<p>It was a foreboding of the success of the ACA, because they had researched the market, thought there were multitudes needing this type of coverage, thought they had priced it right, and funded it sufficiently. They ended up wrong on all counts.</p>
<p>dstark, it would be preferable paying for high risk pools and subsidies for poor people from broad-based taxes rather than reordering the health insurance marketplace. I would reform health insurance but do it much differently than what we are seeing with ACA.</p>
<p>Bay, it does sound familiar. There were probably many people with preexisting conditions who were not interested in paying any premiums.</p>
<p>GP, how are we going to cover everybody?</p>
<p>I want numbers. Opinions are easy.</p>
<p>I already cut your premiums. What more do you want? :)</p>
<p>dstark, we are not covering everybody under ACA.</p>
<p>Just give me your plan. With the numbers.</p>
<p>I need to hire a couple of actuaries.</p>
<p>The $300 each for the top third income earners sounds good to me. It appears like we could take care of all the people with preexisting conditions.</p>
<p>“I need to hire a couple of actuaries.”</p>
<p>I’ll wait. :)</p>
<p>dstark, I am signing on to your plan. See previous post.</p>
<p>:)…</p>
<p>Ok… You have to convince a few people. :)</p>
<p>I got a notice from BCBS North Carolina today that if I do nothing, my existing plan will be renewed (yay??) I will find out the cost is December, but I am guessing about a 25% increase. Previously, if I did nothing they told me my existing plan would be cancelled and I would be switched to a new plan that was going to cost more than twice as much. I am surprised they are actually uncancelling the canceled plan. I will probably sign up for a new plan with subsidies, but still waiting to price everything out.</p>
<p>NJres, North Carolina is a very enlightened state. :)</p>
<p>I looked into that CA plan when our COBRA ran out and insurance companies were giving me a hard time. I believe I needed to be uninsured for several months before application. Which seemed kind of dense.</p>
<p>Goldenpooch said,
</p>
<p>I am definitely getting rid of it. The only reason I have it is because I couldn’t afford a better plan. I really couldn’t afford that plan. I started my own business at the worst possible time so every dime I saved really mattered. I gambled that I wouldn’t need expensive prescriptions, but I can’t keep gambling as I age.</p>
<p>NJRes, you might check your state department of insurance to see whether BCBS has filed any paperwork re rate increases. See [NCDOI</a> | North Carolina Department of Insurance](<a href=“http://www.ncdoi.com/]NCDOI”>http://www.ncdoi.com/)</p>
<p>
</p>
<p>Well, that’s a very political spin on it. Also inaccurate, I think. The state high-risk pools didn’t work except in a handful of states like Minnesota that heavily subsidized them. The federally supported high-risk pools were never intended as more than a stopgap–a BandAid upon a BandAid. That it didn’t work should come as no surprise to anyone.</p>
<p>By the way, while Minnesota did support its generous and largely successful high-risk pool with some general fund appropriations and some special appropriations from tobacco settlements, most of the funding came from “assessments” (i.e., an excise tax) on health insurers, based on their relative market share. Essentially, this is an indirect tax on purchasers of health insurance in the private market. So while the mechanism differs, I’m not sure the ultimate incidence of the costs of insuring high-risk and previously “uninsurable” people with pre-existing conditions is much different under Minnesota’s approach to funding its high-risk pool, and the ACA.</p>
<p>I have to boil this down to avoid it sounding political. But, no matter who gets taxed or assessed, one way or another, someone is going to be upset. No matter how you build it, where you cut and paste, someone is going to find fault.</p>
<p>Tonight, I have been reading about the Independent Payment Advisory Board (IPAB) which will be created in 2014. This is the board that has been referred to as a death panel, but that term is definitely incendiary and only serves to obfuscates the powers this board does have.</p>
<p>ACA specifically say the IPAB will not have the power to ration health care, raise revenues or Medicare beneficiary premiums. The President has specifically referred to this section of the law to object to any suggestions that the law can ration Medicare benefits or tax Medicare beneficiaries. This section is going to be very controversial and could rival the debate regarding the President’s promises to keep your plan if you like it.</p>
<p>Essentially, the law does give IPAB the power to make recommendations to Congress to reduce Medicare spending if the growth of Medicare exceeds a target growth rate each year. Congress would need a super majority of the Senate and a majority of the House to reduce the cuts recommended by IPAB. In practical terms this gives the board enormous leeway to reduce Medicare spending.</p>
<p>The law is written to allow IPAB to cut payments to hospitals and hospices after 2020, clinical laboratories after 2016, physician fees, Medicare Advantage plans, Medicare’s Part D prescription-drug program, spending on skilled-nursing facilities, home-based health care, dialysis, durable medical equipment, ambulance services, and services of ambulatory surgical centers after 2014. The law gives percentage ranges for the amount of the cuts that can be imposed each year.</p>
<p>Interestingly, Congress has only one chance to repeal the existence of the board. It has a 29-day window in 2017 to repeal IPAB. It will take a super majority of Congress to eliminate the board. After 2017, Congress is prohibited from taking any votes to repeal IPAB.</p>
<p>Obviously, the board has been set up to act independently without interference from Congress. The question is whether the board can ration medical care at least with respect to Medicare. The ACA law says no but it gives IPAB extraordinary powers to curtail Medicare spending by cutting reimbursements for doctors, hospitals, drugs and other services. So what do you think? If IPAB can control Medicare spending with very limited oversight is that tantamount to rationing health care?</p>
<p>^Even if they “could” ration healthcare, why is that such a bad idea, GP? I mean, you don’t like your new premiums, and they don’t even include Cedars. Would you like your new premiums doubled if Cedars was included? Do you want Medicare or Medicaid to cover Cedars on your tax-dime? In your experience, has the healthcare market controlled cost and waste left to its own devices?</p>
<p>Maybe what you meant instead of the loaded word “rationed” is “fiscal oversight.” :)</p>
<p>I question the constitutionality of a portion of a law that cannot be repealed except during a small window. To have a one vote majority ( all Democrats) bind future Congresses for all time seems to me to be a denial of basic democracy.</p>