List the good thing about Obama care...

[Vandalshandle]

First, My credentials. 50 years in health insurance and HMOs, most of which was at VP level. Certified Life Underwriter. Chartered Financial Consultant. Fellow Life Office Management Institute designation. Health Insurance Association of America designation, both individual and group. BBA degree, majoring in insurance. Retired.

The universal insurance code, adopted by all states, has a requirment for an "incontestable period" of two years, after which, coverage can not be recinded for misrepresentation on an application. PERIOD. Anyone who tells you differently is lying. If the company did that, the individual would file a complaint with the state insurance department. They would log and forward the complaint to the company. The company would have up to 60 days to respond. If they recended after the 2 year period, they would be foreced by the insurance commissioner to reinstate coverage with no lapse. The company would also be fined. In addition, the individual would have various civil remedies. Someone at the insurance company would lose thier job. If they determined that the individual was not eligible for coverage under the terms of the contract, due to reasons other than health conditions, they may recind coverage with NO time limit. For example, I once recinded coverage under an employer group health insurance plan after 6 years, when I discovered that the guy was a friend of the employer, NOT an employee.

As to the advantaes of AHCA, the answer is simple. No one will ever again have to do what I did for a living, which was to tell people that I really am sorry that their child was born with a hole is his heart, and will die if he does not have an operation, but sinice he was not enrolled during the open enrollment or initial eligibility period, he is now classified as a "late enrollee", and his health condition is such that I am turning down thier request for coverage...with full knowledge that I was condemning this child to death. I did this daily for decades, as the VP of Underwriting.

 

[Greenbeard]

According to what? I understand that the new exchanges are supposed to increase competition but really all they are is a store. Essentially, it gives you some insight as to the various insurance available BUT that only is going to increase the visibility NOT the number of insurers. You make the claim that will happen but I see nothing that backs that claim up.

First off, the number of insurers is not the only problem afflicting the individual market. This useful overview of what exchanges are lays out some of the issues with the marketplace (that exchanges seek to correct):

One of the great challenges in buying health insurance has been a highly fragmented market. Individuals and group purchasers lack a reliable means for seeing their choices in one place and in a manner that allows them to compare what the plans cover, which providers are in various plans’ practice networks, how cost-sharing might differ, and how numerous competing plans might compare on key measures of quality performance. Nor has there been an active, consumer-oriented system for assuring that insurance plans that are offered in the individual and small group markets provide comparable coverage, cover the benefits that are considered essential to any health insurance plan, have accessible provider networks, and are accountable for specific measures of health care quality. State insurance departments play a different role in most states, overseeing health insurers’ solvency and marketing and business practices. But typically insurance departments do not, as part of their work, organize the health insurance market to make it accountable and user-friendly to individual and group consumers.​

Creating a structured marketplace is crucial to making sure that insurers actually have to compete with each other on a level playing field. That's a key part of where the new competition comes from.

That said, looking at the number of participating insurers (each offering a number of different plan options) in the marketplaces, it's not bad. In future years, we can expect more, as certain insurers are hanging back for the first year out of caution. But some of the state-based marketplace numbers that have come out: Maryland has 13 insurers offering plans in its marketplace, California has 13, Oregon has 12, Washington has 9, Colorado has 11.

And I've already mentioned somewhere above what we know about states with a federally-facilitated marketplace but I'll reiterate it:

New Choices for Consumers:

• The Marketplace is attracting new insurance choices and increasing competition for consumers, especially in States where it is really needed.
• The majority of States will have new health insurance choices that are not available today. The insurance reforms, coupled with premium tax credits, and premium stabilization programs, have made the Marketplace an attractive option for new entrants.
  • In about 75% of the States with an HHS-run Marketplace, at least one new insurance company intends to enter the market and plans to offer individual market coverage.
  • One out of every four insurance companies proposing to offer coverage next year in the HHS-run Marketplace has newly entered the individual market.
  • About 65% of new issuer entrants to the individual market in the HHS-run Marketplace will be in States where only one insurance company dominates the market today.
  • Multi-State plans will be offered in at least 31 States nationwide in 2014, with coverage expanding to all 50 States and D.C. no later than 2017. OPM is currently reviewing over 200 proposed Multi-State qualified health plan options. This type of plan offers similar coverage across State lines, and helps promote choice and competition.

Strong Competition:

• About 90% of target enrollees will have five or more difference insurance company choices – based on data from the 19 States with a HHS-run Marketplace and from other State-run Marketplaces that have publicly released information about their submissions. Together, these States represent an estimated 80% of the 7 million people CBO estimates will enroll in the Marketplace in 2014.
• While the number of issuers may change, today, over 120 issuers have applied to offer qualified health plans in the HHS-run Marketplace.
• Consumers will have multiple options in each tier of coverage: catastrophic, bronze, silver, gold, and platinum. On average, issuers plan to offer more than 15 qualified health plans per State, with some plans being offered in part rather than all of the State.1

So I'm not sure what you mean when you say you see nothing to back up that claim.

That is one reason why I stated the exchanges were a GOOD idea. That does not mean that completion is necessarily going to be better though. The exchanges can be voluntary as well and virtually all insurers would use them as almost all car sales companies congregate – the customers go to those places and that is where the business lies. That might be good for the consumer BUT I already gave you that and it is not good when rapped in the 2000 other pages of legislation.

I get that folks are suspicious of the fact that legislation is 900+ pages long (2,000 is a bit of an overestimate). But that's because it's not short on ambition. Reforming insurance markets is important but that's not all the law does. The law is made up of nine titles--only the first is about reforming private insurance and creating real markets.

One title reforms Medicaid, not just expanding and simplifying eligibility for the program but offering the states that run it new options for meeting the (often complex) needs of its beneficiaries. That's important.

One is dedicated to reforming Medicare, orienting the program to getting more for the money it pays. That's important (and may already be paying dividends, improving care while holding down cost growth).

One is dedicated to preventing chronic disease and investing in America's local public health infrastructure. That's important, maybe more now than ever.

Whenever someone sneers that it doesn't create any new health professionals, I have to shake my head. Because of the nine titles that make up the law, an entire one is devoted completely to health care workforce development. That's important.

One title is dedicated to modernizing program integrity and transparency requirements around the public health insurance programs (Medicare and Medicaid), giving the feds new tools to crack down on those who're bilking the system. They're doing that and that's important.

One is dedicated to revenue provisions, not just to pay for the coverage expansions (though it helps to do that) but to make sure our tax code is better aligned with the goal of helping communities address their public health needs and the goal of helping payers achieve cost containment.

It's a big law. That's why, as Joe Biden rightly pointed out, it's a big fucking deal. They call me a booster for this law and I am because it's simply that important. The coverage stuff is great and I support it, but it's the other things--things that most people will never know or appreciate about it--that truly get me excited. There are things going on now that are potentially game-changing. And that's exciting!

But that was my entire point: that is a HORRIBLE thing. I WANT that to erode. Employer provided care is a disease in the whole system. It should have been phased out and made entirely illegal.

I understand that. And I don't disagree when it comes to the problems of employer-sponsored insurance as it has traditionally functioned. But policy tends to suffer from path dependence, meaning where we go from here is always heavily influenced by where we are and where we've been. You almost never get to start from scratch. Because radical change like that simply doesn't work--folks, understandably, tend not to like that.

In that respect, the ACA is a deeply conservative law, largely preserving what is but pointing us in the direction of and putting us on the path to something better. Which is what I'm talking about when I describe what's going to happen to the group markets for insurance over the next decade or so.

IF that occurs, that would be a good thing. I am skeptical that it will happen though. Employers choose plans because they are getting something out of it – essentially kickbacks and a company that looks out for the employer rather than the individual. If it does happen, then I will have to admit, that would be another positive in the plan.

Employers offer coverage because 1) employees want it, and 2) a dollar of health benefits is more valuable than a dollar of wages thanks to the tax code. On the first point, that's largely been because people want insurance (which will be even more true when the individual mandate kicks in next year) and getting insurance through a group is a much better deal, thanks to consumer protections in those markets and other safeguards that haven't existed in most individual markets.

It's historically been much better and much safer to get coverage through work than try to buy it on your own in loosely regulated individual markets (which is why some employers have viewed it as something of a moral imperative to offer coverage). That will change next year as new consumer protections kick in for people buying in the individual market. The good deal vs. raw deal asymmetry between the group and individual insurance markets is largely going to disappear in January.

But the second point persists, though in a diminished way. The tax preference for health benefits over wages will still exist, though for the first time it's going to essentially be capped (thanks to the excise tax on health benefits over a certain dollar amount) meaning the subsidy for group insurance will no longer be limitless. But there's still going to be some benefit to employers offering benefits, up to a limit.

I never made that assertion BUT they are going to begin to receive some things for free and they are going to be subsidized as well. If you think that things are going to stop there though, I think you are being naive about how politicians work. There are going to be pushes and promises made continually with small children’s faces on commercials about forcing one thing or the other to be subsidized. Another reason that I don’t want the government determining what must be provided and whether or not that coverage should be 100 percent. They are going to start to get involved in places that politicians simply do not belong.

People buying in the individual market are going to be subsidized, yes. But they still have to pay, particularly when it comes to cost-sharing at the point of service.

I don't have a crystal ball. But I can say, looking at the history of the Medicaid program, that when benefits come at the public's expense, the impulse has been to pare them, not to increase them. I didn't mention this in my post, but in fact the requirement that plans offer essential health benefits may well in the future be a key mechanism for getting states to repeal private insurance mandates, not multiply them.

This did only cover a few of my points though. Employer provided care is STILL going to be the norm, the taxing power increase to unprecedented levels is still affirmed along with the ability to demand that you buy 10 apples a year from a specific source, they are still defining coverage limits and political bias is going to play into that, and you are still going to increase usage without any real increase in capability.

Your counter revolves around the HC markets increasing competition. That is not the only problem with Obamacare and I don’t see any real evidence that there is going to be any real increase in competition through the market. Visibility is going to increase and I agree that it is a good thing BUT I don’t think it is enough or sufficient to counter the big negatives as I see them; particularly the new powers that politicians are gaining over you and the definition of a ‘qualified’ insurance plan. Coincidently, that is one of the counterbalances to gaining competition, the need for the government to approve your plan and the requirements that you are going to have to meet to be an approved plan.

I didn't address all your points because some of it was about ideological points I simply don't want to get into at this point. I'm happy to discuss lots of these issues--really I am, I find most of this extremely valuable and, in case it doesn't show, I like this stuff--but I have very little interest in re-litigating questions about the extent of the taxation power and the like.

Anyway, you're correct that most people are still going to get insurance through an employer. But I stand by my statement that the nature of employer-sponsored insurance is going to change. The distinctions between different types of insurance (particularly individual vs. group, but also Medicaid which is already primarily in the hands of private insurers) are going to blur. People with employer-sponsored plans are increasingly going to have the opportunity to shop for their own plans in the marketplace, using a contribution from their employer. That's a transition--and something of a compromise--between what exists now and some idealized world. Employers still get to offer a tax-privileged health benefit as part of their compensation package and employees still get to receive it, but the employer gets greater certainty about what he's offering (since it's a dollar amount to be applied to a plan, not a particular plan and the associated volatility in its pricing) and the employee gets to choose from competing plans on his own.

It's not going to be instantaneous but the group market is going to evolve toward that over the next decade and beyond. That's the opportunity that's been created here. Again, quoth the Biden, a BFD.

You talk about the government approving plans. This may surprise you (or not) but I supported the Senate's more "federalist" approach to health insurance exchanges, in which individual states are responsible for the design and administration of their own marketplaces. The House bill called for a single national health insurance exchange run by a federal commissioner.

Back at the beginning of all this (how young we all were!) before the extent of the political sabotage became clear, Deloitte did a nice summary of what general design philosophies different states may opt for as they design and build their own exchanges to meet the demands of local conditions and preferences:

What different exchange models do you think will emerge in the states?

The ACA prescribes basic functions that all exchanges must be able to perform but gives the states some design flexibility. A host of factors are expected to impact the eventual design and functionality of the operating model of a given state exchange. The two main factors are:

• Market Environment – Some states manage markets through regulation, while others employ a free-market approach.
• Exchange Capabilities – Some states will take a de minimis approach, while others will opt to build robust operational capabilities as they bring these exchanges online.

We anticipate that four health insurance exchange operating models will emerge, each with distinct characteristics: Information Aggregator, Retail-oriented Exchange, Guided Exchange, Market Curator (Figure 1).

1. Information Aggregator – Takes a laissez-faire approach, where the state facilitates the transaction, and little more.
2. Retail-Oriented Exchange – Seeks to develop a competitive marketplace focused on providing a robust shopping experience for the consumer.
3. Guided Exchange – Reduces confusion for new consumers by offering a reduced number of more standardized products and a simplified shopping experience.
4. Market Curator – Manages competition on a robust platform, where the state curates who can be on the exchange and, to a lesser extent, which products can be offered.

The model that emerges for any given state will factor heavily into a health plan’s decision to participate in the market, as well as influence development of its go-to-market strategy in “entry” states.

I was interested in seeing what emerged.

Some states would be (and are) "active purchasers" that negotiated more aggressively with insurers and limited those who access the exchanges to leverage additional policy or performance requirements on insurers who desire to sell in the exchanges. California has taken this approach; the 13 insurers selected to sell in their market are only about a third or so of those who applied to sell.

Other states would throw their markets wide open, allowing any insurer offering plans that met the minimum requirements of the law to sell in their marketplaces. You can see in this table which states (among those opting to design and manage their own marketplaces) are choosing which approaches.

It was to be a grand experiment in federalism with multiple different approaches taken across states. But most states opted to let the federal government run their marketplaces, some taking on some functions in partnership with the federal government (which, by the way, is not an active purchaser). After the 2010 GOP wave at the state level, many state leaders decided they disliked or publicly had to express distaste for the ACA--if not markets themselves--for political reasons, abandoning the chance to tailor the exchanges to local conditions and political preferences.

I'll say I'm a little less sold on the Senate's federalist, state-driven approach now than I was in 2009-10 due to (mostly) red states' apparent interest in the federal government taking charge anyway. I was hoping to see dozens of state-tailored approaches and that simply hasn't happened. At least not in the way anyone expected. But the point is, the amount of government involvement in plan certification and selection should vary by the political tenor of the state, offering a test of which approaches work best. Unfortunately, it turns out the experiment is a bit more limited in the number of varied approaches being tried but there are still are a number of different things going on (and I still expect that more states will opt to take their exchanges back from the feds in coming years--indeed, I expect that to become an important campaign issue in many states, if not next year then in 2016).

 

[Greenbeard]

Didn't you read it?

252 hospitals and physician groups across the U.S. have signed up to join the administration’s accountable care program, in which they share the financial risk of keeping patients healthy.

Under the program, hospitals and physician practices take responsibility for tracking and maintaining the health of elderly and disabled patients. If costs rise beyond an agreed upon level, hospitals may become responsible for reimbursing the government. If they cut the cost of care while maintaining quality, hospitals share in the savings. The government expects the savings may be as much as $1.9 billion from 2012 to 2015. Early indications suggest they are starting to add up.

Presumably he did not, considering the article is largely a catalog of the ways providers are working to improve care delivery and quality.

 

[The Rabbi]

First, My credentials. 50 years in health insurance and HMOs, most of which was at VP level. Certified Life Underwriter. Chartered Financial Consultant. Fellow Life Office Management Institute designation. Health Insurance Association of America designation, both individual and group. BBA degree, majoring in insurance. Retired.

The universal insurance code, adopted by all states, has a requirment for an "incontestable period" of two years, after which, coverage can not be recinded for misrepresentation on an application. PERIOD. Anyone who tells you differently is lying. If the company did that, the individual would file a complaint with the state insurance department. They would log and forward the complaint to the company. The company would have up to 60 days to respond. If they recended after the 2 year period, they would be foreced by the insurance commissioner to reinstate coverage with no lapse. The company would also be fined. In addition, the individual would have various civil remedies. Someone at the insurance company would lose thier job. If they determined that the individual was not eligible for coverage under the terms of the contract, due to reasons other than health conditions, they may recind coverage with NO time limit. For example, I once recinded coverage under an employer group health insurance plan after 6 years, when I discovered that the guy was a friend of the employer, NOT an employee.

As to the advantaes of AHCA, the answer is simple. No one will ever again have to do what I did for a living, which was to tell people that I really am sorry that their child was born with a hole is his heart, and will die if he does not have an operation, but sinice he was not enrolled during the open enrollment or initial eligibility period, he is now classified as a "late enrollee", and his health condition is such that I am turning down thier request for coverage...with full knowledge that I was condemning this child to death. I did this daily for decades, as the VP of Underwriting.

Sad story. What you didnt see were the hundreds of children who had health insurance available to them because their parents played by the rules and did everything right and had an insurance company that was prudent in denying claims they were not responsible for.

 

[lynn63]

First, My credentials. 50 years in health insurance and HMOs, most of which was at VP level. Certified Life Underwriter. Chartered Financial Consultant. Fellow Life Office Management Institute designation. Health Insurance Association of America designation, both individual and group. BBA degree, majoring in insurance. Retired.

The universal insurance code, adopted by all states, has a requirment for an "incontestable period" of two years, after which, coverage can not be recinded for misrepresentation on an application. PERIOD. Anyone who tells you differently is lying. If the company did that, the individual would file a complaint with the state insurance department. They would log and forward the complaint to the company. The company would have up to 60 days to respond. If they recended after the 2 year period, they would be foreced by the insurance commissioner to reinstate coverage with no lapse. The company would also be fined. In addition, the individual would have various civil remedies. Someone at the insurance company would lose thier job. If they determined that the individual was not eligible for coverage under the terms of the contract, due to reasons other than health conditions, they may recind coverage with NO time limit. For example, I once recinded coverage under an employer group health insurance plan after 6 years, when I discovered that the guy was a friend of the employer, NOT an employee.

As to the advantaes of AHCA, the answer is simple. No one will ever again have to do what I did for a living, which was to tell people that I really am sorry that their child was born with a hole is his heart, and will die if he does not have an operation, but sinice he was not enrolled during the open enrollment or initial eligibility period, he is now classified as a "late enrollee", and his health condition is such that I am turning down thier request for coverage...with full knowledge that I was condemning this child to death. I did this daily for decades, as the VP of Underwriting.

I could never do your previous job knowing that I created the final nail in their coffin.

 

[Synthaholic]

First, My credentials. 50 years in health insurance and HMOs, most of which was at VP level. Certified Life Underwriter. Chartered Financial Consultant. Fellow Life Office Management Institute designation. Health Insurance Association of America designation, both individual and group. BBA degree, majoring in insurance. Retired.

The universal insurance code, adopted by all states, has a requirment for an "incontestable period" of two years, after which, coverage can not be recinded for misrepresentation on an application. PERIOD. Anyone who tells you differently is lying. If the company did that, the individual would file a complaint with the state insurance department. They would log and forward the complaint to the company. The company would have up to 60 days to respond. If they recended after the 2 year period, they would be foreced by the insurance commissioner to reinstate coverage with no lapse. The company would also be fined. In addition, the individual would have various civil remedies. Someone at the insurance company would lose thier job. If they determined that the individual was not eligible for coverage under the terms of the contract, due to reasons other than health conditions, they may recind coverage with NO time limit. For example, I once recinded coverage under an employer group health insurance plan after 6 years, when I discovered that the guy was a friend of the employer, NOT an employee.

As to the advantaes of AHCA, the answer is simple. No one will ever again have to do what I did for a living, which was to tell people that I really am sorry that their child was born with a hole is his heart, and will die if he does not have an operation, but sinice he was not enrolled during the open enrollment or initial eligibility period, he is now classified as a "late enrollee", and his health condition is such that I am turning down thier request for coverage...with full knowledge that I was condemning this child to death. I did this daily for decades, as the VP of Underwriting.

I could never do your previous job knowing that I created the final nail in their coffin.

His post confirms that 'Death Panels' have been around longer than Sarah Palin has.

 

[Vandalshandle]

First, My credentials. 50 years in health insurance and HMOs, most of which was at VP level. Certified Life Underwriter. Chartered Financial Consultant. Fellow Life Office Management Institute designation. Health Insurance Association of America designation, both individual and group. BBA degree, majoring in insurance. Retired.

The universal insurance code, adopted by all states, has a requirment for an "incontestable period" of two years, after which, coverage can not be recinded for misrepresentation on an application. PERIOD. Anyone who tells you differently is lying. If the company did that, the individual would file a complaint with the state insurance department. They would log and forward the complaint to the company. The company would have up to 60 days to respond. If they recended after the 2 year period, they would be foreced by the insurance commissioner to reinstate coverage with no lapse. The company would also be fined. In addition, the individual would have various civil remedies. Someone at the insurance company would lose thier job. If they determined that the individual was not eligible for coverage under the terms of the contract, due to reasons other than health conditions, they may recind coverage with NO time limit. For example, I once recinded coverage under an employer group health insurance plan after 6 years, when I discovered that the guy was a friend of the employer, NOT an employee.

As to the advantaes of AHCA, the answer is simple. No one will ever again have to do what I did for a living, which was to tell people that I really am sorry that their child was born with a hole is his heart, and will die if he does not have an operation, but sinice he was not enrolled during the open enrollment or initial eligibility period, he is now classified as a "late enrollee", and his health condition is such that I am turning down thier request for coverage...with full knowledge that I was condemning this child to death. I did this daily for decades, as the VP of Underwriting.

I could never do your previous job knowing that I created the final nail in their coffin.

His post confirms that 'Death Panels' have been around longer than Sarah Palin has.

We rationalized what we did, because "we are not a welfare organizarion. We are a privately owned company responsible ot our owners, the stockholders". The truth is that all companies had to do this. If one did not, then that one company would soon attract every adverse , uninsurable risk in the nation, and would soon be out of business.

 

[The Rabbi]

That's exactly the point. If companies didnt deny spurious claims they would be unable to pay lawful ones.