<p>But there are others as well. Low information. Lack of effective outreach by the agency administering the program. Confusion in the midst of swirling misinformation. </p>
<p>Public opinion surveys say two-thirds of uninsured respondents say they don’t have enough information about “Obamacare” to know how or whether it will benefit them. Those same surveys say substantial pluralities of respondents incorrectly believe the ACA will reduce or eliminate Medicare, establish federal “death panels” to make end-of-life determinations, and establish a “public option” as an alternative to private health insurance. A smaller but not insubstantial portion of the public believes that “Obamacare” will create a vast new federal health insurance program that will displace all existing health insurers. One poll found that 12% of respondents incorrectly believe the ACA has been repealed (not entirely surprising in light of the fact that the U.S. House of Representatives has in fact voted to repeal the ACA 40 times, which of course is empty symbolism in the absence of Senate action), another 7 percent incorrectly believe it has been overturned by the Supreme Court, and another 23% said they didn’t know enough to know whether it was the law or not. With that much confusion abroad in the land, it’s a wonder anyone has found their way clear to sign up for the federal high risk pool.</p>
<p>Yes tom, my company competes globally. And I’m assuming that all companies write off health care costs as a cost of doing business. Though since my company is self-funded, I’d guess they pay less cost per person than most companies do. I do suspect (though I can’t know for sure), that they are talking out of both sides of their mouth a bit, with the changes due to ACA. Of course they are unhappy paying additional tens of millions of dollars in fees due to ACA, but I don’t think they are forced to change the plan right now in order to avoid the “cadillac plan” taxes, as you mentioned that doesn’t come into effect until 2018. I think it may be a rather convenient and well timed excuse to lower their health care costs sooner than required. They could have done this at any time if they wanted, though, except to unionized workers.</p>
<p>From what I can glean online, the number of enrollees was much lower than predicted, possibly because although premiums were priced at “healthy person” rates, they were not income-based; and because the costs of care ended up being much higher than anticipated. The PCIP program was running out of money ($5billion) with its 110,000 enrollees, so it shut down the program to new applicants, even though it had anticipated covering 375,000.</p>
<p>Hopefully this is not a foreboding of miscalculations to come.</p>
<p>Well… I spent a few hours with somebody that is actually working with health insurance companies in Cal to get ready for ACA. </p>
<p>Are the health insurance companies ready today? </p>
<p>No, but they will be better prepared in Oct. </p>
<p>The pricing of the plans was tough for the insurance companies because the companies dont know how healthy the customers are going to be. There will be adjustments.</p>
<p>Lookingforward, I liked your link about preconditions. Thanks.</p>
<p>So what you’re now saying, Bay, is that the unmet health care needs of all those previously uninsured people with pre-existing conditions were in fact much greater than had been anticipated?</p>
<p>I still dont understand why there isnt more outrage ober the fact that the US pays more for the same procedures than other countries. If we paid what people pay for procedures in other countries… We might not need ACA.</p>
<p>It is not a matter of what I’m saying. You can do the research yourself and decide what you think happened. From the numerous articles I perused, it looks like the federal government grossly underestimated how much it would cost to provide high-risk care for 375,000 Americans. They spent $5 billion dollars on 110,000 people, when they expected to spend that amount on 375,000 people. You can draw your own conclusions about what that means to you, but to me it means they were unable to predict the costs of that type of care, despite being the experts. I personally find that to be unsettling.</p>
<p>One big difference in the US is that we pay for services based on specific procedures rather than an hourly or daily rate. In many other countries a hospital stay will cost $X per day, no matter what happens during each day, whereas here there hospitals will tack on a charge for every piece of equipment, medication, procedure, etc. - often at huge markups. (Such as charging $50 for a single tylenol or a piece of rubber tubing). </p>
<p>I can understand when there is an extra charge tacked on for the use of an expensive piece of equipment – an MRI machine is not exactly a cheap acquisition – but I do think that one way to cut down on costs tremendously would to end all the piecemeal charges that do not involve use of expensive materials, equipment, or medications.</p>
<p>My conclusion is that the more we slice and dice the American people into small risk pools, the more expensive insurance becomes. If you put the very sickest people – people who are so sick that they can’t get insurance anywhere else – into a risk pool by themselves, of COURSE it’s going to be very, very expensive, and the government had no way of knowing how expensive they would be until they got in. Why does that surprise you? Everyone needs to be in the SAME pool, and ACA is a step toward that.</p>
<p>That seems a fair conclusion. I’m only pointing out that it’s completely inconsistent with your previous line of attack, which was to suggest that the ACA was misguided because it vastly overestimated the unmet medical needs of people uninsured due to pre-existing conditions, as evidenced (you suggested) by the fact that only 110,000 were enrolled in the federal high-risk pool. Turns out only 110,00 people are enrolled because the rest were turned away, and they were turned away because the unmet medical needs of those who had been uninsured and enrolled first were in fact much greater, and more costly, than anyone had anticipated. In short, the problem was bigger than the authors of the ACA thought they were setting out to solve, and so their Band-Aid solution–or at least this particular part of it, which is a small piece of the overall puzzle, adopted as a transitional measure–turned out to be inadequate.</p>
<p>OK,so I’m troubled by that, too. Not surprised, but troubled. Not surprised because we’re talking about people who have been systematically excluded from the health care system for lack of means and lack of insurance, in many cases for a long, long time, and it’s not surprising to me that their health care problems would have spiraled out of control for lack of treatment, and that the experts who were guesstimating how healthy they were and how much their health care would cost were wildly off base, because these people had just not been in the system and so nobody knew. And if course, there’s adverse selection at work here, too; those most likely to be early enrollers would include many of the most desperate, those in the worst shape medically speaking, with enormous unmet needs.</p>
<p>My guess is that many parts of the rosy scenarios for how well the ACA is going to work will turn out to be wrong, but other parts will turn out to be even more right than anticipated. My further guess is that the critics who claim to “know” the ACA will be a disaster for this, that, or the other reason will also turn out to be wildly wrong in some of their claims, and surprisingly right in others. That’s the nature of public policy. It’s messy, and no one has a crystal ball. But in the case of the uninsured with no access to medical care except for the occasional trip to the emergency room, we have a public policy problem of the first magnitude. And we had to try something. </p>
<p>The ACA wouldn’t have been my first choice. Probably it was very few people’s first choice, but it apparently was the only approach that could cobble together enough votes to pass, and then just barely. I think there’s a lot we don’t know about how it will work, but we’ll see, and if we’re attentive and approach it with a constructive, problem-solving attitude, we’ll learn, and then we’ll either improve it or junk it in favor of another approach. But I do think we’re perhaps finally past the point in this country when we just put out heads in the sand and ignore the problems the ACA set out to solve. I don’t think we’ll ever return to the status quo ante. And that’s a certain kind of progress.</p>
<p>The way I read it, the program evolved in a way that was unexpected. They budgeted $5billion to serve 375,000, but after 3 years of running the program, surprisingly, only 110,000 had enrolled. This was the aspect that made no sense to me. With millions uninsured, they could capture only 110,000 needy enrollees. </p>
<p>At around year three, they determined that costs had run so high with the 110,000 that they could no longer keep enrollment open. So they shut it down prematurely, under-serving their projected goal by 2/3. The entire program was miscalculated.</p>
<p>“Even before its suspension to new enrollees, the program’s existing structure was preventing some people from enrolling, Zurface said. PCIP has a requirement that patients must be uninsured for six months before being able to enroll for its benefits. For cancer patients, and for other patient populations who are seriously ill, living for six months without health insurance coverage can be a death sentence, she told the House panel.”</p>
<p>Yeah… 6 months without insurance makes no sense…</p>
<p>This is going to be a problem with ACA. What happens to those that refuse to buy insurance and then get cancer?</p>
<p>Personally, I was never willing to let anyone I cared about even have a gap in coverage, much less 6 months (if there was any possible way I could get coverage). I do wonder what happens to those who refuse to buy insurance and then get ANY long term chronic condition, need surgery, cancer, or a host of other VERY expensive conditions. What happens now? They end up on Medicaid if they are poor enough or heavily indebt, bankrupt or dead? At least that’s what I believe.</p>
<p>Dstark, the 6 month waiting period was only for PCIP – with ACA, the exchanges will have have an annual open enrollment period. So basically, if someone is uninsured, they should plan on getting cancer in October or November. </p>
<p>Obviously, no one plans cancer, but the idea of a limited open enrollment period didn’t originate with the ACA – it’s fairly common, and that is essentially the main incentive for healthy people to sign up and pay. Without that, everyone would just forego insurance until they got sick.</p>
<p>That’s what my daughter did when she changed jobs, essentially – she left job #1 at the end of August, but her insurance at job #2 didn’t start until October – so she had a few weeks without coverage. The COBRA premiums were too high to be reasonable – but COBRA does allow a person a period of time (I think 60 days) to decide whether to accept the coverage – and it can be used retroactively. </p>
<p>HImom – ANYONE will be able to sign up for the exchanges during that open enrollment period. So let’s say someone who has no insurance is diagnosed with an expensive chronic condition in June. That person is going to have to wait until October 1 until the exchange opens up to sign up for a plan. When that happens, the premium will be the same as for anyone else, and the plan will eventually cover the chronic condition. However, the plan won’t pay retroactively for the medical bills incurred from June and September. </p>
<p>I’d note that most serious, chronic (and expensive) health conditions tend to impair the ability of a person to work and earn a living, so it may be that even with ACA many of those people will end up on Medicaid. But more people will qualify for Medicaid than before – although unfortunately that will not be true in all states. </p>
<p>I really think that the Medicaid expansion was a very much overlooked cornerstone of the ACA program – even though the focus is on the exchanges, I think a huge part of plan was based on the idea that a large number of people on the lower end of the economic spectrum would be moved onto Medicaid. It’s a shame that part was thrown out by the Supreme Court (though I understand why – I think there was some Congressional overreach there in the coercive aspects of the Medicaid expansion).</p>
<p>The info I see says they did not reach the 5 bil spending mark, run out of funds. Rather: *The PCIP program had spent about $2.4 billion of its $5 billion in total federal funding on medical claims and about $180 million on administrative costs as of Dec. 31, 2012, federal officials told state officials. *</p>
<p>Point being, from the pcip site, to help ensure that funds are available through 2013 to continuously cover those who did enroll. </p>
<p>It looks like that 2.4b for 115000 comes out to about 20k per individual. That’s not ordinary diabetic care; I’m curious what sorts of service it was spent on.</p>
<p>Can anyone comment on “how bad” Medicaid is? I know how Medicare works for my older relatives, but not Medicaid.</p>
<p>My grandmother and her recently deceased husband are/were on Medicaid. I think it works great for them - even better than for people on Medicare. My grandmother has 26 hours per week of in-home care covered by Medicaid, which allows her to live at home. I don’t think people on Medicare have this coverage. </p>
<p>The only problem is that some times it is hard to schedule an appointment in timely manner, but I am not sure what is the reason and if people on Medicare have the same problem.</p>
<p>There is no Medicare in pediatrics; all of my poor kids are on Medicaid. It works fairly well, though it is sometimes difficult to get specialty care covered, and services like counseling, dental care and some referrals are very poorly covered. The most medically impacted patients on Medicaid (kids with massive disability) are well-covered.</p>