So What Was The Point of Obamacare Again?

[Foxfyre]

I see ads for signing up for Obamacare. The biggest sales point is that YOU can be eligible for federal help. YOU can become dependent. YOU can have your healthcare dictated to you. It is all up to YOU.

One of the major changes I noticed is the increase in the number of plans on the exchange. In Chicago I found 143 plans. The big surprise is number of higher deductible low cost plans. For a family of two 30yr old non-smokers and a child in Chicago with income of 50,000 family income plans started at $258/mo. Also, there are more zero deductible plans. For the above family, they start $558/mo. For the above family, similar plans start at $210/mo.

You do understand that if those premiums hold up, that the government

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

I don't think guaranteed profits is the correct term, but one of the dirty little secrets of Obamacare is the deal that was cut with the insurance companies so they would go along with it. The insurance companies are guaranteed government subsidies for any losses they take due to reduced premiums to accommodate Obamacare. So of course they don't care what happens to any of us--they'll get paid whether or not the policy holder pays. And just like all other government entitlements, those reimbursements to the insurance companies come out of your and my pockets. And I'm pretty sure its rigged so that the CBO doesn't factor that it when it reports the actual costs of Obamacare and, of course, this is another one of those inconvenient truths that will be under reported by the MSM who does its damndest to prop up leftist policies and programs:

ObamaCare 8217 s insurance company bailout New York Post.

You're speaking of the risk corridor program to stabilize premiums during the first 3 years of the operation of the exchanges. It certainly doesn't guarantee insurance companies a profit.

The insurer may receive a subsidy or may have to pay HHS a portion of the premiums depending on how costs match to targets. The bottom line is that some companies will collect from HHS and other will pay. Most companies will receive or pay HHS very little because they have been able to accurately determine their premiums. Those that receive money from HHS are those companies that end up with sicker subscribers; that is those that establish their premiums too low. Those that pay HHS are those that get healthy subscribers; that is those that have premiums too high above costs. This same program was used when Part D Medicare was started.

The law specifies that insurers that have a ratio of allowable costs to the target amount that is within 3 percentage points in either direction (97-103 percent) will keep all of their profits and be responsible for all of their losses. Insurers with actual costs between 92 percent and 97 percent of the target amount would pay HHS half of their gains within that range, while insurers with costs between 103 percent and 108 percent would be reimbursed half of their losses within that range. Insurers with actual spending below 92 percent of the target amount would refund the federal government 80 percent of those gains within that range.

Conversely, insurers with actual spending above 108 percent would be reimbursed 80 percent of those losses within that range by the government. While the risk corridors are symmetric, the ACA does not require the program to be budget neutral. As a whole, if the market suffers from adverse selection and premiums are inadequate, more payments will go out than are collected. On the other hand, if the market is priced too high, the government will receive more payments than it will spend on reimbursements. Referring to the program as an insurance company subsidy is incorrect.

Without this provision many insurance companies would not offer plans to individuals because they had no data to base their premiums. After 3 years of operation the companies should have a sufficient handle on costs to accurately determine premiums which is why the risk corridor program expires in 2015.

Health Policy Briefs

I believe the risk corridor lasts through 2016 and Obama sold it on the theory that insurance companies who wound up with healthier than expected policy holders would likely pay most of the bailout of the others and therefore that aspect of the ACA would be revenue neutral. I'm sure he had a pocketful of pixie dust and was petting a unicorn when he said that too. Just as he was so honest about all the other aspects of the ACA.

The best economic experts (including insurance company execs) are confident the bailouts will total hundreds of billions before its done despite collection of a miniscule amount from 'lucky' insurance companies. And once the reimbursement corridor expires, if the whole house of cards has not collapsed by then or we somehow have not wiggled out of the mess we're in, insurance companies will not eat those losses. And we can expect insurance premiums to as much as double and triple immediately.

There is no such thing as a free lunch. And the piper will be paid in one way or another.

 

[Flopper]

decreased be

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

I don't think guaranteed profits is the correct term, but one of the dirty little secrets of Obamacare is the deal that was cut with the insurance companies so they would go along with it. The insurance companies are guaranteed government subsidies for any losses they take due to reduced premiums to accommodate Obamacare. So of course they don't care what happens to any of us--they'll get paid whether or not the policy holder pays. And just like all other government entitlements, those reimbursements to the insurance companies come out of your and my pockets. And I'm pretty sure its rigged so that the CBO doesn't factor that it when it reports the actual costs of Obamacare and, of course, this is another one of those inconvenient truths that will be under reported by the MSM who does its damndest to prop up leftist policies and programs:

ObamaCare 8217 s insurance company bailout New York Post.

You're speaking of the risk corridor program to stabilize premiums during the first 3 years of the operation of the exchanges. It certainly doesn't guarantee insurance companies a profit.

The insurer may receive a subsidy or may have to pay HHS a portion of the premiums depending on how costs match to targets. The bottom line is that some companies will collect from HHS and other will pay. Most companies will receive or pay HHS very little because they have been able to accurately determine their premiums. Those that receive money from HHS are those companies that end up with sicker subscribers; that is those that establish their premiums too low. Those that pay HHS are those that get healthy subscribers; that is those that have premiums too high above costs. This same program was used when Part D Medicare was started.

The law specifies that insurers that have a ratio of allowable costs to the target amount that is within 3 percentage points in either direction (97-103 percent) will keep all of their profits and be responsible for all of their losses. Insurers with actual costs between 92 percent and 97 percent of the target amount would pay HHS half of their gains within that range, while insurers with costs between 103 percent and 108 percent would be reimbursed half of their losses within that range. Insurers with actual spending below 92 percent of the target amount would refund the federal government 80 percent of those gains within that range.

Conversely, insurers with actual spending above 108 percent would be reimbursed 80 percent of those losses within that range by the government. While the risk corridors are symmetric, the ACA does not require the program to be budget neutral. As a whole, if the market suffers from adverse selection and premiums are inadequate, more payments will go out than are collected. On the other hand, if the market is priced too high, the government will receive more payments than it will spend on reimbursements. Referring to the program as an insurance company subsidy is incorrect.

Without this provision many insurance companies would not offer plans to individuals because they had no data to base their premiums. After 3 years of operation the companies should have a sufficient handle on costs to accurately determine premiums which is why the risk corridor program expires in 2015.

Health Policy Briefs

All of that for less then 4 million people that WERE LEGAL citizens, were not covered by Medicaid and WANTED health insurance!
Wouldn't have been far simpler to tax the lawyers 10% as the tanning salons are taxed in ACA.
The $27 billion in tax revenue would then provide a $5,000 a year premium for any of those 4 million that were uninsured, could not get insurance that wanted insurance.
The 10% tax would be tied to the $850 billion in unnecessary, duplicate tests submitted by physicians that were concerned about being sued...hence
"defensive medicine"!
As the $850 billion decreased because lawyers no longer sued at the drop of a hat, the tax would reduce as an incentive to help reduce premiums that the insurance companies charge because they pay these $850 billion in defensive medicine claims.

Apples and Oranges

 

[Flopper]

I see ads for signing up for Obamacare. The biggest sales point is that YOU can be eligible for federal help. YOU can become dependent. YOU can have your healthcare dictated to you. It is all up to YOU.

One of the major changes I noticed is the increase in the number of plans on the exchange. In Chicago I found 143 plans. The big surprise is number of higher deductible low cost plans. For a family of two 30yr old non-smokers and a child in Chicago with income of 50,000 family income plans started at $258/mo. Also, there are more zero deductible plans. For the above family, they start $558/mo. For the above family, similar plans start at $210/mo.

You do understand that if those premiums hold up, that the government

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

I don't think guaranteed profits is the correct term, but one of the dirty little secrets of Obamacare is the deal that was cut with the insurance companies so they would go along with it. The insurance companies are guaranteed government subsidies for any losses they take due to reduced premiums to accommodate Obamacare. So of course they don't care what happens to any of us--they'll get paid whether or not the policy holder pays. And just like all other government entitlements, those reimbursements to the insurance companies come out of your and my pockets. And I'm pretty sure its rigged so that the CBO doesn't factor that it when it reports the actual costs of Obamacare and, of course, this is another one of those inconvenient truths that will be under reported by the MSM who does its damndest to prop up leftist policies and programs:

ObamaCare 8217 s insurance company bailout New York Post.

You're speaking of the risk corridor program to stabilize premiums during the first 3 years of the operation of the exchanges. It certainly doesn't guarantee insurance companies a profit.

The insurer may receive a subsidy or may have to pay HHS a portion of the premiums depending on how costs match to targets. The bottom line is that some companies will collect from HHS and other will pay. Most companies will receive or pay HHS very little because they have been able to accurately determine their premiums. Those that receive money from HHS are those companies that end up with sicker subscribers; that is those that establish their premiums too low. Those that pay HHS are those that get healthy subscribers; that is those that have premiums too high above costs. This same program was used when Part D Medicare was started.

The law specifies that insurers that have a ratio of allowable costs to the target amount that is within 3 percentage points in either direction (97-103 percent) will keep all of their profits and be responsible for all of their losses. Insurers with actual costs between 92 percent and 97 percent of the target amount would pay HHS half of their gains within that range, while insurers with costs between 103 percent and 108 percent would be reimbursed half of their losses within that range. Insurers with actual spending below 92 percent of the target amount would refund the federal government 80 percent of those gains within that range.

Conversely, insurers with actual spending above 108 percent would be reimbursed 80 percent of those losses within that range by the government. While the risk corridors are symmetric, the ACA does not require the program to be budget neutral. As a whole, if the market suffers from adverse selection and premiums are inadequate, more payments will go out than are collected. On the other hand, if the market is priced too high, the government will receive more payments than it will spend on reimbursements. Referring to the program as an insurance company subsidy is incorrect.

Without this provision many insurance companies would not offer plans to individuals because they had no data to base their premiums. After 3 years of operation the companies should have a sufficient handle on costs to accurately determine premiums which is why the risk corridor program expires in 2015.

Health Policy Briefs

I believe the risk corridor lasts through 2016 and Obama sold it on the theory that insurance companies who wound up with healthier than expected policy holders would likely pay most of the bailout of the others and therefore that aspect of the ACA would be revenue neutral. I'm sure he had a pocketful of pixie dust and was petting a unicorn when he said that too. Just as he was so honest about all the other aspects of the ACA.

The best economic experts (including insurance company execs) are confident the bailouts will total hundreds of billions before its done despite collection of a miniscule amount from 'lucky' insurance companies. And once the reimbursement corridor expires, if the whole house of cards has not collapsed by then or we somehow have not wiggled out of the mess we're in, insurance companies will not eat those losses. And we can expect insurance premiums to as much as double and triple immediately.

There is no such thing as a free lunch. And the piper will be paid in one way or another.

That doesn't make sense. The only companies that get money from the fund are those that under price their plans. The companies will be reimbursed only 50% to 80% of their loss so there is no reason they should under price their plans