The Obama Presidency - 2008 & 2012

[flere-imsaho]

Originally Posted by gstelmack

Are their numbers on our overhead, i.e. how much of our health care spending goes to actually collecting and distributing the money, as opposed to directly providing care?

Medical Loss Ratio is what you're looking for.

[Arles]

Originally Posted by cartman

What we are afraid of is if they elect to only go with the catastrophic plan, and not also one the cheap plans, which is an option you are providing. That changes nothing from how things are today, and part of the reason the ACA mandated minimum coverages for the plans.

People in that option probably have no insurance now, extremely high deductible similar insurance now or feel they can risk having crap coverage (20s, no kids, ...).

There's no magic bullet that will solve all the problems out there. What I proposed was simply a way to get everyone access to catastrophic coverage and go from there. Yes, there will be some people who have crap coverage or no coverage now and join a plan that doesn't promote wellness/prevention. But, what people are essentially doing is answering the old classroom question of "A man offers free college to 10 of 30 kids in a poor area classroom. Do you take it?" with "No, because 20 kids won't get to go to college". Even though this potentially benefits 10 kids and doesn't adversely impact the other 20, we can't do it because it doesn't solve the problem of all 30 going to college.

[JonInMiddleGA]

Originally Posted by molson

I don't know why death panels get such a bad rap. I say, bring 'em on!

The only bone of contention I have with that is the critera for determining who lives or dies.

The concept itself? Not a big problem for me tbh.

[flere-imsaho]

Originally Posted by Arles

So, what conditions are we afraid people won't go to the doc for if they elect a cheap private plan with $50-60 doc visits as opposed to $20 ones?

Hold on a sec. You started out by positing a 6K deductible catastrophic plan and did not mention the cost of doc visits, but now you're qualifying that as only a $40 difference in the cost of doc visits? That's moving the goalposts.

Anyway, if we take a catastrophic plan with a 6K deductible and having to pay full costs for doctor's visits (which is what is implicit in your original proposal), I'd bet good money many women wouldn't go to the full suite of prenatal visits usually recommended, because those costs would add up too much. And then, on average, costs for live births would be considerably higher.

Single-payer countries already mitigate this with births by offering more in the way of prenatal visits as it's been shown that more education and care prior to birth will lead to less overall live birth costs when aggregated across the population.

Even U.S. private insurance companies realize this, and offer incentives for pregnant mothers to see their doctors, attend wellness sessions, get screened, etc.... Catching a problem only once you're in labor is far more expensive than getting it in the first trimester.

[cartman]

Originally Posted by Arles

People in that option probably have no insurance now, extremely high deductible similar insurance now or feel they can risk having crap coverage (20s, no kids, ...).

There's no magic bullet that will solve all the problems out there. What I proposed was simply a way to get everyone access to catastrophic coverage and go from there. Yes, there will be some people who have crap coverage or no coverage now and join a plan that doesn't promote wellness/prevention. But, what people are essentially doing is answering the old classroom question of "A man offers free college to 10 of 30 kids in a poor area classroom. Do you take it?" with "No, because 20 kids won't get to go to college". Even though this potentially benefits 10 kids and doesn't adversely impact the other 20, we can't do it because it doesn't solve the problem of all 30 going to college.

But if you are trying to control costs, then just giving access to catastrophic coverage doesn't do much at all.

[flere-imsaho]

Originally Posted by JonInMiddleGA

The only bone of contention I have with that is the critera for determining who lives or dies.

The thing is, however, is that in most cases that's not the question.

The question tends to be do we keep you alive for another 4 weeks at a cost of $2.3M, or do we let you die in peace now.

Studies have shown that most people, when presented with the option, including the fact that those extra 4 weeks (or whatever) aren't really great from a quality of life standpoint, will choose the former.

Relevant reading: A Pacemaker Wrecks a Family's Life - NYTimes.com

[flere-imsaho]

Originally Posted by Arles

There's no magic bullet that will solve all the problems out there.

Sure there is!

1. Extend Medicare Advantage to the entire population.

2. Remove state-by-state regulation of health insurance (i.e. allowing plans to be truly nationwide).

Single-payer, aggregated data upon which to make good health policy decisions, and private administration of the system (who tend to do it better) that still allows space for innovation and keeps a market component (with oversight based on good measures) that weeds out the lousy actors. Everyone wins!

[Blackadar]

Originally Posted by Arles

To really reduce costs, people would actually have to negotiate directly with doctors and hospitals to pay for services. Maybe some higher level private insurances would get you a discount, but you would still be paying for what you use in some capacity (no different than taking your car to the shop and the warranty covers some of the parts while you pay for labor and other parts on a negotiated price). But, we are a LONG way from that point. There's simply too much entitlement in the idea of health care in the US to get there anytime soon.

Your whole post is horribly incorrect...but in the interest of actually trying to educate someone, I'm only going to use your last paragraph to demonstrate why perhaps you need to better understand the issue before commenting or presenting "solutions" that don't work. After all, much of what you have proposed others have commented on and shown why those ideas don't work.

---

Do you know that you can't negotiate directly with doctors and hospitals? Or, more appropriately, they won't negotiate with you because those same "private companies" that you tout won't let them? *shock*

I'll provide an example so it's easy to understand. For whatever reason, Blue Cross decided after 3 years of health payments to not cover my birth of daughter. Yep, they decided to drop the coverage, leaving me high and dry because it was now a preexisting condition for all the other insurance companies. That's not legal now, but that required government regulation to enforce. It was legal then. So instead of a couple of grand, I was facing about $15k in costs.

I have a little money in the bank, so I went to the two hospitals nearby and had the same exact discussion. I offered to pay for the prenatal care and the birth care IN CASH if I could get a discount. Nope. Do you know why? Because the "private companies" - this insurance industry you want people to rely on - had specifically written into their contracts that they could not give Joe Average Cashpayer the same rate that they had pre-negotiated with the doctor & hospital. So while the hospital would only get about $5-$6k for birth of my daughter through the insurance companies, I had to pay full price ($12k) because of the price-fixing that is legal in this industry even if I paid in cash (meaning they had no billing or collection costs).

So simply put your final paragraph demonstrates how little you understand about health care coverage and shows why your opinion is ill-informed and incorrect. It's nothing like taking your car to the shop. There are 20 repair places and they're in competition with each other. The two hospitals nearby are both owned by the same conglomerate.

A defacto monopoly + an inelastic good = free market solutions don't work

[Arles]

Originally Posted by flere-imsaho

Hold on a sec. You started out by positing a 6K deductible catastrophic plan and did not mention the cost of doc visits, but now you're qualifying that as only a $40 difference in the cost of doc visits? That's moving the goalposts.

Anyway, if we take a catastrophic plan with a 6K deductible and having to pay full costs for doctor's visits (which is what is implicit in your original proposal), I'd bet good money many women wouldn't go to the full suite of prenatal visits usually recommended, because those costs would add up too much. And then, on average, costs for live births would be considerably higher.

Then I would recommend getting either employer-paid coverage or additional private insurance if you plan on having a kid. Makes sense. FYI, a lot of single moms qualify for state access coverage which currently pays for a lot of the expense of having a kid. They do here in Arizona.

Even U.S. private insurance companies realize this, and offer incentives for pregnant mothers to see their doctors, attend wellness sessions, get screened, etc.... Catching a problem only once you're in labor is far more expensive than getting it in the first trimester.

Again, how does that change with my proposed plan above:

1. If you or your husband work and get pregnant - you are covered through employer plan.
2. If you are a single mom who doesn't make much or make near the poverty level as a family - you currently can enroll in a program like ACCESS here in AZ.
3. If you are a middleclass family where neither parent has employer coverage but you make more than what is needed to qualify for state programs (maybe self employed), you would have to buy a private plan with better prenatal coverage (just like now). However, you atleast would have cheap access to catastrophic coverage - something you don't have now.

So, again, who is worse off with what I proposed as compared to what's available today?

[Arles]

Originally Posted by flere-imsaho

Sure there is!

1. Extend Medicare Advantage to the entire population.

2. Remove state-by-state regulation of health insurance (i.e. allowing plans to be truly nationwide).

Single-payer, aggregated data upon which to make good health policy decisions, and private administration of the system (who tend to do it better) that still allows space for innovation and keeps a market component (with oversight based on good measures) that weeds out the lousy actors. Everyone wins!

And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...

[cartman]

Originally Posted by Arles

And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...

Well if it is just a matter of what goes to the insurance company now (your contribution + the employer's) + existing Medicare withholdings would instead go to the uber-Medicare, then it is close to a wash.

[Arles]

Originally Posted by Blackadar

Your whole post is so absurdly misguided it's laughable. But I'm going to only pick on your last paragraph to demonstrate why you need to understand the issue better before commenting.

First, you obviously didn't read my post as this paragraph was simply a sidebar on how to reduce costs if that was your main objective. My comment "To really reduce costs, people would actually have to negotiate directly with doctors and hospitals to pay for services. " is true. But, it won't happen anytime soon because that's too drastic a change for what people expect from health insurance.

I'll provide an example so it's easy to understand. For whatever reason, Blue Cross decided after 3 years of health payments to not cover my birth of daughter. Yep, they decided to drop the coverage, leaving me high and dry because it was now a preexisting condition for all the other insurance companies. That's not legal now, but that required (OMG!) government regulation to enforce. It was legal then. So instead of a couple of grand, I was facing about 15k in costs.

So, you were with BC for 3 years and then they dropped you because your wife got pregnant? Was it a 3-year pregnancy? Otherwise, I can't see how that would be a pre-existing condition. I've worked directly with Blue Cross on the employer-provided, self-employed and private side and in no situation on any plan does it drop someone who is paying their premiums on a plan that covers prenatal care when they have a child. Your post simply doesn't make any sense.

[Marc Vaughan]

Originally Posted by molson

I don't know why death panels get such a bad rap. I say, bring 'em on!

The concept of 'death panels' was impressing PR/marketing from the anti-ACA crowd tbh ... especially so when you consider most private policies I've seen in the US have 'maximum' amounts which are covered in most areas, effectively being exactly the sort of thing they decried.

[Arles]

Originally Posted by cartman

Well if it is just a matter of what goes to the insurance company now (your contribution + the employer's) + existing Medicare withholdings would instead go to the uber-Medicare, then it is close to a wash.

It's not a wash. Look at how much a normal family pays for health insurance and that number will be well below that.

[Blackadar]

Originally Posted by Arles

And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...

Actually, most everyone does win, except the insurance companies who rake in the premiums hand over fist.

From a GDP standpoint, the USA spends 50% more than any other industrialized nation in the world. The US spends 17.7% of its GDP on healthcare, whereas every other nation is 12% or less. Per capita, the US spends about $7,500k on healthcare while the next closest country (Norway) is at about $5,000. In the UK and Switzerland, that number is closer to $3k.

Simply put, raising taxes $5k/yr isn't a problem for me if I don't have to spend $8k/yr on health care. I still come out with $3k more in my pocket. So yeah, most everyone does win.

[Arles]

At the end of the day, no one would even consider what I proposed because it doesn't fit the agenda of the democrats (full government provided single payer system) or the republicans (no government interference at all). So, we end up with this Obamacare option that will probably end up doing more damage to quality of coverage and overall cost than just staying put. Either way, time will tell.

[Arles]

Originally Posted by Blackadar

Actually, most everyone does win, except the insurance companies who rake in the premiums hand over fist.

From a GDP standpoint, the USA spends 50% more than any other industrialized nation in the world. The US spends 17.7% of its GDP on healthcare, whereas every other nation is 12% or less. Per capita, the US spends about $7,500k on healthcare while the next closest country (Norway) is at about $5,000. In the UK and Switzerland, that number is closer to $3k.

Simply put, raising taxes $5k/yr isn't a problem for me if I don't have to spend $8k/yr on health care. I still come out with $3k more in my pocket. So yeah, most everyone does win.

Glad it works for you. For the employed crowd and much of the self employed, this would be a massive cost increase with no guarantees of the system being any better long term and the risk of worse coverage.

[Blackadar]

Originally Posted by Arles

First, you obviously didn't read my post as this paragraph was simply a sidebar on how to reduce costs if that was your main objective. My comment "To really reduce costs, people would actually have to negotiate directly with doctors and hospitals to pay for services. " is true. But, it won't happen anytime soon because that's too drastic a change for what people expect from health insurance.

No, it won't happen because Big Insurance doesn't allow it.

Originally Posted by Arles

So, you were with BC for 3 years and then they dropped you because your wife got pregnant? Was it a 3-year pregnancy? Otherwise, I can't see how that would be a pre-existing condition. I've worked directly with Blue Cross on the employer-provided, self-employed and private side and in no situation on any plan does it drop someone who is paying their premiums on a plan that covers prenatal care when they have a child. Your post simply doesn't make any sense.

Yep, they did. Or more precisely, they refused to pay for her pregnancy even though I had the paperwork that showed we checked the appropriate box and all the documentation they sent talked about maternity coverage. They claimed we hadn't been paying for it (we fully paid the premium every month) and flat out refused to cover the pregnancy. We appealed and providedthe documentation. They refused again. We sent it to the insurance commissioner of NC. Blue Cross dropped us. The NCDOI did diddly squat for almost a year, by which time my daughter was already born and we had found other coverage. Since we no longer had coverage with Blue Cross, the insurance commission's inquiries went nowhere. Meanwhile, I got stuck paying the bill. Thank you very much.

[Blackadar]

Originally Posted by Arles

Glad it works for you. For the employed crowd and much of the self employed, this would be a massive cost increase with no guarantees of the system being any better long term and the risk of worse coverage.

I am employed, you pompous asshole. I've been working for 30 fucking years now. Don't be a jackass.

And the math is simply the math. Overall costs will be reduced in a single payer system. There's no logical way to deny it, there's no historical way to refute it. The math is the math. Due to this very simple fact, there will be far more winners in a single payer solution than losers. In fact, the self employed would be some of the biggest winners because their premiums are so damned high. It's the self-insured that would likely be "losers", but the single biggest loser would be Big Insurance. Sorry if I don't cry over that.

[flere-imsaho]

Originally Posted by Arles

Then I would recommend getting either employer-paid coverage or additional private insurance if you plan on having a kid. Makes sense. FYI, a lot of single moms qualify for state access coverage which currently pays for a lot of the expense of having a kid. They do here in Arizona.

You were positing a system where people were given a 6K deductible catastrophic plan. Now you're changing the context, or, simply put, moving the goalposts.

It's very difficult to have a meaningful discussion with you if you keep changing the rules of the conversation.

Again, how does that change with my proposed plan above:

1. If you or your husband work and get pregnant - you are covered through employer plan.
2. If you are a single mom who doesn't make much or make near the poverty level as a family - you currently can enroll in a program like ACCESS here in AZ.
3. If you are a middleclass family where neither parent has employer coverage but you make more than what is needed to qualify for state programs (maybe self employed), you would have to buy a private plan with better prenatal coverage (just like now). However, you atleast would have cheap access to catastrophic coverage - something you don't have now.

So, again, who is worse off with what I proposed as compared to what's available today?

Um, that is what's available now, due to the ACA. #1 is employer-provided coverage, #2 is Medicaid, and #3 is an Exchange plan. Prior to the ACA, #3 didn't exist.

[flere-imsaho]

Originally Posted by Arles

And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...

Not really. Medicare Advantage reimburses at close to (sometimes above, sometimes below) Medicare A & B rates, with bonuses and penalties for plans with good and bad quality ratings, respectively.

I haven't (and probably can't) run the numbers, but it probably saves money overall, from a system-perspective.

But it also makes it far easier to control costs in the future, and also moves the entire system, through use of incentives and penalties, to outcome-based care, which really should be our overall objective.

[flere-imsaho]

Originally Posted by Arles

Glad it works for you. For the employed crowd and much of the self employed, this would be a massive cost increase with no guarantees of the system being any better long term and the risk of worse coverage.

Huh? If I'm employed and spend $8K on health care (premiums, co-pays, deductible, etc...) and the government comes along and says I can have single-payer care for an extra $5K in taxes, meaning I no longer have to pay $8K on health care, I'm taking that deal.

[Arles]

I think I've figured out this thread after a long period of posting:

1. Someone comes out with an idea that isn't equal to "single payer"
2. 80% of the readers tar and feather that idea because it isn't single payer.
3. Rinse and repeat

I doubt we will ever see a single payer plan anytime soon because of:

1. The hold of the insurance companies on both sides of congress
2. The increased cost and decreased coverage to people who currently have employer based coverage
3. The fact that a sizeable percentage (maybe 25-30%?) don't want a government managed health care system in the US.

Hate to be realist, but that is the situation we are in.

[cartman]

Originally Posted by Arles

It's not a wash. Look at how much a normal family pays for health insurance and that number will be well below that.

Last year the average premium for employer-provided coverage was $16,351, of which $4,565 was paid by the employee. Medicare's tax rate is 1.9%. Average income last year was $50,054 per household.

Take the $16,351 plus the 1.9% Medicare tax, and it sure looks like it would come out to a wash, probably even less than the 20% hike you predict. To the employee, the $4,565 (~9%) would turn into a tax.

[flere-imsaho]

Originally Posted by Arles

It's not a wash. Look at how much a normal family pays for health insurance and that number will be well below that.

Well, a normal family with an employer-sponsored plan pays ~$9,000/year for health insurance, while their employer picks up ~$12,000.

So take what that family pays in tax for Medicare, plus $9,000, and keep the new taxes below that. Ta-da! And since every single other single-payer system actually costs less on a per capita basis, this seems likely.

And that's not even discussing the money the employer gets back for not having to pay the other part of the premium. How to pro-business Republicans not like that?



Data from here: Annual Healthcare Costs For Family Of 4 Now At $22,030 - Forbes

[Arles]

Originally Posted by cartman

Last year the average premium for employer-provided coverage was $16,351, of which $4,565 was paid by the employee. Medicare's tax rate is 1.9%. Average income last year was $50,054 per household.

So, your assumption is that if employers no longer had to pay a premium, employees would immediately get an across the board $12,000 raise? As someone who helps control hiring for a major international company with thousands of US employees - I can say with 100% certainty that would not happen at my company. But, maybe we are an outlier...

[molson]

Since when has the government ever felt the need to increase taxes to pay for stuff?

[cartman]

Originally Posted by Arles

So, your assumption is that if employers no longer had to pay a premium, employees would immediately get an across the board $12,000 raise? As someone who helps control hiring for a major international company with thousands of US employees - I can say with 100% certainty that would not happen at my company. But, maybe we are an outlier...

No, I'm saying that would be a tax, not a premium payment.

[flere-imsaho]

Originally Posted by Arles

I doubt we will ever see a single payer plan anytime soon

Well, over 100M Americans get their insurance from a single-payer entity, i.e. the government, now (Medicare, Medicaid, VA). So there's that.

Hate to be realist, but that is the situation we are in.

I know, right?

[Arles]

Originally Posted by flere-imsaho

Well, a normal family with an employer-sponsored plan pays ~$9,000/year for health insurance, while their employer picks up ~$12,000.

Originally Posted by cartman

Last year the average premium for employer-provided coverage was $16,351, of which $4,565 was paid by the employee.

You guys might want to get your numbers right. Here's an FYI, the average worker at our plan pays $300 a month for a very good plan ($500 deduct). So, that means that they pay around $3,600 for premiums. But let's go with the 5K number. You still have to pickup that extra $12K and I can tell you we aren't giving a $30-50K a year guy a $12K raise if we drop benefits.

[cartman]

Originally Posted by Arles

You guys might want to get your numbers right. Here's an FYI, the average worker at our plan pays $300 a month for a very good plan ($500 deduct). So, that means that they pay around $3,600 for premiums. But let's go with the 5K number. You still have to pickup that extra $12K and I can tell you we aren't giving a $30-50K a year guy a $12K raise if we drop benefits.

WE AREN'T SAYING THAT

You take a line from the OpEx budget for insurance premiums, and that exact same amount moves to the increased Medicare tax. Yes, the amount paid in taxes goes up, but the amount paid by the company for insurance payments would go away. You seem to be saying that a single-payer plan would only be funded by what employees were contributing, and the amount that companies paid doesn't count.

BTW, here is where I got my figures for premiums: http://www.ncsl.org/research/health/...-premiums.aspx

[Arles]

Originally Posted by flere-imsaho

Well, over 100M Americans get their insurance from a single-payer entity, i.e. the government, now (Medicare, Medicaid, VA). So there's that.



I know, right?

If it's such a great idea, why is public sentiment like this?
46% Oppose Single-Payer Health Care System - Rasmussen Reports™

38% in favor
46% oppose
16% not sure

You would need well over 60% support to override the big business aspect of health care and get close to a single payer across the board. Ain't happenen.

[Blackadar]

Originally Posted by Arles

I think I've figured out this thread after a long period of posting:

1. Someone comes out with an idea that isn't equal to "single payer"
2. 80% of the readers tar and feather that idea because it isn't single payer.
3. Rinse and repeat

Thank you for that wonderful example of Ad Hominem!

I imagine that if you ever have an idea that is at least equal to single payer, you'll find people more receptive. When your ideas are ill-conceived and illogical, I think you'll find that people aren't receptive to them. Also, insults don't work well either.

Originally Posted by Arles

I doubt we will ever see a single payer plan anytime soon because of:

1. The hold of the insurance companies on both sides of congress
2. The increased cost and decreased coverage to people who currently have employer based coverage
3. The fact that a sizeable percentage (maybe 25-30%?) don't want a government managed health care system in the US.

Hate to be realist, but that is the situation we are in.

#1 = True.
#2 = False. This was already addressed above.
#3 = True, because they have a vested interest in keeping the current system or they're too ill-informed to know any better.

[Blackadar]

Originally Posted by Arles

If it's such a great idea, why is public sentiment like this?
46% Oppose Single-Payer Health Care System - Rasmussen Reports™

38% in favor
46% oppose
16% not sure

You would need well over 60% support to override the big business aspect of health care and get close to a single payer across the board. Ain't happenen.

Yeah, and look at the numbers on gay marriage a few years ago.

[JonInMiddleGA]

Originally Posted by Blackadar

#3 = True, because they have a vested interest in keeping the current system or they're too ill-informed to know any better.

Gosh, wouldn't want it to be because we don't believe that's an area where government involvement should be increased.

[flere-imsaho]

Originally Posted by Arles

You guys might want to get your numbers right.

I cited a respected annual study for my numbers and provided a link.

It is you who should get your numbers right.

Pull it together Arles.

[flere-imsaho]

Originally Posted by Arles

If it's such a great idea, why is public sentiment like this?

You mean Medicare's 60 to 70% approval rating?

Who's Afraid Of Public Insurance? - NationalJournal.com

Americans love single-payer healthcare... except when it's called single-payer, universal, or Obamacare.

[lighthousekeeper]

Regarding healthcare.gov, having a not-ready-for-primetime website is one thing, but a bigger issue is how prices are hidden. I still haven't been able to figure out what the marketplace prices are. Is there some complexity I am missing - shouldn't a spreadsheet be posted somewhere that lists all possible prices based on a combination of factors? How many factors go into determining price?

And their online live chat assistance makes Comcast support look awesome:

Spoiler

[10:23:31 am]: Welcome! You're now connected to Health Insurance Marketplace Live Chat.
Thanks for contacting us. My name is Allison. To protect your privacy, please don't provide any personal information, like Social Security Number, or any other sensitive medical or personal information.
[10:23:53 am]: Allison
Good morning. How may I help you ?
[10:24:10 am]: doug
i am trying to complete enrollment but i seem to be stuck
[10:24:37 am]: doug
It says "You're not enrolled yet" but there is no option i see to complete enrollment
[10:24:45 am]: Allison
I apologize for the inconvenience.
[10:24:55 am]: Allison
Thank you for your question today. It will take me just a moment to review and respond to your question.
[10:25:34 am]: Allison
Thank you for your interest in the Marketplace and for sharing your feedback. We apologize for any technical difficulties you may be experiencing as you use HealthCare.gov. We know this can be frustrating, and we're working around the clock to improve HealthCare.gov and to make sure your experience with it is a positive one.
[10:26:31 am]: doug
Is this a bug or am I doing something wrong?
[10:26:51 am]: Allison
I will make a note of your feedback. In the meantime, you can still complete an application right now by selecting the following link to download a paper application:
Publications & articles | Marketplace.CMS.Gov. Choose the application that best fits your needs under "Marketplace Consumer Application."

You may also call the Marketplace at 1-800-318-2596 for help with completing an application or to request a paper application by mail.
[10:28:13 am]: Allison
Again I apologize for the inconvenience.
[10:28:22 am]: Allison
Do you have any other questions that I can help you with?
[10:29:00 am]: doug
I really just want to see what the plan prices are to shop from but the paper application at the link you sent does not seem to provide prices. Anywhere I can see the prices?
[10:30:32 am]: Allison
Thank you for your patience. I am still researching that information.
[10:35:36 am]: Allison
Thank you for your patience.
[10:35:43 am]: Allison
For Web assistance, you can also visit us at HealthCare.gov or chat with us online at HealthCare.gov/chat. Online assistance in Spanish is available at CuidadoDeSalud.gov.
[10:36:34 am]: doug
i am already on healthcare.gov/chat, right?
[10:37:26 am]: Allison
What state do you live in ?
[10:37:30 am]: doug
NJ
[10:37:46 am]: Allison
Thank you. One moment please while I look that up.
[10:39:58 am]: Allison
Navigators are one type of in-person assistance available in your community, and they can help you apply for coverage, understand your coverage options, and enroll in a plan. They may also help you apply for lower costs on your monthly premiums or out-of-pocket expenses. In addition, Navigators may provide assistance in many different languages.
[10:41:04 am]: doug
Is there any web resource that lists marketplace prices for NJ?
[10:41:36 am]: Allison
No I am sorry.
[10:42:31 am]: doug
hmm. ok. thanks.

[Arles]

Pretty good article on CNN about the launch:

What else could go wrong with Obamacare? - CNN.com

"Young invincibles" are key. They are the young and the healthy. If they don't purchase health insurance, the program is at risk.

If too many exchange consumers are older or unhealthy, then monthly premiums will likely skyrocket in 2015 and this could cause the exchanges to topple. If that occurs, one of the highest-profile parts of the law will be viewed as a failure.

To pass this test, the administration figures roughly 40% of exchange consumers -- 2.7 million if the Congressional Budget Office's estimates are correct -- need to be between the ages of 18 and 35.

Younger and healthier premium pools will keep overall costs lower and ease the financial hit to the program when it does pay benefits.

This is where the numbers start posing a problem. Many young people in that range get employer provided coverage and have no reason to pay for more expensive exchanges. My fear is that the only way this system will survive is if "healthy" people with employer-provided coverage are somehow forced on to the exchanges (where they will get worse coverage at higher costs to them).

While the President has said that "You can keep your health care plan" if you like it, that's not necessarily true.

That's because the law now mandates that insurance plans cover certain services. So regardless of which plan you choose, whether it's the low-cost, high-deductible bronze plan or the most expensive, low-deductible platinum plan, they all have to provide basic services. Those services include immunizations, ambulatory care, prenatal care, newborn care, mental health and substance abuse services.

The Kaiser Family Foundation wrote in February that unsubsidized premiums for individuals and families "will be somewhat higher under reform than they are today."

Kaiser said many reasons are to blame for higher monthly out-of-pocket costs, including higher quality coverage due to minimum coverage requirements, prohibition on preexisting conditions and caps on out-of-pocket costs.

In addition to higher premiums, plans, especially the lower cost bronze and silver plans, include high deductibles. For instance, in Washington, D.C., deductibles for a family of three run up to $12,000.

While high premiums might prohibit people from being able to afford the monthly cost, high deductibles mean some may not be able to afford getting sick.

An estimated 4.8 million low-income people are likely to fall into what is called the insurance "gap." They are the people who make too much to qualify for Medicaid in their state but too little to qualify for federal subsidies for the insurance marketplace.

That's because subsidies for health insurance are available for people who make 138% of the poverty level, or about $31,300 for a family of four.

To accommodate the individuals and families who don't make that much, the federal government is paying for states money to expand Medicaid, but 25 states opted to not take the federal government's money and not expand Medicaid.

So many wage-earners, including most workers who earn a minimum wage, make too much to qualify for Medicaid but are too poor to receive federal subsidies. Purchasing insurance without subsidies is likely to be cost prohibitive for most in this category.

I don't know that this is a bad thing long term. But, people will be paying more than what they expect for coverage not much better than what they had.

[JPhillips]

I know I've seen polls where support for ACA is highest among the youngest age group and drops as age goes up. That doesn't necessarily translate into enrollments, but there is reason to believe the young want health insurance.

[flere-imsaho]

Originally Posted by Arles

This is where the numbers start posing a problem. Many young people in that range get employer provided coverage and have no reason to pay for more expensive exchanges.

Almost 30% of those aged 18-35 are uninsured. (Source) Assuming a general population of 300 million, that's 90 million young people who will likely be going to the Exchange or Medicaid.

The risk you raise is a real one, of course, but it is also very easy to overstate.

My fear is that the only way this system will survive is if "healthy" people with employer-provided coverage are somehow forced on to the exchanges (where they will get worse coverage at higher costs to them).

You're still making the assumption that the Exchange plans are, on average, worse in terms of cost & benefits to employer-provided coverage.

I don't know that this is a bad thing long term. But, people will be paying more than what they expect for coverage not much better than what they had.

As I linked before, the average family of four pays over $9,000/year for their employer-sponsored plan. Which means some are far worse than that.

Again, it's a concern, but it's an easily-overstated concern.

[Arles]

Originally Posted by flere-imsaho

You're still making the assumption that the Exchange plans are, on average, worse in terms of cost & benefits to employer-provided coverage.



As I linked before, the average family of four pays over $9,000/year for their employer-sponsored plan. Which means some are far worse than that.

Again, it's a concern, but it's an easily-overstated concern.

They are. In Arizona, coverage costs $300 a month ($3600 a year) for a family plan with a $500 deductible at our plant. Intel, Motorola, On Semi and most other manufacturing plants in Phoenix have the same cost as we are all part of the same network for coverage under BCBSAZ. To get an exchange plan with a $1000 deductible for a family under BCBSAZ, it costs $775 a month. That's an increase of $5700 a year for a worse plan.

Most of the factory workers also make more than 40K, so they wouldn't qualify for a subsidy. Now, I know everyone is going to say "Well, they are only paying $300 a month and the company is paying the remaining $700." That is correct, but we are not giving every worker a 5K raise if we cut benefits. There are tax benefits to our company of covering workers and if those go away or we decide to drop coverage because of financial reasons with exchanges, those employees will be forced to eat that $5700 a year. That's reality and that's what no one is saying. Just like these other "unintended consequences" we are seeing now where it's obvious the "you can keep the plan you had" line was a farce - you will see companies start dropping coverage in 2015 and most employees aren't going to get a $5K raise to makeup the difference.

Finally, the plans on the exchange have double the deductible as the lowest deductible you can get on the exchange is a $1K/2K. You couldn't even get the plan subsidized by our employer if you went to an exchange.

So, here's what we are going to see over the next 2-3 years:
(2010) "Hey, if you like your plan, you can keep it"
(2012) "Hey, if you lose your plan, there's a similar one on an exchange"
(2014) "Hey if you lose your plan, there's one on an exchange that costs $5-7K more a year with a deductible twice as high as you had"

I'm scared at what this will morph into in 2015+. A lot of people making between $40K and $80K are going to take it in the shorts if/when exchanges start replacing employer coverage.

[lighthousekeeper]

Originally Posted by Arles

They are. In Arizona, coverage costs $300 a month ($3600 a year) for a family plan with a $500 deductible at our plant. Intel, Motorola, On Semi and most other manufacturing plants in Phoenix have the same cost as we are all part of the same network for coverage under BCBSAZ. To get an exchange plan with a $1000 deductible for a family under BCBSAZ, it costs $775 a month. That's an increase of $5700 a year for a worse plan.

Most of the factory workers also make more than 40K, so they wouldn't qualify for a subsidy. Now, I know everyone is going to say "Well, they are only paying $300 a month and the company is paying the remaining $700." That is correct, but we are not giving every worker a 5K raise if we cut benefits. There are tax benefits to our company of covering workers and if those go away or we decide to drop coverage because of financial reasons with exchanges, those employees will be forced to eat that $5700 a year. That's reality and that's what no one is saying. Just like these other "unintended consequences" we are seeing now where it's obvious the "you can keep the plan you had" line was a farce - you will see companies start dropping coverage in 2015 and most employees aren't going to get a $5K raise to makeup the difference.

Haven't really followed the debate here closely, but this post seems to have some flaws in reasoning. Why bring up the tax savings benefits for employers while not accounting for them on the employee side? The dire scenario you paint is one where employers drop benefits and don't give raises (thus saving ($8,400-tax savings)/employee) and lament how this will be worse for employees. Of course, in that worst-case scenario.

This scenario really avoid the big picture, which is overall costs (who cares how it is split out between employees and employers - capitalism should help shake that out).

[DaddyTorgo]

Originally Posted by lighthousekeeper

Haven't really followed the debate here closely, but this post seems to have some flaws in reasoning. Why bring up the tax savings benefits for employers while not accounting for them on the employee side?

Because he's fear-mongering.

[Arles]

Originally Posted by lighthousekeeper

Haven't really followed the debate here closely, but this post seems to have some flaws in reasoning. Why bring up the tax savings benefits for employers while not accounting for them on the employee side? The dire scenario you paint is one where employers drop benefits and don't give raises (thus saving ($8,400-tax savings)/employee) and lament how this will be worse for employees. Of course, in that worst-case scenario.

I just think that will be more the norm. I can't see a bunch of $15-20 an hour jobs getting $5K raises the moment a company drops coverage. They will say how employees are welcome to check out the exchanges and similar plans will be there and leave it at that. Maybe they get a 2-3% raise, but you are still looking at a gap of around $500 a month for people in this situation.

This scenario really avoid the big picture, which is overall costs (who cares how it is split out between employees and employers - capitalism should help shake that out).

All I'm trying to say is that there will be a ton of pain felt by the middle class as more companies remove benefits and people get tossed to exchanges. In the long term is that better? Maybe. But it's going to be tough in the short term for many middle class working families - most who will be blindsided by this as no one ever told them that Obamacare could hurt them in the short term. We were always sold the line that if we like our current plan, we can keep it. And, as we get closer to 2015, that will be far from the truth for many people.

[Edward64]

A legit #2.

Leader of Pakistan Taliban killed in US drone strike, US, Pakistani officials say - Investigations

The leader of the Pakistan Taliban was killed Friday in a U.S. drone strike in Northwest Pakistan, U.S. and Pakistani officials tell NBC News.
A U.S. official, speaking on condition of anonymity, confirmed the death of Hakimullah Mehsud, head of the Tehrik-i-Taliban Pakistan (TTP), in a CIA drone strike.

A Pakistani security official, also speaking on condition of anonymity, told NBC News earlier that Mehsud was killed earlier in the day in Danday Darpakhel village of North Waziristan.

A senior member of the Pakistani Taliban, who also spoke on condition of anonymity, confirmed the death.

"It is very painful to announce that our dearest, brave and sincere leader Hakimullah Mehsud died in drone attack," he said.

[DaddyTorgo]

Good hit.

Hakimullah was a legit baddie.

[Mizzou B-ball fan]

More discussion on the new 5%.....

Health Care Shoppers Aren’t as Dumb as Obama Thinks - Yahoo Finance

[larrymcg421]

Originally Posted by Mizzou B-ball fan

More discussion on the new 5%.....

Health Care Shoppers Aren’t as Dumb as Obama Thinks - Yahoo Finance

I love that in all the anecdotal examples in that article, they don't mention what the specific coverages are for these new more expensive plans or what the coverage was under the current plan these people have. That comparison would seem to be necessary, especially if you're going to use terms like "with coverage that’s more or less the same as far as he’s concerned".

[flere-imsaho]

All three of those people are trying to replace their individual plans with new individual plans from their current insurer, as opposed to shopping the marketplace for a new plan. So what they're seeing is their current insurer's non-Exchange plan that their current insurer would like to keep them on (as the premiums are higher).