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<p>No Premise left behind!</p>
<p>Why will there be <em>plenty</em> more cash cows? </p>
<p>The existing risk pools excluded a lot of people with pre-existing conditions. A lot of those people are guaranteed negative policies. </p>
<p>Compare it to mortgage back securities. Not all of the subprime mortgages were late. Just 10% was enough to cause serious disruption in the risk pools. Except instead of being 30 year bond now these are Y2Y resets.</p>
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<p>H and I sat down this afternoon to review our 2014 options as it is now open enrollment until Nov. 1. Our employee + family plan for BCBS PPO Plus will run us just under $400/month. If and when D2 gets off our plan (well, she WILL get off after turning 26, but that’s not this year), it will decrease a bit. To be honest, it’s been several years since I’ve even looked at our options - usually we just re-enroll with what we’ve always had, but this year I decided to take a look. Two things I was disappointed in - there is no indemnity plan (H thinks there may not have been for a few years). All of our options were PPOs. I had a LOT of medical expenses this year, and we chose to go out-of-network for much of it; I was willing to pay a higher premium for 2014 to get out of a PPO, even if it meant we’d have a higher deductible, but no option existed for that. Second thing was that you could only take advantage of the HSA if you were in the UHC high deductible plan; UHC is the devil incarnate to me, so I absolutely refuse to pick their plan. So we have re-committed to BCBS PPO Plus again, and will max out the FSA at $2500 again. We will just have to accept that again, if we have serious medical needs and believe the best providers for that need are not in network, we will pay more for that care. I know… first world problems. All in all, I do know that we are incredibly fortunate to have the health insurance we do and the income to cover out-of-network care when we want it. </p>
<p>Has anyone ever tried to find out from their employer exactly what the full premium is?</p>
<p>dstark: There are 6300 instance of Catastrophic policies being offered under ACA.
I am not understanding why they are not supposed to be mathematically valid anymore. </p>
<p><a href=“https://data.healthcare.gov/dataset/QHP-Individual-Medical-Landscape/ba45-xusy[/url]”>https://data.healthcare.gov/dataset/QHP-Individual-Medical-Landscape/ba45-xusy</a></p>
<p>Right, the Medicaid people are not included in the risk pools for individual insurance, because they are not getting individual insurance.</p>
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<p>It’s on your W2.</p>
<p>argbargy, I suspect the fear about catastrophic plans is adverse selection. They’re actuarially valid, as you say, but the framers of the ACA wanted to avoid the adverse selection death spiral for non-catastrophic plans.</p>
<p>That is what I read. Report from Milliman. It was on a right wing website. Maybe it was a forgery. Seriously.</p>
<p>ca.gov is a right wing site! Hell, this thing goes deeper than I thought…</p>
<p>I really didnt see an impact on catastrophic plans though.</p>
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<p>The amount that the employer is paying? Not our portion.</p>
<p>That wasnt the link for the catastrophic plans. </p>
<p>I dont have that link. I shouldnt have posted that catastrophic stuff without a link.</p>
<p>If you work for an employer who employs more than 250 people, the employer portion and the employee portion of your insurance premium are both on your W2.</p>
<p>I was too tired to go look for the W2 (I’ve been reorganizing our filing cabinet - doing some purging - and I’m not sure where our taxes from last year are at this moment), so H signed on to his HR portal and was able to find it there, which surprised me because usually when we try to find anything on the HR portal, it’s like trying to find a needle in a haystack. So I got my answer; I feel much better about the almost $400 per month!</p>
<p>Here is the link argbargy.</p>
<p>[Affordable</a> Care Act makes high deductible, low cost health plans, LESS affordable | Obamacare Watcher](<a href=“http://obamacarewatcher.org/articles/347]Affordable”>Affordable Care Act makes high deductible, low cost health plans, LESS affordable | Obamacare Watcher)</p>
<p>Ok…so what do snowbirds who are not Medicare age do? They reside in one state for half of the year, and another the other half. How do they find a plan that has in network doctors in two states?</p>
<p>So the problem is with high deductible plans without a lot of subscribers. They would need to amortize payouts over more than one year, but they can’t because of the medical loss ratio (where they have to return premiums in excess of 80/85% of health costs) each year. Or at least, that’s what dstark’s link says.</p>
<p>I’m surprised they don’t have enough subscribers to average it out every year.</p>
<p>I should never have brought this up. :)</p>
<p>This link isnt really the Milliman study. Dangerous to draw conclusions.</p>
<p>(My nickname used to be Dangerous). ;)</p>
<p>This link is an interpretation of a study.</p>
<p>An important thing to remember when trying to figure out who wins and loses under the ACA is that it won’t create any new people and it won’t make anyone sicker. (It’s actually designed to make less people sick, through more preventative and early-intervention care, but that benefit will, of course, not appear until after it’s been in effect for a few years.) Nothing in the ACA creates a net increase in demand for medical treatment - it just will skew more towards prevention and less towards catastrophic intervention. </p>
<p>So initially we’ll have the same number and degree of sick-person-days per year as we did before. We’re just seeing that their care is paid for differently. And even there it’s only a small change - those of us with employer-provided health plans or Medicaid/Medicare already are covered. So we’re really talking about the people who are now at risk for being excluded for pre-existing conditions, those too poor to buy insurance but not poor enough to qualify for Medicaid, and those who are willing to play bankruptcy roulette by “going bare” - the latter mostly, but not entirely, young folks with little to lose financially. I don’t see much overall benefit from the current system. Young people who might be willing to gamble their own financial ruin are actually gambling the community’s money, since we won’t just let them bleed to death outside the ER. Either way it’s going to be paid for. It’s not clear to me how the ACA will cause a net increase in medical costs.</p>
<p>A number of suggestions have been posted here about how to improve the plan, but for the present the only legislative debate is whether to destroy it or not, not how to improve it, so those tweaks will have to wait for another day. Realistically, what you see is what we’re gonna get for the foreseeable future.</p>
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<p>It is interesting but can be empirically evaluated if the ACA cat pools are large enough. One solution is for Majority Leader Ryan to make the MLR’s for cat over 3 years.</p>
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<p>Lets say opinions differ. The larger the sunk cost, the higher the utilization will be. Value for money and all that.
We already see this with a demand to prescribe antibiotics for viral infections.</p>
<p>Ryan’s running for Senate?</p>
<p>I agree with argbargy that the MLRs for catastrophic could be made over three years. But that doesn’t take care of the adverse selection issue.</p>
<p>I like to think I am at least mentally, if not emotionally, prepared for reality to be more complex than models, but how is the cat pool any more subject to adverse selection that the rest of this mess?</p>