<p>I think that if you have a vote in which 67% percent of the people stand to benefit, and 33% stand to lose, and everyone votes their own interests… then the 67% will win. </p>
<p>I’ve posted before: I knew I would pay more after ACA. I knew that I was getting a “preferred” rate in a system that purposefully excluded people who had greater medical needs. I have eyes and ears and all I had to do was look around and listen to the stories of my friends and relatives who were shut out of the system or could buy only into high-risk pools and were paying premiums well beyond mine.</p>
A legislative decision has been made that an $8000 per person deductible is too high. Only someone who was very well off financially would want that sort of plan, so I’m guessing that your sister can afford to pay the kind of rates that everyone else has been paying for years, in order that others who are less fortunate than her can also have health insurance.</p>
I think a lot of employees would be much happier with that. I love my HSA – it makes me feel so much better to have that chunk of money sitting there in an interest bearing account, and to be able to spend it on all sorts of things that insurance won’t cover – or that I might have to dispute with my insurance company. </p>
<p>It might be something of a bump for the employees to get used to, but I think that 2 or 3 years down the line when the healthier ones had accumulated nicer balances in their HSA’s, you’d see a shift-- they would realize that the money was available to them for purposes that go beyond meeting their deductible.</p>
<p>“It might be something of a bump for the employees to get used to”</p>
<p>This is why there is a need for you to be Evil Navigator Lady. Forget the complexity registering at a web site, the real complexity is optimizing a persons overall health spending.</p>
<p>Allowing you, your sister, and me to buy cheap insurance at “preferred rates” from companies that refused to sell insurance to sick people was hurting the sick people who couldn’t get insurance. </p>
<p>I don’t think that the ACA prevents a company from selling a policy with an $8000 deductible – it’s just that such a policy would not qualify as being acceptable insurance to avoid payment of the penalty. But it’s not cost effective for any company to sell such a policy, at least not right now. And if you and your sister have higher incomes, then I’m not sure you’d come out ahead after you also paid the penalties–maybe in year #1, but not by year #3 when the penalty is higher.</p>
Financially, no- our premiums were high and, at least for us older folks, they are getting higher. But the main web site is wonderful – easy to navigate and highly informative. The live chat and the 800 number work pretty well – they tell you how long the wait will be on the 800 line and if you call outside of peak hours it gets picked up within minutes. The portal where you sign up to buy insurance is harder to navigate and buggy, but it looks like they’ve got most of the kinks worked out. The main problem we Californians are having is ascertaining networks – Kaiser is Kaiser, but its not clear if or when other insurers have finalized their networks. Part of the problem is there is considerable variation in medical costs, and costs can be extremely high in California – so obviously it makes market sense for the insurers to seek out the lower-cost facilities. </p>
<p>I think that would have happened eventually anyway – and some of it was already happening before ACA – but it would probably have happened on a more gradual, piecemeal basis. I know that Anthem & Blue Shield have a testy relationship with Sutter - a for-profit concern that owns many hospitals and has bought up more – and there have also been longstanding disputes between the UC Med system and Blue Shield over costs. So that’s not a new development – it’s just that the opening of the exchange has brought those issues to a head.</p>
<p>Calmom, my understanding is that Covered California will not report sign-ups until Nov 15. There have been reports that almost all sign-ups to date have been for Medicaid not private insurance. It will be interesting to see the numbers in November and then how many actually make their first payment.</p>
There are not-for-profit as well as profit-making companies, and in California the premiums for the not-for-profits are not necessarily any better than the for-profit premiums. The real distinguishing factor is HMO v. PPO. I think that it’s an industry that, for the most part, relies on a fairly thin profit margin. When I was growing up, my mom told me to always buy insurance from a “mutual” company because the policy owners were the shareholders, and that meant any profit would come back to me with a premium reduction. I have followed that advice when I had the option, but that money back is pretty small. </p>
<p>Outside of insurance, if you look at major retailers, they typically have lower prices than smaller stores – they are leveraging the volume of their sales in a way that keeps prices down. So I think a for-profit company like Anthem - which has committed to entering the exchanges in all 50 states – is hoping to become market-dominant - and in part the best way for it to do that is to low-bid its premiums. They’ll save costs down the line in other ways – but the point is that the profit / nonprofit distinction isn’t going to make a huge difference in a highly regulated industry, especially with the 80/20 rule.</p>
<p>Catastrophic plans don’t work for the insurance companies. </p>
<p>The insurance companies have to use 80 to 85 percent of their revenues for health care.</p>
<p>Catastrophic plans results are too variable.
Many years the insurance companies would have to pay penalties because policy holders did not use their plans. Other years…there would be too many people using the plans.</p>
<p>Plus…there would be cost increases for preventive care requirements, preconditions, etc.</p>
<p>Its called a risk pool. Its mathematically no more difficult to offer Catastrophic health than any other product because person A’s claim is unlikely to make person B’s more likely. </p>
<p>Goldenpooch, you seem to think that your sister’s premium doubled because she now has a lower deductible. That may be part of the increase, but the bulk of the increase would have been her moving into the risk pool with the sick people. As Calmom said, she had an incredibly cheap premium, so either some things weren’t covered, or she had caps, or she was in a risk pool without many sick people.</p>
<p>In other words, even if she could buy a policy with the higher deductible, her premium would go down very little.</p>
<p>Okay, why is the risk pool riskier because of ACA? Along with pre-existing conditions, there should be plenty more new young and healthy uninsured people forced into this. Its not like everybody without insurance is sick. Most aren’t.</p>