The Dismantling of ObamaCare - Ongoing Updates.

[junkman]

I don't see how this is any different from what we have now. The burden of funding high risk patients will still be placed on the general population. Only difference being it's now in the form of taxes instead of mandatory coverage.

The top 5% of people incur 40% of the claims. Claims per member in high risk pools go the roof and ultimately end up crashing. These claims are normally rolled into the entire group if we're talking about a employer plan.

Shine a light on how expensive the high risk pool is and people eventually decide that it is "too" expensive. There is no group cohesion and it only affects a "few" so let it die.

That has been the case of every state sponsored pool and also the trusts I've seen that accept individuals with no underwriting. They always go belly up.

This will be straightened out as soon as the masses of those slightly above subsidy level start running out of options. They are feeling the squeeze now. I'm expecting ACA to hobble along for next year with at most 2 carriers but 0 to 1 in many areas. All who can will bail. Repubs will allow some underwriting but won't do much. More insureds will bail as will carriers. This will cause rates to go quickly much higher and 2019 will require a massive contentious revision.

That's of course IF there are any carriers in 2018. Carriers can be bribed - but it takes money.

 

[AllenChicago]

I think liberal states that opt to stay with all the Obamacare protections will attract zero Health insurers for 2018.

Their love for ObamaCare will be a disaster for the individual Market in those States.

 

[Yagents]

It's funny when the resident libs (who don't even sell health insurance) try to spout that it's the penalty that drove people to buy.

Less than 5-10% of my clients bought ACA to avoid the penalty, and they were very high income. Any moron can crunch the numbers and see the penalty is less than the premium in most cases. Or, maybe it was the morons who wrote the law, and put the penalty to low.

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When you only have 1 HMO carrier under ACA in your county, are these people with pre-ex really getting "covered" insurance or a good choice of doctors? Of course not. HRP's would be an upgrade for most of the country if it were a subsidized PPO (like PCIP, which was also dramatically underfunded by libs, and had to be cut off early)

Keep whistling past the graveyard.
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Lastly, find me one state governor that has expressed interest in getting exempted from ACA, and implement the provisions of AHCA. Silence.

Only TX may be stupid enough to cross that politically suicidal bridge.

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Good luck getting those who are 35 and under to buy a health insurance policy if they don't have to.

Ooops, even the NYT gets it...........

https://www.nytimes.com/2017/05/04/...-in-the-latest-gop-health-care-bill.html?_r=0

Who benefits?

Young, middle-class people without pre-existing health conditions: The bill would change how insurance companies price their products in a way that would lower prices for young customers. It also gives them a flat subsidy that is, in many cases, higher than what they would receive under Obamacare. There is some variation by region, and people with pre-existing conditions could be charged higher prices in some states.

 

[tonyisme]

Here is a 5 year old report...

https://www.dhs.gov/sites/default/f...lation Estimates in the US January 2012_0.pdf

The estimate back then...the underground economy. Will they need to buy coverage somehow?....remember they dont file returns.
But they will use medical facilities.
Its probably up to 15 mil by now...

https://www.dhs.gov/immigration-statistics/population-estimates/unauthorized-resident

 

[junkman]

I think liberal states that opt to stay with all the Obamacare protections will attract zero Health insurers for 2018.

Their love for ObamaCare will be a disaster for the individual Market in those States.

TN is not a "liberal state" and unsubsidized TN premiums for ages I checked were higher than in CA, MD and DC. I don't remember the exact ages but was checking for a friends (1 each) male mid 50s in DC/MD and female 37 or 38 in CA.

The Repubs are pretty good at throwing stones but have absolutely no proposal that makes coverage available to those without access to group. They "talk" about market forces and cross-state insurance but anyone with any understanding realizes that the very act of paying for healthcare with insurance eliminates "market forces" from healthcare.

I suggest dropping all of the crap and going back to basics. Basics are
1. Who has access to healthcare? Everyone? Those with incomes over $x? Those with access to group? Only the healthy defined as claims under $x? Everyone? To not decide is to decide by default.

Once you define who has access, you can decide how much access they have. I had a dog that got old and crippled with arthritis. I didn't buy him a hip replacement but did feed him and let him lay around until he died. Had he been able to afford his own hip, I might have bought it for him. Probably not. I'd still let him lay around but would keep his money because owners inherit their dog's money.

I remember a cartoon where the owner and dog were at a vet. The caption read "only fix him if it doesn't cost more than $x". We could apply something like that.

Have a premature birth, only get 10x the cost of a normal birth in care IF the premee meets some criteria and isn't going to need ongoing care. We could save on premium if care was limited to $50,000. That would be cool.

Hip replacements last 10 or 20 years. Perhaps we shouldn't pay for anyone over 70 to get one. We'd save another $60,000 there - really $120,000 because the 2nd hip frequently needs changing within a few years of the 1st.

Anyone with self-induced illnesses especially the younger would have to pay for their own. We'd save on care for fat people, druggies & those that suck down a lot of soft drinks and smokers.

After we decide who gets access, we only need to pay for it. We aren't talkin about a big portion of the population so it don't really matter but paying shouldn't be a big deal once we get those that don't deserve care out of the system.</sarcasm>

<real thought>Pinche Trump

 

[Yagents]

Just give it a chance, 58% increase in MD is mild and lower than pre ACA rate ups.

http://www.beckershospitalreview.com

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I thought SBE's we're supposed to be self funded and sufficient by now. Guess they still need federal nipple. 24 hours was all it took for blame to begin.

http://wtnh.com/2017/05/05/conn-health-exchange-would-collapse-

 

[HoosierLife]

Here's a pretty even handed look at HRPs:

High-Risk Pools For Uninsurable Individuals | The Henry J. Kaiser Family Foundation

So HIPPA laws allow people to move from employer plans to Indy plans without UW? Did I read that correctly?

 

[ARus]

No I understand all that. But just 2 years ago, a PCP visit would still only cost ~$30 and a specialist ~$50.

Now the cost is much more.

Plus it's hard to justify double the premiums and $6000s less in taxable income.

We actually use all of our HSA each year too.

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Plus it's all about to change. My wife is having our 2nd in Nov and will be coming home after that.

So then it's all up in the air. Hopefully whatever craziness comes of Trumpcare will have worked itself out by then.

Cobra on her plan is $18,000/yr. Well that's with funding the HSA.

Last year HSA plans aren't what they used to be before. Now you pay everything out from your pocket until deductible is met. Only preventive care is free.

 

[AgentOrange]

So HIPPA laws allow people to move from employer plans to Indy plans without UW? Did I read that correctly?

The quick answer would be it depends on your state. How your state complies is a whole other story. Some states ran high risk pools for HIPPA eligibles, others, like NJ, have "an insurer of last resort" for these purposes.

If anyone has any more experience with this, please feel free to chime in.

Here's a good resource that gives a broad overview of HIPPA eligible rules. I quoted a relevant section below:

https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8327.pdf



How is guaranteed issue regulated under current law?
1996, some insurance companies are required to guarantee issue policies to certain individuals, referred to
as HIPAA-eligible individuals, regardless of their health status and disability. These individuals include
In most states, insurers are not required to guarantee issue policies to individuals. However,
under the federal Health Insurance Portability and Accountability Act (HIPAA) of
people who have had at least 18 months of prior coverage, the last day of which was
under a group health plan. They cannot have more than a 63-day gap in coverage, and they
must have exhausted any COBRA or state continuation coverage for which they were eligible.
Such individuals must be guaranteed some type of coverage. States can decide whether that
coverage should be available from private insurers or available in some other way (such as
through the state's high risk pool
). Although federal law requires that coverage be available, it
does not limit how much insurance companies can charge HIPAA-eligible individuals for
coverage. Without a limitation by the states, this coverage can be very expensive.
In the small group market, HIPAA requires all health plans for small groups (employers with 2 to
50 employees) to be guaranteed issue. HIPAA does not require guaranteed issue for self- employed adults or for groups with more than 50 employees. However, some states have broader guaranteed issue requirements than the federal rules.
In addition, insurers can still deny coverage for a handful of other reasons, including:
 The applicant does not live in the insurer's service area;

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I should also mention this isn't relevant today. Loss of coverage under the ACA is a qualifying life event that will open a special enrollment period and get anyone access to community rated coverage, not subject to underwriting and no pre-x exclusions.

 

[Yagents]

Last year HSA plans aren't what they used to be before. Now you pay everything out from your pocket until deductible is met. Only preventive care is free.

Hell-oooooooo.........that's been the law for 13 years.
This is the definition of a HDHP.
Go read IRS publication 969