<p>"Must be the exchanges fault you havent received a bill GP. "</p>
<p>No, but I doubt I would be dealing with this nonsense if it were not for ACA. </p>
<p>“I would trash Blue Shield but I know S. Jacobs.”</p>
<p>Who is S. Jacobs?</p>
<p>GP, you commented on him. I figure you know.</p>
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</p>
<p>I think a better analogy than amazon.com is enrolling in a college (appropriately enough, since this is a college admissions website). Last spring, through a series of online transactions, my D2 selected a college to attend, choosing from among several that had made competing offers of admission and financial aid. She clicked a button that committed her to attend one particular college, and that was that; done deal. We didn’t actually receive a bill from the college until much later, roughly the middle of the summer, and we didn’t pay that bill until the end of summer, about 2 weeks before her freshman orientation started. </p>
<p>No doubt colleges lose some small fraction of those who have made binding commitments to attend, but the decision to accept an offer of admission (and to forsake others) is more than just “putting something in the shopping cart.” It represents a definite decision to purchase a particular product and not others. That the billing and payment happens later in a separate transaction is of little consequence; the crucial decision is made at the time of acceptance. And that’s just how enrolling in a health insurance plan on an exchange works.</p>
<p>I think the idea that large numbers of people, having committed to purchasing a particular insurance product, will ultimately not pay for it is just a delusional fantasy held by some people who are still hoping against hope that the ACA will just somehow go away, and standing on the sidelines rooting for it to fail, if not one way then another. Sorry, it ain’t happening; so far all the doomsday predictions have proven inaccurate. And when large numbers of people do follow through on their purchases and do pay, I wonder what will be the next line of attack.</p>
<p>Well Bclintonk, I wrote the next issue on my timeline of complaints.</p>
<p>Not enough young people are signing up.
Or is it the coverage isnt good enough or is too expensve. </p>
<p>Doesnt matter. ;)</p>
<p>I think that’s a good analogy as well, although the colleges my kids chose all required a deposit with the acceptance. But once the person “enrolls” at the exchange, they have made their decision. I do think that there will be some “melt” (the college term for the accepted students who go somewhere else) – some for financial reasons, and others like Romani who may have selected a plan and then opted to stick with what she had before. The confusion about cancellations and extensions will contribute to that. But that’s going to to be a relatively small fraction.</p>
<p>“Plus, readmission penalties. I love them.”</p>
<p>Is that a great thing? I was listening to the guy who owns the law firm that we use on the radio awhile ago. He is a specialist in Elder Law and is very knowledgeable. What I understood from him, is that the hospitals are finding a way to get around this. When someone has to go back to the hospital, they don’t readmit them, they keep them for “observation.” The problem with that being, if you have to go into a rehab facility (or skilled nursing facility), for Medicaid to pay, you must have a “qualifying hospital stay,” which means three inpatient days in a hospital. If you are not admitted, it doesn’t qualify.</p>
<p>If Medicaid doesn’t pay for it, you’re either not going, or paying for it on your own…which could be incredibly expensive. Is it any surprise that hospitals would find a way to get around this?</p>
<p>So tell me again how great the readmission penalties are.</p>
<p>“just a delusional fantasy”</p>
<p>Here is a delusional fantasy: the govt will save money with 30 million newly insured people with at least 20 million of these people receiving substantial subsidies or free care (medicaid). </p>
<p>For people who have never paid for insurance in the past, it will be interesting to see how many of them will start paying now, particularly for those people who were corralled by the swarm of navigators and paid govt contractors</p>
<p>Readmission penalties are great because they are forcing hospitals to make sure someone is healthy enough to be discharged, understands what he is supposed to do to continue his recovery, and either is able to do what he is supposed to do or has people at home to support him.</p>
<p>Medicaid? Was that a typo? Readmission penalties apply to Medicare. They have nothing to do with Medicaid.</p>
<p>[Obamacare</a> Incentives Push Hospitals to Keep Medicare Patients Healthy - Businessweek](<a href=“http://mobile.businessweek.com/articles/2013-09-26/obamacare-incentives-push-hospitals-to-keep-medicare-patients-healthy]Obamacare”>http://mobile.businessweek.com/articles/2013-09-26/obamacare-incentives-push-hospitals-to-keep-medicare-patients-healthy)</p>
<p>“While the work isn’t cheap or easy, Mount Sinai has assembled data that show the efforts are worth it in the long run. During a test run from September 2010 to May 2012, the program reduced admissions by 43 percent and cut emergency room visits by 54 percent among more than 600 patients. It also saved an estimated $1.6 million in medical costs over a six-month period.”</p>
<p>dstark, how much time do you spend googling for favorable ACA stories? :)</p>
<p>Are you on the Administration’s email list for their daily talking points?</p>
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</p>
<p>No, you are missing the point.
The administration claimed that people who went to the site and selected a plan BUT MADE NO COMMITMENT TO PURCHASE THE PLAN “signed up”.</p>
<p>Originally, the only way you could even get pricing on a plan is if you entered all your information. So once you put in all your info and said you were interested in a plan, voila you were signed up.</p>
<p>That is total BS.</p>
<p>Your analogy is silly since you said that she clicked a button which said she was committed.</p>
<p>The correct analogy was her Common App in which she expressed interest in a bunch of colleges but made no commitment. Besides, she may decide not to go to a college or go to one that doesn’t use the Common App.</p>
<p>I spend a lot of time googling the good and the bad. I prefer the good. ;)</p>
<p>Obamacare is here to stay. Sorry. </p>
<p>My timeline of negative bs goes from repeal to change. </p>
<p>As I said before, I dont want to spend my time in the negative and wrong quartile.</p>
<p>I was thinking I should get a job… :)</p>
<p>Does it really matter if they all pay or not? Whatever numbers they use they are all way below the original 7-million needed number. Now everybody’s all excited about 1-million. Or 4 million. Or whatever.</p>
<p>CCdaddio, you better come up with a better link. Your unnamed administation source in your last link was wrong.</p>
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</p>
<p>Do we know how many people currently without health insurance but now buying insurance on the exchanges “never paid for insurance in the past”? I don’t have good data on this, but my impression is that the number of “chronically uninsured”–people who go year after year without any health insurance–is much smaller than the total pool of uninsured at any given time. Even among people who pre-ACA were effectively barred from purchasing health insurance on the individual market by pre-existing conditions, many have previously had health insurance but their policies were canceled. Or they exhausted lifetime caps. Or they couldn’t afford to keep paying insurance premiums for a policy that didn’t cover their pre-existing condition, where their priority medical needs were. Some previously had employer-sponsored insurance (which typically requires a co-contribution from the employee) but lost it along with their jobs in the recent recession. Others had purchased insurance on the individual market when they could afford to do so, but couldn’t keep up their coverage when they lost income, or when premiums soared out of sight based on their age or medical history. Based on all this, my guess is that the fraction of people now buying health insurance on the exchanges who “never paid for insurance in the past” is relatively small, except perhaps among young people without employer-sponsored insurance who will be buying health insurance for the first time. </p>
<p>And a large fraction of the chronically uninsured, it is beginning to appear, are Medicaid-eligible, especially in the states that have gone along with Medicaid expansion. Reports here in Minnesota are that state officials are absolutely delighted with the number of people they’re now signing up for Medicaid, including some who would have been Medicaid-eligible in the past but didn’t realize it, and others who are newly Medicaid-eligible under the expanded program. This is probably the most important impact of the ACA in Minnesota. Even pre-ACA, we had one of the lowest rates of uninsured (9%). Some substantial portion of that 9% will now be newly enrolled in Medicaid; any additional previously uninsured people who purchase individual policies on our state exchange are just gravy.</p>
<p>“Does it really matter if they all pay or not?”</p>
<p>No.</p>
<p>@dstark</p>
<p>Proof of being wrong?
It was confirmed at the hearings.</p>
<p>@actingmt</p>
<p>That is a good point.</p>
<p>I was also curious about the data from acasignups. Particularly that the estimates for first year signup was really low compared to the number of uninsured. Since many of those signups are coming from people whose policies were cancelled, I am surprised at how few people they think will get insurance. Wasn’t it the goal to get all those uninsured insured?</p>
<p>Ccdaddio, Really? </p>
<p>So how many sign ups are enrolled?</p>
<p>You think 10 to 15 percent of 2,000,000?</p>
<p>“Previous data showed that only 5-15% people who selected a plan actually enrolled.”</p>
<p>“Medicaid? Was that a typo? Readmission penalties apply to Medicare. They have nothing to do with Medicaid.”</p>
<p>Yes, it was a typo. I meant Medicare. Medicare, medicaid, a couple glasses of wine and what’s two letters?</p>