<p>People were saying the uninsured get care anyway through ER and that insuring them will save us money. Now they are saying our premium has to go up since we are insuring sick people. What happened to the savings we were supposed to get from eliminating ER visits?</p>
<p>The 85 percent rule is a cost-saving measure.</p>
<p>“Uh, not really. (There are essentially no cost saving measures in the law.”</p>
<p>These are all in the law. </p>
<p><a href=“http://www.urban.org/UploadedPDF/412665-Despite-Criticism-The-Affordable-Care-Act-Does-Much-to-Contain-Health-Care-Cost.pdf[/url]”>http://www.urban.org/UploadedPDF/412665-Despite-Criticism-The-Affordable-Care-Act-Does-Much-to-Contain-Health-Care-Cost.pdf</a></p>
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<p>That was my understanding as well, Igloo. I think the cost savings just applies to people who had to pay for medical care or go to the ER and now get it at reduced rates.</p>
<p>^ It’s much cheaper to go to a doctor when you have the flu, a cold, a sprained foot, etc., etc., etc. , then to go to the ER. People who have insurance generally do not run to the ER for anything other than a real emergency.</p>
<p>I apologize in advance if we are not allowed to talk about this, but ER visits did not go down in Massachusetts after their similar overhaul.</p>
<p>Does anyone know what the 2014 tax forms will look like? If we have extra tax liability because of advance premium credits (due to underestimating MAGI), will that show up under lines 56-60 on a 1040? If we overestimate MAGI, will the premium credit go on line 67? We have AOTC and carryforward energy credits, so I’m interested in projecting how it will work.</p>
<p>emilybee, That’s how I understand it, too. So why are we not getting the saivngs? Most people’s premium is going up not down? Previously, we were collectively paying for other people’s ER visits. With ACA we will be paying for their regular visits which is less expensive. Wouldn’t that imply our premiums should go down? BTW our copay is $10 at the moment. If we join ACA our copay will go up to $70! That’s insane.</p>
<p>Because other things in ACA offset those savings, such as eliminating the lifetime cap and covering people with pre-existing conditions. </p>
<p>Co-pays have always been one of mechanism to reduce health care costs and why they were introduced in the first place many years ago. It’s a way to limit people going to the doctor for every sniffle and sneeze, but not onerous enough to stop people from going to see a doctor when they are really sick.</p>
<p>The ACA was sold to the public as a way to cut health care costs, remember?</p>
<p>Emilybee, I don’t buy it. If I am forced to ACA, I think I’d just get a $1M life insurance instead of paying the ACA premium. My ACA premium happens to be the same as $1M life insurance premium. I’ll get treated up to $1M and pull the plug.</p>
<p>Bay – Have Massachusetts ER visits now gone down?<br>
My daughter lived in MA when their health care reform went into effect. I think (and I’m just guessing, since I wasn’t living there) that it took a while for people to catch on – to realize they had to get insurance, and now their office visits were covered, so don’t go to the ER … It may take a while for us to see the changes brought about by this federal reform.</p>
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<p>But it’s all about ME, ME, ME and I want it NOW!</p>
<p>“I’ll get treated up to $1M and pull the plug.” </p>
<p>^and if you have to pay for treatment along the way before you die and your heirs get the 1M? Or what if it’s something not too complicated - like a car accident, with broken bones, damaged spleen requiring multiple surgeries and hospitalization then rehab etc., etc., which if you get treated for won’t kill you but could cost $250K-ish or so. What will you do then?</p>
<p>ACA depends on the insurance companies’ estimates of their costs. Since they must spend at least 85 percent of premiums on benefits, they can’t just collude among themselves to jack up prices and make more money. As they get better at estimating the risks of covering pre-existing conditions and if more healthy people sign up, policies will get cheaper and they will get better at signing deals with more providers and offering better networks. That will be a way for insurers to compete with one another.</p>
<p>I’m going to repost this, because it was deleted and then undeleted:</p>
<p>The ACA includes a number of cost-control mechanisms. One of the most famous is the readmission penalty: hospitals are now penalized if they discharge too many patients who are then readmitted within the month for the same diagnosis. Right now, the readmission penalty only is effective for heart attack, pneumonia and heart failure, but it is due to be expanded for other diagnoses. A large hospital readmission rate is a quality failure, but it is also a big expense, so reducing readmissions both improves quality and lowers cost.</p>
<p>Another cost control mechanism trial included in the ACA is bundled payments, which paying hospitals and doctors per diagnosis, rather than per procedure. This encourages cost-saving coordination of care: Doctor X and Doctor Y aren’t going to order separate CAT scans for the same patient if the cost comes out of their own pocket. Zeke Emanuel, one of the authors of the ACA and a champion of bundled payments, tells the story of the San Antonio Baptist Health System’s experience with bundled payments. The COO enrolled the hospital system in a bundled payments trial without consulting the doctors (who tend to resist change). The hospital system ended up saving money using bundled payments, which they shared with both doctors and patients. At the same time, various quality metrics improved. </p>
<p>Here’s one example of how they saved money: They had previously used all eight different artificial hips in hip replacement operations. The device cost didn’t matter, since they were passing it on to Medicare anyway. But under a bundled payment per hip replacement, they wanted to get the cost down. So they called up all eight manufacturers, and said, by such and such a date we need a bid from you, less than $X, for your artificial hip, or we will stop using it. But midnight of that date, three of the manufacturers had submitted a conforming bid, one had submitted a bid that was too high, and four manufacturers had not submitted any bid. So the hospital was down to three devices. But then the five manufacturers who didn’t come up to scratch realized they were frozen out; by 6 am, the hospital had conforming bids from all manufacturers. And, remember, the hospital system could keep the savings, which in the biggest case was a $6000 difference between the old cost and the new cost.</p>
<p>The end of a lifetime cap on coverage is a driver of the premium increase. Many people may have had cheaper plans that really would not have served them well if they or their family had a serious illness or accident.</p>
<p>If the majority can’t handle the increased premiums, can’t find a doctor in the smaller networks, can’t keep their old plans that they liked, then it won’t last long.</p>
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<p>I don’t live in MA, I have just read about it, and I think the answer is “no.” The theories for this include that now that people know their ER visits will be paid for, they go just as, or even more freely than they did without insurance. So no cost savings there.</p>
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<p>A lot of people’s premiums are going down-- down from infinity. A lot of people couldn’t buy insurance on the individual market for any price. The savings are going to giving those people insurance.</p>
<p>And a lot of people’s premiums are going down because they are getting subsidies.</p>
<p>If you were already able to buy insurance, and if you make too much to get subsidies, congratulations! You are relatively rich, and you are healthy! You’re a lucky person. You’ll probably have to pay more for your insurance, but you’re still lucky because you’re still healthy and (relatively) wealthy.</p>
<p>People on CC are not at all representative of “most people.” We’re a lot richer on average, and in the Parents section, we skew older. It’s a mistake to generalize from people on CC to all Americans.</p>