it impacts their daily life more obvioulsy than something like the early stages of diabetis.

 

[Deacon923]

 

[PhDeac]

I would think that most mid-level emergencies are things like broken bones and other physical ailments that people would want to and be more willing to pay to get addressed because it impacts their daily life more obvioulsy than something like the early stages of diabetis.

And they'd be less able to pay if they lost part of their HSA due to missing checkups.

 

[SkinsNDeacs]

And they'd be less able to pay if they lost part of their HSA due to missing checkups.

I know this is cliche but at some point people have to take responsibility for their own health. Sure, there will be people that will not (not as many as people think IMO) but you can't create policy around a few people don't take personal responsibility. That is no way to conduct affairs.

 

[RJKarl]

But you are OK with the insurance companies charging each of us about 10-12% of our premiums and other costs to cover the people who don't have insurance and don't pay.

You oppose mandates that will make people take responsibility. Hmmmmmm...

 

[SkinsNDeacs]

Do you ever ad anything constructive to a conversation?

 

[2&2 Slider To Leyritz]

And they'd be less able to pay if they lost part of their HSA due to missing checkups.

So don't miss check-ups. That's part of the point.

 

[PhDeac]

I know this is cliche but at some point people have to take responsibility for their own health. Sure, there will be people that will not (not as many as people think IMO) but you can't create policy around a few people don't take personal responsibility. That is no way to conduct affairs.

We don't want people hanging around with broken bones either.

 

[SkinsNDeacs]

We don't want people hanging around with broken bones either.

You could create system where it is covered at a future penalty. Sort of like withdrawing from your 401K before retirement age.

 

[RJKarl]

Do you ever ad anything constructive to a conversation?

Far more than you.

I show flaws in post after post by you and you can never counter it.

The fact is your position on "personal responsibility" is purely transactional and determined not by principal but the politics of the side you wish to discuss.

To you people should have "personal responsibility" in the case you describe, but not in general if it supports the concept of a mandate.

The fact you refuse or can't see this is much more about you than me.

Your response is consistently it's my fault for pointing it out not yours for taking such positions.

 

[CHDeac]

There are numerous ways to handle this issue. Put HSA $ into peoples accounts if they manage their disease well. Give them $ if they maintain healthy lifestyles. HSAs $ roll over so the fund idea wrapped around a catashopic plan will lower trend. Not a hard idea to implement at all. And one that will totally chaneg the dynamic. Daniels did something like this for the State plan in Indiana.


And BTW insurers dont directly price for people without insurance as suggested. BUT they will price for an individual mandate...And the prices will go UP. There are a lot of sick uninsured people entering the pool. And that will rasie prices for many.

The cost storm is coming....

I'll gladly discuss the susbtantive nature of the rate changes coming if anyone wants to. Where do we want to start?

 

[Deacon923]

this is fun. I promise to stop now.

 

[CHDeac]

this is fun. I promise to stop now.

I prefer pics of Daenerys Targaryen.

For additional enjoyment, this week has been a horrible one for the ACA and HHS. HHS is having nothing but issues getting exchange applications from carriers submitted. These are essentially excel files that carriers need to fill out and submit. How hard right?

Well, HHS had to delay submission as they didn't work, had errors, etc. Had issues uploading an excel file.

This isn't the exchange itself where the feds will need to calculate subsidies, etc real time. Nope. This is the process to apply to be on the exchange. T Minus 5 months.

I really hope this gets better. If not, a lot of people are in for a world of hurt...

 

[Deacon923]

thanks for your posts CH. I'd like to hear more about the rate increase and anything else you want to add about ACA implementation. The signs are not looking good. While the law may do some things, Obama may find himself spending the last 3 years of his term fighting a serious rearguard battle if this thing spirals out of control. If the GOP gets the Senate and the House in 2014 and the ACA is in a death spiral, shit will get even uglier politically than it is now as there will be (even more) open warfare between Congress and the White House.

 

[SkinsNDeacs]

Ill wait for CH's answer but this is what you get when you go for the "win" instead of good policy.

 

[CHDeac]

thanks for your posts CH. I'd like to hear more about the rate increase and anything else you want to add about ACA implementation. The signs are not looking good. While the law may do some things, Obama may find himself spending the last 3 years of his term fighting a serious rearguard battle if this thing spirals out of control. If the GOP gets the Senate and the House in 2014 and the ACA is in a death spiral, shit will get even uglier politically than it is now as there will be (even more) open warfare between Congress and the White House.

More delays as the fed portal will be shut down this weekend to get fixed. Sigh. There was also a technical issue that they made us do that made no sense. It ended up tripling our work. We asked 5 times if they were sure and they said yes. After we filed they issued a press release saying you could do it they way we (and others) suggested. Thanks for nothing. If you are interested, I'll share the absurdity of how abortion coverage, subsidies and premiums work. Its beyond scary.

My biggest worries about costs in the short run are that the subsidies will mask the real cost of care, that a lot of healthy people will get insane rate increases and that the law mandates coverage thats too rich for many. There are scenarios where it gets really ugly especially if the weak mandate ($95 or 1% of income) keeps too many healthy people out of the pool. There are examples where young males on lean (but comprehensive) plans that could see increases of 100%, 200%, hell 500% (or more).

I can easily see subsidies getting cut if the Rs gain the Senate. They would defund this thing quickly.

One funny note....I get to go to the White House Tuesday to talk with some folks about the usability of the exchanges. Thats kind of cool.

So many better easy to fix this problem, but we did get the win...

 

[ConnorEl]

Some explanation here: Capitol Hill Caught Up In Health Act's Sticky Situation.

Quote:
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ROVNER: Well, under the law, as it passed, most members of Congress and staff are only eligible for coverage in a health exchange, starting January 1, 2014. But the people who wrote the amendment forgot to make any provision for those members and their staff to take their 75 percent government premium contribution with them. So instead of making these federal workers like everyone else, it would instead put them at a huge disadvantage compared to everyone else in the exchange, because it's not at all clear that they'll be able to have that government contribution to take with them into the exchanges.

GREENE: OK. So they were used to having the federal government paying about 75 percent of their premiums and the problem here is they might not be able to have that money when they go to these exchanges, money that you and I would sort of have from our employers when we go to these exchanges.

ROVNER: That's right. And we don't know for sure because the Office of Personnel Management, which oversees the federal workforce and its health insurance hasn't yet said how it's going to interpret the law. So these members of Congress and their staff could, of course, end up facing huge insurance bills. And what worries Congress about this is that it could lead into a huge brain drain, where particularly the more senior staff would simply quit. You know, working for a member of Congress is already a hard job with long hours and not particularly great pay, at least compared to what they could be getting in the private sector. Seeing your insurance costs quadruple, which is what this would be, would be kind of the last straw for a lot of people.
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