Obamacare - practical discussion

[quote=“JoeFriday, post:121, topic:31”]
Just the opposite. Millions who were priced-out were able to purchase insurance.[/quote]
Yes, that’s true. And separately, millions who didn’t want insurance had to pay for the privilege, and won’t now if the mandate goes away. Different groups.

No, the insurance companies will return to ripping-off consumers and making outrageous profits.

What profits? Not from the individual market they weren’t, or do you mean making money like they were in the pre-ACA days? As long as we end up with some semblance of a competitive market, I’d be happy. That way you can direct taxpayer subsidies to the people individually rather than the insurance companies, and hopefully avoid having the taxpayer getting ripped off. Currently a lot of marketplaces are down to 1 insurer, about 1/3 I think, so they can set prices quite high and rip off the taxpayer when many of their customers are paying with other people’s money.

Healthcare costs are rising at a third the rate annually than they were prior to the ACA, and the previous rising national healthcare cost curve has been bent downward.

Maybe, not sure about that. But whatever cost savings or healthcare inflation migitiation people claim, it sure isn’t showing up in those 50% ACA premium hikes for next year, and the 20% hikes each of the last several years.

For most people who are getting subsidies their insurance rates will go up to the AGI cap. The biggest issue is for people at the cliff between getting some subsidy and no subsidy.

[quote=“xerty, post:122, topic:31, full:true”]

[quote=“JoeFriday, post:121, topic:31”]
Just the opposite. Millions who were priced-out were able to purchase insurance.[/quote]
Yes, that’s true. And separately, millions who didn’t want insurance had to pay for the privilege, and won’t now if the mandate goes away. Different groups. [/quote]
Those are not comparable groups.

As the younger and healthier irresponsibly drop coverage, it means the hospitals will return to the pre-ACA practice of cost-shifting uncompensated care to overpricing care to those with coverage, spiraling healthcare costs upwards once again, as an additional 13 million have no coverage.

Millions of seriously ill or chronically ill Americans will no longer be able to afford coverage, frequently resulting in their deaths.

No, the insurance companies will return to ripping-off consumers and making outrageous profits.

Bad examples.

Aetna, United, Anthem and others made political moves, and intentionally lost money, while crying poor-mouth. It’s well documented that they low-balled their premiums and then all in one fell swoop brought them up to where they should have been all along, smack in the middle of the election campaign, portraying a false impression of large premium hikes due to the ACA.

They also pulled out of markets, once again claiming they were losing money, but Centene, Medica, and Oscar proved the lie as they swooped in to the areas that had been intentionally abandoned and they are profitable.

Healthcare costs are rising at a third the rate annually than they were prior to the ACA, and the previous rising national healthcare cost curve has been bent downward.

You should check with Kaiser or the ACA info sites to inform yourself.

[quote=“JoeFriday, post:124, topic:31”]
As the younger and healthier irresponsibly drop coverage, it means the hospitals will return to the pre-ACA practice of cost-shifting uncompensated care to overpricing care to those with coverage, spiraling healthcare costs upwards once again, as an additional 13 million have no coverage.[/quote]

Young healthy people don’t have lots of expenses, so I doubt they will have a big impact on the whole pricing system. The rest still have insurance via the ACA. Even if it does somehow play out the way you describe, cost shifting at the provider level is another way to transfer costs from people who can’t pay to people who can (that’s good, right?). Also, in your example, the group market bears its share of the costs instead of just the individual market, so it’s a much smaller price impact overall and hence more sustainable.

Millions of seriously ill or chronically ill Americans will no longer be able to afford coverage, frequently resulting in their deaths.

Why? They just have to quit their job so they can subsidized policies. Here was an example of a gainfully employed contractor who had to either get divorced or slash her full time job to be able to afford health insurance. Of course at $2100/month for two people, it’s still not particularly “affordable”, they just look poor enough that someone else like you or me are paying for them via our taxes.

I don’t know why you can say all the biggest insurers are bad examples. They are most of the market.

Aetna, United, Anthem and others made political moves, and intentionally lost money, while crying poor-mouth. It’s well documented that they low-balled their premiums and then all in one fell swoop brought them up to where they should have been all along, smack in the middle of the election campaign, portraying a false impression of large premium hikes due to the ACA.

They were pressured by the Obama administration to offer low premiums initially to sell the country on the law in exchange for various taxpayer bailouts later (many of which were later canceled). Then as those bailouts and desired merger approvals didn’t materialize, they had to raise prices to reflect their actual costs. The last of the risk corridor payments ran out in 2016, so this year was the first year we got to see the true cost of Obamacare’s impact on the individual market and they’re pretty ugly.

They also pulled out of markets, once again claiming they were losing money, but Centene, Medica, and Oscar proved the lie as they swooped in to the areas that had been intentionally abandoned and they are profitable.

Centene and Medica are running bottom tier Medicaid-style plans (their core business is Medicaid), and yes, they are profitable since at the bottom of the income scale, everyone is spending the taxpayer’s money. Since it’s “free”, there’s no adverse selection. That business model doesn’t work if people have to actually pay with their own money, though.

You’re wrong about Oscar. Unlike the other two, Oscar offered a traditional decent insurance network, and, like all the others trying to provide traditional insurance benefits to the ACA market, they are losing tons of money and just slashed their networks last year trying to contain losses:

https://www.bloomberg.com/news/articles/2017-02-28/losses-mount-for-obamacare-startup-oscar-as-law-s-repeal-looms

Healthcare costs are rising at a third the rate annually than they were prior to the ACA, and the previous rising national healthcare cost curve has been bent downward.
You should check with Kaiser or the ACA info sites to inform yourself.

One can torture the stats to say anything you want. What’s clear to me is that my ACA premiums are going up a lot, and that’s true across nearly all the country every year, and that’s what matters to my wallet. Whatever cost savings might be going on, they’re not showing up for ACA customers.

[quote=“xerty, post:125, topic:31, full:true”]
Young healthy people don’t have lots of expenses, so I doubt they will have a big impact on the whole pricing system.[/quote]
They will if they get hit by a bus or are in an auto accident, or run up other uncompensated care.

Of course not. As I posted, that’s what was the cause of the runaway spiraling healthcare inflation prior to the ACA.

On what planet ?

And lose their house and vehicles and savings and…

Silly.

Because it’s a fact.

Exactly.

False.

THEY intentionally low-balled their premiums.

If they’re in the ACA marketplace (which they are), they meet ALL the same requirements. You’re falling for the propaganda.

That was LAST YEAR. They were a startup.

No need for torture. The CBO, Kaiser, and others have been spot-on for eight years.

Which has nothing to do with the ACA and everything to do with the for-profit health insurance companies.

Of course they are. Imagine where we would be if healthcare cost inflation had been rising by double digits every year of the past eight years.

There are no ACA network size or doctor quality or wait time requirements. Also, there’s no requirement for the clinic to be in part of town you want to visit, or that’s safe for your personal ethnicity. I looked at where some of those places were in my area and never looked back at them again.

They started selling insurance in 2014 at the start of the ACA and have lost money every year so far. Their PE backers are running out of patience, which was behind the network slashing in NY and pulling out of NJ entirely last year. Why they think they’ll do better in some new state markets they’re trying to enter now is beyond me. Smells of desperation.

Funny, the same big for-profit companies are running the large group market and those premiums are going up 5% per year and not 50%. It’s not the healthcare prices that are different, it’s the risk pool.

You can imagine it would have been higher, I can imagine the opposite. That kind of wishful thinking will never have you stop digging when you’re in a hole. “If only we had wasted 2x or 5x as much of the taxpayer’s money, maybe this program would have succeeded”.

[quote=“xerty, post:127, topic:31, full:true”]
There are no ACA network size or doctor quality or wait time requirements. Also, there’s no requirement for the clinic to be in part of town you want to visit, or that’s safe for your personal ethnicity. [/quote]
The requirements are all the same as any on the ACA marketplace.

I didn’t mean they started last year. I meant that was of last year. They were still a startup.

The ACA was rolled out in 2010.

Which also has nothing to do with the ACA and everything to do with the for-profit insurance companies.

You can imagine whatever you like, but the CBOs projections have been spot-on, and they’ve proved you wrong.

So whats the latest regarding the mandate? If no mandate I myself would just self insure…

TBD based on the tax reform bill reconciliation, still in progress. One version removes it, one does not. If I had to guess, I’d say it goes out (so you could self insure without penalty), but in the meanwhile I’d recommend signing up for something if your decision is based on whether there would be a penalty or not. It’s cutting it close to get Jan 1st coverage at this point, and you can always just not pay and they’ll drop you.

https://www.wsj.com/article_email/obamacares-individual-mandate-on-its-way-out-or-already-gone-1512914404-lMyQjAxMTI3NDEwMTgxMjE5Wj/

Sen­ate Re­pub­li­cans in­cluded a mea­sure to re­peal the man­date in their re­cently passed tax over­haul; the House didn’t, leav­ing GOP lead­ers to ham­mer out a fi­nal agree­ment for the com­pro­mise bill they hope to pass by year’s end. Pres­i­dent Don­ald Trump on Fri­day night threw his weight be­hind the push to strike the man­date, promis-ing a crowd in Pen­sacola, Fla., that it would soon be gone.

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Some coverage on FL specifically, where rates are up 45% for 2018. Half the individual market is unsubsidized and getting squeezed by higher premiums.

http://www.miamiherald.com/news/health-care/article188987144.html#fmp

The new tax bill, which should pass next week, removes the ACA penalty for not getting eligible health insurance.

GOP releases its final tax plan — here's what's in it

However, when I read the text of the bill, sec 11081, it seemed that it started removing those penalties after 2018 so that for 2018 you might still be penalized.

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Looks like the mandate and penalty stays for 2018 only, and then goes away until the reconciled tax bill, so you might put off self insuring until 2019.

Obviously they don’t want to go into the midterms with millions losing their healthcare coverage and premiums spiking for everyone else, but by delaying, it also means it may well never go into effect.

I guess it depends if they get around to replacing Obamacare with anything else; otherwise this seems to be poor tactics. If they had repealed the 2018 penalty, people could drop their insurance (just not pay) or not sign up while the sick people could still buy at fixed rates for 2018 set under the assumption the penalty would be at least somewhat helping to stabilize the exchanges’ risk pool. That would have left the insurance companies holding the bag with higher than expected claims since those who didn’t really want insurance at those prices wouldn’t be subsidizing the insurers.

Instead, come midterms in Nov 2018, the insurance companies will have priced higher premiums for the upcoming lack of 2019 penalty and everyone will be seeing their higher renewal rates right as they’re deciding who to vote for.

[quote=“xerty, post:135, topic:31, full:true”]
I guess it depends if they get around to replacing Obamacare with anything else…[/quote]

They don’t have the votes for that now, and they may not even have majorities after the midterms.

That’s exactly what WILL happen, because the 2019 premiums (with the mandate removal rate-jacks) have to be submitted before the mid-term elections.

Repubs are their own worst enemy with the ACA. They’re going to get pilloried when the markets start collapsing - the death spiral is coming with mandate repeal and they own every bit of it.

There won’t be a “death spiral” as the exchanges are pretty stable, now that the insurers that were intentionally attempting to crash them have been replaced, but more like a price spiral.

As people drop coverage, the premiums for those with pre-existing conditions and chronic medical issues will sharply rise, and many will be priced out of the market again, while those without insurance hit the ERs when they get hit by a bus, the cost-shifting will return which will reignite the medical inflation spiral.

The GOP will try and blame “Obamacare”, but I don’t see that working. You can’t run a rental car into a ditch, bring it back all smashed-up, and then say it was because it was a terrible vehicle.

Not so sure that we won’t see more insurers leaving the market now that the pool will basically consist only of the sick and older population. You’re saying that they’ll stay in and collect more and more subsidies, I’m not so sure it will be enough to keep some of them in the market.

Remember that in many markets now there’s only one or two insurers left (including mine in metro ATL) and the big one here, BCBS, just pulled out. BCBS is the only provider in a lot of areas now, think they’ll stick around for the high-risk pool that we’ll have in 2019 and beyond? I wonder.

We’re lucky to have Kaiser as a fallback option here btw, they are firmly committed and I don’t see them leaving. But BCBS as sole provider across the South, not so sure. They almost pulled out of TN next year IIRC but stayed with a lot of arm-twisting.

In the longer run, you’re quite accurate, but it’s not looking like this will last very much longer.

It’s possible that without the mandate penalties, the ACA market may evolve into a combination of a higher tier of Medicaid (subsidized for the slightly less poor) and a toxic high risk pool. I would expect increasing and explicit subsidies to the insurers will be required to get them stay.