<p>Not to argue – just for clarification: The DRAFT regulations have been “issued” - that is what I linked to above. There is a mechanism for public commentary that will now take place, which will be followed by issuance of final regulations:</p>
<p>Again- I am not trying to promote any sort of online discussion of this. I just want to assist anyone who happens to live in Texas and wants to know the process in case they want to know how to register their own concerns. </p>
<p>Busdriver, I’m trying to word my posts carefully in a way that they do not get deleted. When I take the time to look up laws and regs and find the links, it really is frustrating to see those posts get taken down because they are perceived as being mixed up with a political discussion. So I hope that if I am careful to use a neutral tone and link to actual laws and regs, that the posts and links will still be there when I come back to CC in a few hours.</p>
<p>I suggest we wait for these if someone is really interested. I think it is a topic that impacts no one at the moment since it is in Texas and I don’t see anyone from Texas here having issues with enrollment. This discussion at this point will make it an offshoot giving rise to irrelevant recriminations with no value.</p>
<p>That’s the only part of ACA being implemented for now. What you say about people covered by employers may or may not hold but it is irrelevant at the moment as far as ACA discussion is concerned. Sick people covered by employer plans was not a problem to be addressed by ACA. For most prounced issue ACA set out to solve is the sick people who can’t get an insurance and ACA solved that problem by grouping them into individual plan.</p>
<p>I object your calling my opinion complaints. It sounds marginalizing. Personally, I have an excellent coverage through an employer provided plan. I am opinionating for the overall well being of the nation.</p>
<p>Some of them go into individual insurance. Some of them go into Medicaid.</p>
<p>Let’s assume that the individual insurance risk pool is now exactly as healthy as the employer insurance risk pool. What then is the point of your comment?</p>
<p>emilybee, interesting article. Thanks for posting it.</p>
<p>Calmom and I had a long discussion about age curves in this thread; we’re way ahead of Paul Downs. Under the ACA, age curves are chosen by the state, or the feds if the state declines to choose. In California, the age curve is a straight line, unlike the Pennsylvania curves shown in the article. If you look at the author’s graphs, you see clearly that the 64-year-old rates are exactly three times the 21-year-old rates, a ratio which is, again, mandated by the ACA.</p>
<p>SamuraiL asked about rate hikes in the future thousands of posts ago. This writer and I came up with very similar age increases. I averaged out the rate increases to 2.5 percent a year. The one difference I see is he doesnt have health inflation in his numbers. </p>
<p>But the main point the writer makes is correct. We are going to have much more predictable rate increases going forward and people can plan for the increases in rates.</p>
<p>It’s getting boring. Again, people going into medicaid is great but not part of ACA. We didn’t need ACA to cover people with medicaid.</p>
<p>ACA placed 50 million previously uninsured people in the individual plan with 15 million who had had insurance in the private market to share the cost. My “complaint” is that the burden is not spread out enough.and that if federal employees are added to the pool joining the 15 million previously insured, it may make a difference or at least make a statement.</p>
<p>ETA, texas, I deleted the objectional portion.</p>
<p>There is a lot of useful and inciteful information here. Kudos to all of those who have the free time to inform the workers amongst us who don’t have the time or inclination to learn the ins and outs of a complicated healthcare system.</p>
On the contrary, the Medicaid expansion is a critical element of the PPACA, and all of the provisions in the law about individual coverage, exchanges, and subsidies were built on and around the expansion. The US Supreme Court’s rejection of the Medicaid expansion provisions seriously undercut the law, albeit in a way that tends to discriminate against people who have the misfortune to live in one of the non-expansion states.
The PPACA provided for the expansion of Medicaid to a large group of people previously ineligible, and provided federal funding for the implementation of the expansion.</p>
<p>When you read reports from states that X number of people have been enrolled in Medicaid since Oct. 1, that is indeed an important measure of success of ACA. I know that in California, the financial questions used for the exchange are clearly structured with the primary goal being to screen for Medicaid eligibility, ahead of the screen for subsidy eligibility. </p>
<p>The goal of PPACA is to get everyone covered by some form of health insurance, either public or private. The individual health marketplaces are just one of at least four ways that the law is structured to achieve that (the other three being the Medicaid expansion, the SHOP exchange, and the requirement that larger employers provide health insurance to their employees).</p>
<p>dstark, I have good and bad news. Let’s begin with the good news. </p>
<p>All providers in EPO regions are available to all members who live in PPO regions. So UCSF, UCLA, and any other Anthem EPO provider will all be in network. Interestingly, the reverse is also true. Anyone in an EPO region can go to any Anthem provider in a PPO region. That kind of surprised me. The only difference between an EPO and PPO is that you cannot go out of network in an EPO plan. I think this issue got resolved in the last 24 hours. My inquiry may have brought it to a head. </p>
<p>Now the bad news. Your kid is going to be out of network for the two months in question. This is a problem because of the balance billing issue. If he needed to be hospitalized they would not cover that portion of the bill that would exceed their allowable amount. This could be considerable. I asked him about the broken leg scenario, and he felt that it would not be considered emergency care because it was not life threatening. He told me if he was in your shoes, he would purchase a plan in NY for the two months. I asked him why they changed the Blue Card program but this was beyond his pay grade. I told him Blue Shield retained it and they needed to do likewise. He is going to pass my suggestion upstairs. I wouldn’t hold your breath.</p>
<p>He knows the PDF is old and is out of date. The plan is to provide a workable interactive provider search tool on their website. Unfortunately, it is not really working yet, so it is not going to be easy to find out who is in the Anthem network for the time being. All his agents are complaining, so he is very aware of the problem. </p>
<p>One issue people should be aware of is that the drug formulary has changed for the 2014 ACA-compliant plans. So if your plan was cancelled and you are taking a prescription drug, make sure it will be covered under the new plan. This could be a huge problem for some people.</p>
<p>He also promised to memorialize all these representations. I should have a written copy in the next few days.</p>
<p>^^That’s so technically. We cover some uninsured through medicaid expansion and the rest with the private plan which I consider the major portion of ACA.</p>
<p>The NY Times article doesn’t make sense to me. Trying to predict rate increases only using the ages of the members in the pool is not going to work. The more important factor is the overall health of the pool and the total benefits needed to be paid out in a particular year. If you have sicker people and more services covered than in the past, guess what…your rates are going up. It will also be impacted by the ages of the enrollees, but this is certainly not the only factor or even the most important element. </p>
<p>This guy can draw all the graphs he wants but he has no idea what his plan is going to cost in the future.</p>
<p>I guess I am going to be on the phone with stinking insurance companies in NY tomorrow.</p>
<p>How do people travel out of state now? </p>
<p>I am glad you have coverage with the UCs and Stanford.</p>
<p>I was just talking to somebody today. One of the top hospitals in the US killed her brother many years ago. Got the chemo dosage wrong. A year after the brother’s death, the hospital called the dead person’s phone. The caller wanted to know why the dead person did not show up for his appointment. I dont know. I Just felt like sharing that story. </p>
<p>As far as the story in the NY Times goes…those of us in the individual market are going to have a good idea what the rate increases are. But if you are in a smaller market, you can have problems. </p>
<p>Well…I know what my rates are going to be in 2014… A little more…</p>
<p>Let’s consider, then, only the people newly buying private insurance. The CBO projected seven million on the exchange for this year, and let’s say another two million off the exchange. In what way is this a burden to existing private insurance buyers like calmom, dstark and GP (and you, Iglooo, if you buy private insurance)?</p>
<p>If I were dstark, GP, calmom or romani, I would be hoping that the projections were low. We can be sure that expensive sick people will buy, so the more the rest of the potential buyers jump in, the lower the premiums for everybody.</p>
<p>If I was a relative of the person you were talking to, I can promise you this hospital would be dealing with my attorney. They wouldn’t have to worry about appts not being kept.</p>