The Dismantling of ObamaCare - Ongoing Updates.

[somarco]

Claims are function of utilization and procedure price. We've dealt with procedure price for years. It is minor compared to ACA utilization.

Utilization has always been an issue. It increases when low deductibles and copay's are in play.

Obamacare changed the game by allowing those in risk pools, no coverage, COBRA to enter penalty free. Subsidies made it an all-you-can-eat health care buffet.

As you pointed out, Obamacare also drove the healthy ones away. Never saw that coming . . .

Either the healthy are enrolled or pre-existing is reinstated.

Doesn't have to be one or the other.

Reintroduce underwriting for the general population that can qualify (90 - 95% of us fit that definition) and subsidized risk pool for the unhealthy ones. This is what should have been done from the start.

There are currently underwritten major medical with coverage close to ACA plans at 50% of premium.

Define close.

Groups (50+) are in different pool and rates hover not been impacted nearly as much.

Groups of 50+ are at least partly experience rated. At 200+ almost entirely experience rated.

 

[bluemarlin08]

Why not do "group" for say one's zip code? Guaranteed issue, claims based rates?

 

[Yagents]

I agree with Somarco, and it's proven to work with this recent article on the Alaska high risk pool that was implemented in emergency fashion to combat huge rate increases. You can't ask 95% of the population to pay for the 5%, at least not visibly thru a premium. It can be handled through blind taxes instead to fund the risk pool.


Alaska

Alaska’s Novel Plan to Cut Health Premium Costs
State agrees to pay costs for about 500 sickest residents to hold down insurance prices for everyone else

ANCHORAGE, Alaska—Health-insurance premiums for individuals in Alaska have been soaring almost 40% a year. The main reason: the cost of covering fewer than 500 residents who are among the sickest in the state, according to one state analysis.

That prompted the state government to come up with a novel solution. It agreed in June to kick in $55 million for at least a year to cover the health-care costs for those patients, whose outsize medical bills prompted insurers to boost premiums for all 23,000 customers in an effort to remain profitable.

Individual-plan premiums will now go up just 7.3% on average next year, instead of the more than 40% that had been projected, though Alaska’s exchange plans are still expected to be among the nation’s most expensive.

 

[somarco]

Why not do "group" for say one's zip code?

Too small a sample. Risk pools can work in states with large enough population.

A subsidized national risk pool would have been ideal but the folks that designed Obamacare must have considered that too simple.

 

[junkman]

@somarco and Yagents

I had years of complete monthly data for an 800 member group that BCBST said was 100% credible. I ran a simple regression on 2 yrs of monthly data and the numbers came back only 30% credible. Credibility was less than 60% when looked at on a 24 month rolling basis. Standard deviation was huge (to quote the donald). Anyone that says rates based on anything less than several thousand members is credible is ignorant, lying or hasn't done their own calculations. I consider the carriers to be lying because the actuaries are not ignorant and have done the calculations. They simply want the entire block to track.

I disagree on your assessment oh healthy percentage. Back when we used to underwrite individual medical, many more than 5% would be declined. Apps say "have you ever had xxxx. Go back that long and many people cannot pass.

We still have Cobra laws. People almost never elected before ACA and now there is no reason to especially with ACA subsidized for so many.

Look at a large group. The vast majority of claims are incurred by the top 3 or 4% of the people. The problem with ACA is claims/member is at least twice as high as for group. They use the same networks and have similar plan designs. It can only be because of utilization. It is exactly the 95% that pay for the top 5%. This is the definition of insurance.

Most large claims stop for those that are working. We learned this back when group was underwritten. We'd get diagnosis and prognosis on claims over $10,000 and include it with the RFP. A bypass recovered was fine. Recent cancer or severe diabetes wasn't. Those things haven't changed.

Now, many I know are getting joints replaced at $55,000 each. They run in pairs. Get both out of the way and no more problem. Most cannot write that kind of check. Without the joint we have cripples to deal with. You don't want to be one and if you eat like most Americans, you will. Diet or more accurately intake of what we call "food" is another discussion.

Under ACA or any change, we need the 95%. We are too heavy on the 5%. 100% need to pay for it. The working and group enrolled pay because benefits are 1 former of compensation. The working without group access do not pay because those are the low income jobs with large subsidies.

We have pretty much a cluster ****. I blame Congress for ending up with this abomination. Medicare is going down in the sense that providers are dropping out. I was in FL last week and providers are charging a flat fee to become their patient. They then charge for service. Only the wealthy can afford. I don't have a problem with money buying better care but do have a problem with the not wealthy having crappy care. Money,always buys and always will.

 

[somarco]

You surprise me Junkman. I had no idea you were a certified actuary.

FWIW, unless you are assuming the risk all of your math gyrations are just something to chat about with other number crunchers.

I only spent 20+ years on the carrier side, about half that in stop loss underwriting, ceding coverage and at times acting as an intermediary so I probably don't know as much as you or the carriers you put down. We had groups of 300+ that were regularly experience rated and, depending on the number of months of claim data, could be 100% credible.

At one time Hancock, Confederation and Equitable experience rated groups of 100 - 150 as fully credible. Great West was in the mix too although not as aggressive and I think their entry point was 200 lives.

Three years of data with monthly claim and body counts would get you a quote.

Lloyds would self fund groups down to 5 lives and put them on a manual rate the first year but transition to experience rated over time.

BCBSGA gave stats in a meeting a few years ago supporting they made an offer on 96% of apps submitted.

I took thousands of apps (IFP) over the years and can probably count on one hand the number that were declined.

Before COBRA group plans had conversion plans. I wrote a number of group conversion plans with Celtic before COBRA existed.

Some states had risk pools. Others had carriers of last resort. Some had GI. There were almost always an option for sick people.

Whether they took advantage of those options or not does not diminish the fact they could have had coverage.

Medicare has been "dying" for years. Hasn't happened yet. Won't happen.

Concierge practices are not new nor are they the norm. Doubt they will ever be.

You have a nice day.

 

[kgmom219]

the mix too although not as aggressive and I think their entry point was 200 lives.

Three years of data with monthly claim
BCBSGA gave stats in a meeting a few years ago supporting they made an offer on 96% of apps submitted.

I took thousands of apps (IFP) over the years and can probably count on one hand the number that were declined.

That's a bogus number and you know it.

How many did you pre-screen and not write the app because they were going to get declined?

I agree with 50%. Pre ACA, 50% of the people who called me weren't insurable and I didn't write the app.

It's not hard to be uninsurable when its 3 sinus infections in a rolling 12 months. Or ADHD meds.....

 

[Yagents]

10% of mine got declined pre ACA.
10% went assurant for lenient underwriting or riders.
The other 80% found a home

 

[somarco]

Nothing bogus.

Wrote quite a few with GR because of liberal underwriting and riders. Humana also would issue policies with riders. KP was reasonably flexible on some situations.

As I recall most of the folks who called and I never took an app were pregnant.

Pretty sure Aetna took bipolar people at one time. ADHD was a piece of cake.

 

[AllenChicago]

December 31, 2016

LAME DUCK MEETS LOSERS on Wed January 4, 2017.

""WASHINGTON ― President Barack Obama will huddle with House and Senate Democrats next week to strategize on how best to protect the Affordable Care Act.

Republican lawmakers plan to take up a repeal of Obamacare as soon as Congress returns in January.*

“Next week, Republicans in Congress will once again turn to repealing a law that’s provided coverage to 20 million uninsured Americans, extended consumer protections to many millions more, improved the quality of care offered by our health professionals, and helped slow the growth of health care costs,” a White House official said in a statement. “In light of this, on Wednesday, January 4, President Obama will visit a meeting of the House and Senate Democratic Caucuses.”

Source: Obama Will Meet With Congressional Democrats On Strategy To Block Obamacare Repeal | The Huffington Post