Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
6021

<p>GP, when you ask, what about competition, I say, this IS competition. Hospitals are competing to be included in the insurers’ networks. Expensive hospitals are losing that competition, because they are expensive."</p>

<p>So how do you think this works, CF? Apparently in my area, though the insurers won’t allow some of our major hospitals with individual plans, they still are allowed for group plans. And people are still home free with Medicaid. We are getting an increase of people on Medicaid, that’s for sure.</p>

<p>So now they get more patients paying far, far less with Medicaid. They lose a number of patients who actually had insurance paying for their services. And this will make them lower their prices?</p>

6022

<p>“I wouldn’t go to a VA hospital in a million years.”</p>

<p>I used to think that. Then after talking to some VA doctors, it depends. Both me and my husband are eligible to go to VA hospitals. Apparently there are some VA hospitals that are extremely good, and others that are terrible. You just have to know which ones.</p>

6023

<p>Buying off exchange would make sense if no subsidies due to income, and quite honestly, less risk of identity theft, at this point. </p>

<p>I would trust my personal data to private insurers and brokers right now - with less website issues. Been victim of identity theft in past, so I am more nervous about sharing personal data with others, especially online or paper apps. I would trust Covered Cal more than federal exchange as of today, though.</p>

6024

<p>My mom in law was a VA surgical scrub nurse in midwest for a lot of years. She loved working with vets at her hospital, although not always the docs there.</p>

6025

<p>That’s cool, Samurai. I’ll be she has some stories to tell!</p>

<p>I know what you mean about security, you can get worried about that one. It’s been a bad week for us. One lost credit card, and another with a bunch of charges from South Africa. Jeez.</p>

6026

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<p>So far. For 2014. But the price competition isn’t going to go away, and restricting networks is not new this year, as calmom has already pointed out.</p>

6027

<p>[Blue</a> Cross Blue Shield Data Breach Investigated - InformationWeek](<a href=“InformationWeek, serving the information needs of the Business Technology Community”>http://www.informationweek.com/security/risk-management/blue-cross-blue-shield-data-breach-investigated/d/d-id/1084777)</p>

<p>[Anthem</a> Blue Cross Cops to Massive Data Breach](<a href=“http://mobile.esecurityplanet.com/news/article.php/3889951/Anthem-Blue-Cross-Cops-to-Massive-Data-Breach.htm]Anthem”>Cybersecurity Threats Articles | eSecurityPlanet)</p>

6028

<p>Thanks, dstark. </p>

<p>So reassuring. ;)</p>

6029

<p>" I like HSA’s because everyone has skin in the game and for those people who really need subsidies, it would be an easy way to do it"</p>

<p>Deductibles give people skin in the game.</p>

<p>GP, this isnt a secret. Cedars is one of the most expensive hospitals in the country. CF is right.</p>

6030

<p>Sorry… I am not a big fan of the insurance companies. :)</p>

6031

<p>“So far. For 2014. But the price competition isn’t going to go away, and restricting networks is not new this year, as calmom has already pointed out.”</p>

<p>I think that restricting large and popular hospitals, for a great deal of people is rather new, in my area. </p>

<p>I was wondering how the hospitals were going to price, after taking in new Medicaid patients. I assumed for those facilities that accept Medicaid, the price for others would be going up to cover them, not down to compete.</p>

6032

<p>It might be new in your area, but it’s not new. Narrowing networks has been happening for a while, because it saves money. Individual market insurers are more interested in saving money by choosing less expensive hospitals now that they can no longer save money by choosing less expensive patients.</p>

6033

<p>dstark, why do you guys keep pounding on Cedars when there are great teaching and/or specialized hospitals all over the country being excluded from the networks under ACA. This problem is not confined to one hospital. It is pervasive, which is why there are so many upset people.</p>

6034

<p>“It might be new in your area, but it’s not new. Narrowing networks has been happening for a while, because it saves money”</p>

<p>It hasn’t been happening in Ca before 2014.</p>

6035

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<p>Excellent point, well stated. I think this is the nub of it. </p>

<p>In the past, insurers could cherry-pick which individuals they’d cover. Not surprisingly, they chose the healthiest, and offered them gold-plated access to all the most prestigious and expensive providers, knowing that those expensive services were largely illusory; they would rarely be utilized because of the overall health/risk profile of their insured population. Meanwhile, sick people got the shaft.</p>

<p>Now the insurance companies are legally obligated to insure everyone regardless of medical condition. So now if their provider network includes the highest-cost providers, they’ll attract not only people like GP–healthy people who want the peace of mind that comes with knowing they’re insured for the very best health care regardless of price. They’ll also attract the highest risk, highest cost people with such severe medical conditions that it’s truly advantageous to be treated by the “peak of the pyramid” high-cost providers. And those costs will drive premiums for those policies to a level where those products are no longer attractive to people like GP.</p>

<p>It’s understandable that GP prefers the status quo ante. It’s also understandable that the status quo ante just wasn’t working for the majority of people who weren’t covered by employer-sponsored health insurance, and weren’t eligible for Medicare or Medicaid (pre-ACA).</p>

<p>So yes, there are winners and losers under the ACA, mostly in the individual market for private health insurance which represents a small fraction of the overall population. The linked article is mostly anecdotal, but it does make reference to state government estimates that only about 5% of Minnesotans are in the individual market, and that 70% are expected to find their situation improved or unchanged under the ACA, while 30% will end up paying more for similar coverage, or the same or more for more limited coverage.</p>

<p>[MNsure</a> has caused tears, frustration, and, yes, even joy in its users - TwinCities.com](<a href=“MNsure has caused tears, frustration, and, yes, even joy in its users – Twin Cities”>MNsure has caused tears, frustration, and, yes, even joy in its users – Twin Cities)</p>

<p>It remains to be seen whether those projections bear out, but so far the transition to the ACA seems to be going relatively smoothly in Minnesota.</p>

6036

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<p>This is untrue. There have been issues with Sutter Health & UC Med vs. Anthem & Blue Shield repeatedly over the years, and I posted links to past articles.</p>

6037

<p>“This is untrue. There have been issues with Sutter Health & UC Med vs. Anthem & Blue Shield repeatedly over the years”</p>

<p>I have been with Blue Shield and Anthem (Blue Cross before Anthem bought them) for 22 years. Although there have been brief periods (not lasting more than a few months) when these companies were fighting with some of these hospitals, my network has stayed constant the entire time until now. I believe the network today (before Jan 1) is no different than it was 22 years ago.</p>

6038

<p>“Meanwhile, sick people got the shaft.”</p>

<p>Give me a number. How many of these people didn’t have group/individual insurance or Medicaid/Medicare. It couldn’t have been too many because very few of them took advantage of the very attractive federally-run PCIP high risk insurance program.</p>

<p>“And those costs will drive premiums for those policies to a level where those products are no longer attractive to people like GP.”</p>

<p>Since they don’t even offer these products in the CA individual market anymore, it is impossible to even know how unattractive these policies would be.</p>

<p>As I have said repeatedly, people who pay much more for insurance should get better coverage. I know there are some here who may object but there is no way someone who is fully subsidized by the taxpayer (meaning me) should get the same coverage as I.</p>

6039

<p>“I like CFs answers about the networks.”</p>

<p>That’s surprising! :)</p>

6040

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<p>I think this is what a lot of peoples complaints come down to. Personally, I get annoyed there are some Section 8 renters whose apartments were as nice (or better!) than my own, but then I also remember while their housing subsidy allows them a roof over their heads, it doesn’t necessarily mean they get to take the vacations I do, drive the kind of car I do, or have the sorts of other economic freedoms I have.</p>