<p>“But it was their choice.”</p>
<p>How is it a choice when one can only buy an insurance policy which doesn’t cover certain conditions, procedures, prescriptions or any pre-existing conditions?</p>
<p>argbargy, don’t you think that people who are going to get subsidies would go the exchanges even if their policies hadn’t been canceled? Because they’re not idiots, and they know how to count?</p>
<p>And I don’t know that people not eligible for subsidies are making accounts on the exchanges. Goldenpooch, poetgrl, did you try to make an account? Do you plan to?</p>
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<p>According to this article, some insurers are staying out of the excahnge to avoid that.</p>
<p>[Obamacare</a> Faces A ‘Death Spiral’ – But It Turns On The Declining Participation Of Health Plans, Not Just Rising Premiums - Forbes](<a href=“http://www.forbes.com/sites/scottgottlieb/2013/10/28/obamacare-faces-a-death-spiral-but-it-turns-on-the-declining-participation-of-health-plans-and-not-just-their-rising-premiums/]Obamacare”>Obamacare Faces A 'Death Spiral' -- But It Turns On The Declining Participation Of Health Plans, Not Just Rising Premiums)</p>
<p>CF - I was talking about the current crop of cancellations. No-one was ever opposed to fixing the pre-existing conditions problem. And of course it will hurt some and help some but if the sales pitch hadn’t been so dishonest and the execution so poor everyone would feel better about ACA.</p>
<p>CF - I am not sure what you are saying. I think everyone agrees that for ACA to work they need young and healthy people to sign up whether through the exchange or outside. Since the rate is kept the same on the exchange or off, it doesn’t matter whether young and healthy signs up on or off the exchange. Their premium is the same and higher than their cost helping to pay for old and sick. In other words, the gov need to cancel healthy people’s plan. If they stay in their old plan, there won’t be enough healthy and young to newly sign up for a plan. They had a number how many need to be canceled and they got it.</p>
<p>Igloo, since all plans, whether inside or outside the exchange, must be ACA compliant there is nothing preventing a sick person who doesn’t qualify for a subsidy from getting insurance off the exchange. </p>
<p>Sounds like they believe only poor people get sick.</p>
<p>Now that doesn’t apply if insurance stays out of the exchange. Then, they can offer only bronze plan attracting young and healthy who don’t cost them much. That seems to be confirmed by what Aetna CEO says, They expect big profits in private market through bronze plan.</p>
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<p>I saw a news report that 82% of the people in the individual market are/were happy with their coverage. Isn’t a big assumption that they are going to go shopping it around, including looking at radically different and more expensive “medal plans”.</p>
<p>emily Did I say sick people couldn’t get a plan off the exchange? I don’t remember saying that. Whether you buy the plan on the exchange or off doesn’t change the big picture. The rates are the same on or off. Whenever a healthy person buy the plan on or off the exchange, it helps. It wouldn’t have helped if the insurance companies were allowed to have different rates off the exchange. That’s why they are banned to do so. Not only the rates have to be the same on or off the exchange, the company has to offer silver and platinum plans which are likely to attract sicker people as well as bronze. From what Aetna CEO said about making profits off bronze plan, I am guessing bronze plan is overpriced while silver and platinum probably underpriced meaning it is engineered for healthy people to pay more to defray the cost of sick people. If they were all priced according to what they expect of the cost, the gov wouldn’t have to require the insurance companies offer silver and platinum if they want to offer bronze.</p>
<p>CF I did create a dotgov account. I wanted to see if the policies were different or the prices were different. </p>
<p>They aren’t </p>
<p>In fact, in this state, every policy, the combination of premium and deductible gets total out of pocket up to 22000 for a family of four at our ages before it pays 100%. </p>
<p>The only advantage to being on the exchange is if you get a subsidy. Otherwise, it’s not worth the hassle.</p>
<p>ETA. Since a lot of people are speculating about whether or not people on the individual market liked their plans, we did. We chose this rather than the employer provided plan. We thought those were too expensive for us and took the pay instead. We are looking into whether or not that is the same now and may go with employer insurance since we have been tripled.</p>
<p>“Then, they can offer only bronze plan attracting young and healthy who don’t cost them much.”</p>
<p>I guess we will have to see. Imo, the young and healthy - who generally have a much smaller income then older adults, likely will qualify for subsidies if they buy on the exchange - especially if they have a family.</p>
<p>“Did I say sick people couldn’t get a plan off the exchange? I don’t remember saying that. Whether you buy the plan on the exchange or off doesn’t change the big picture. The rates are fixed on or off. Whenever a healthy person buy the plan on or off, it helps.”</p>
<p>The article you posted implied that. It said the exchange plans would be left with a pool of sick people and that would portend a death spiral for OCare.</p>
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<p>Actually, plenty of people were opposed to it: insurance companies, and (some) people who were buying cheap policies that were cheap because people with pre-existing conditions were barred from buying them, were opposed to a simple fix for pre-existing conditions.</p>
<p>This is just a general comment, not a comment about Obamacare as implemented: People with pre-existing conditions are more expensive to insure than other people. That’s obvious. So, if you want people with pre-existing conditions to be able to buy insurance at a non-exorbitant price, then someone is going to have to pay more. </p>
<p>Suppose you wave a governmental wand, and say that insurance companies have to sell the same policies to everyone of a certain age, at the same rates. This is community rating. If you do that, insurance rates will go up, because now sick people will be able to, and will, buy insurance. And then, healthy people will say, why am I buying insurance I’m not using?? I’ll buy no insurance, and then when I get sick, I’ll just go up to the insurance window and buy that insurance the insurance company has to sell me. And that will make insurance premiums skyrocket, because only expensive sick people will be buying insurance.</p>
<p>So, to get around that, you have to say, no more free riders. Everybody has to buy insurance. That’s the individual mandate.</p>
<p>And then you will realize that insurance companies aren’t giving away insurance for a nickel, and some people genuinely can’t afford insurance. So you have to buy it for them. And then you get subsidies.</p>
<p>So, this is a long-winded way of saying, you can’t just “fix the pre-existing conditions problem” without making a lot of other changes at the same time. If you want a private insurance market, and you want people with pre-existing conditions to be able to buy into it, you have to make big changes. If you think that the answer is to just get rid of the private health insurance market, that is also a big change.</p>
<p>Changing the subject slightly, but:</p>
<p>Minnesota has the lowest exchange rates in the country, on average. But the rates aren’t uniform across the state. In southeastern Minnesota, where the health care market is dominated by a single provider, the highly regarded Mayo Clinic in Rochester, rates available on the state exchange are roughly double the rates in the Twin Cities metro area. Experts say that’s because Mayo’s near-monopoly on the provider market in southeast Minnesota allows it to dictate prices to insurers. Mayo’s defense is that it’s “not a community hospital” but instead a high-end teaching and research institution that also provides “top-of-the-pyramid care for the sickest of the sick” and those with rare, complex, or difficult-to-diagnose or difficult-to-treat illnesses.</p>
<p>Of course, both could be true. Residents of southeast Minnesota do in fact treat Mayo as their community hospital because they have no other choice, and they know that puts them in line for premium care if they ever need it; many are quite proud of that. But they’re also paying premium prices for that service.</p>
<p>[Mayo’s</a> dominance skews health insurance exchange in SE Minnesota - TwinCities.com](<a href=“Mayo’s dominance skews health insurance exchange in SE Minnesota – Twin Cities”>Mayo’s dominance skews health insurance exchange in SE Minnesota – Twin Cities)</p>
<p>Are there other states where the in-state market is this skewed?</p>
<p>Cardinal Fang, great point and the main reason I was drawn to the efforts of the ACA. As a provider, I don’t want a pay cut, but I need my family’s preexisting conditions covered. The preexisting condition issue can bankrupt me much quicker than a pay cut. For me, I have to worry about my family first before I worry about society. In this situation (our insurance system), I share a lot of the same concerns.</p>
<p>Surgery for my wife’s preexisting condition, not covered by individual insurance, would cost on average $210,000 retail. That’s before I beg the hospital for a discount. That doesn’t include the cost for any potential bad outcomes. This is CRAZY!! But if I had a good group policy, I would pay a max of $3000. Come on folks, this is nuts!!!</p>
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<p>I am from Minnesota and can attest that Mayo clinic is where everyone in the state goes when they are really sick (tumor, cancer, etc.). People I know in Twin Cities who are/were really sick always went/go to Mayo for at least a second opinion (if not for primary treatments). </p>
<p>For cancer treatment everyone wants to go to MD Anderson or Sloan-Kettering, but not everyone is lucky enough to get accepted and afford to go. So, Mayo is a de-facto premier center for treatments/consultation here in MN. </p>
<p>It is too bad that it is the only option for treatment in a Rochester area. You really don’t need to go to Mayo for simple treatments.</p>
<p>P.s. I am from Twin Cities and rates in Twin Cities are really low and quite affordable without any subsidies. But then again we have a high concentration of providers.</p>
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<p>That’s pretty much built into the way that insurance companies do their pricing. From an actuarial standpoint, every policy is to same to them: they need to collect $X and expect to payout $Y; ideally Y= 80% of X. </p>
<p>There is probably a slightly different profile of buyers that impacts the math – more healthy people go for Bronze, sick people more likely to buy Silver and Gold – but that is offset on the exchange by the the fact that only Silvers qualify for cost-sharing subsidies, which are attractive to poorer customers who need only preventive care. </p>
<p>I think that for most people who don’t qualify for subsidies (by definition somewhat more financially secure than those who do qualify), Bronze is usually the best - when you recognize that to get a lower deductible, you are paying most of the difference in premium costs – then that low deductible doesn’t look as attractive. That’s why I like the HSA’s – it’s a lower premium plus a tax credit – the HSA itself functions as something of a quasi-subsidy for insurance. (That is, if my tax rate is 25, and I put $4000 in an HSA, then I get a $1000 tax cut.)</p>
<p>The complicating factor is for individuals with known health problems with a specific cost and/or copay – I think that in particular, reliance on an expensive prescription drug could shift the balance in favor of a plan structured so that the drug benefits kick in early. But another medical issue requiring regular and frequent medical visits could also shift the balance. The overall out-of-pocket might be the same, but you have to keep in mind that “out-of-pocket” is defined as the patient’s share of the insurance company’s negotiated rate.</p>
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<p>That’s only a partial defense, if Mayo is a de-facto community hospital and they know it. There’s no reason why they couldn’t have a separate section for top-of-the-pyramid care for the sickest of the sick, and a different section with cheaper billing for routine things like uncomplicated deliveries, joint replacements and gall bladder surgery. If residents of Rochester have to go to Mayo to have a baby because there’s no other hospital, they shouldn’t be paying intensive care prices.</p>
<p>[Obamacare:</a> Fewer options for many - CNN.com](<a href=“http://www.cnn.com/2013/10/29/health/obamacare-doctors-limited/index.html?hpt=he_c1]Obamacare:”>http://www.cnn.com/2013/10/29/health/obamacare-doctors-limited/index.html?hpt=he_c1)</p>
<p>And then there are some who cannot use their community hospital if they get insurance on the exchange. </p>
<p>The residents of Concord, New Hampshire have to drive 25 miles to Manchester for in network care. Now for us westerners 25 miles is not much, but I suppose there it is.</p>
<p>The CEO of the Concord Hospital said that the reimbursements that Anthem Blue Cross was going to provide wouldn’t cover their costs. Why the Manchester Hospital is okay with the reimbursements and the Concord Hospital can’t cover costs is not explained (sloppy journalism).</p>
<p>Ummm fired? </p>
<p>Everything about the healthcare.gov schedule was a warning sign because there were only two weeks to test. That in and of itself means its high risk. It crash in testing on the September 26th. And apparently there wasnt compatibility testing with other browsers. </p>
<p>This is maddening- to see the person in charge of the implementation not admit what is obvious to even a junior project manager. </p>
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<p>[Obama</a> administration warned about health care website - CNN.com](<a href=“http://www.cnn.com/2013/10/29/politics/obamacare-warning/index.html]Obama”>http://www.cnn.com/2013/10/29/politics/obamacare-warning/index.html)</p>
<p>She also testified that she was unable to tell how many people had been enrolled until mid-Novemeber. The only way that is possible is if they are still having to manually scrub out 834 errors from the transmissions.</p>