<p>Actually California gave age information for the November update: 22% of enrollees were 18-34 years old. Around 86% of enrollees were eligible for subsidies.</p>
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The ACA mandates a single risk pool for each insurer in each state for all ACA-compliant (2014 and after) plans sold on the individual market, whether on or off exchange. That does not apply to “grandfathered” plans. See: <a href=“https://www.bcbsm.com/content/microsites/health-care-reform/en/reform-alerts/hhs-releases-final-rule-single-risk-pool.html[/url]”>https://www.bcbsm.com/content/microsites/health-care-reform/en/reform-alerts/hhs-releases-final-rule-single-risk-pool.html</a></p>
<p>(That’s also one reason why it doesn’t matter for purposes of evaluating the success of ACA whether the person buys on or off exchange. In a sense, if there are more buyers off-exchange, it would be good news because it would means that more people are buying without needing federal dollars to make it happen)</p>
<p>Keep in mind that the PPACA was drafted with intense input from the insurance companies: the law was written to help them stay in business.</p>
<p>The exchanges are primarily a mechanism to foster the advance payment of premium support credits-- it’s very analogous to the role FAFSA plays in college applications. </p>
<p>In theory the exchanges were also supposed to be a way to make the consumer insurance-shopping process easier: everything all in one place, with ability to compare the prices and offerings of different insurers side by side… but the reality, not so much. The web sites will need to work a whole lot better for that to happen.</p>
<p>thanks Calmom.</p>
<p>I work on commission and even though I’m not close to qualifying for a subsidy this year, i could be in another year. It is very difficult to predict what I will make. For that reason, I will likely sign up on the exchange.</p>
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<p>Amen and amen.</p>
<p>Most here may not understand why readmission penalties are a big deal. But since I began caring for my elderly father 4 years ago, I have personally experienced the re-admit phenomenon 3 times – all of them BEFORE the ACA penalties kicked in – and it is both unpleasant for the patient/family and expensive for the taxpayers (Dad was a Medicare patient). Here’s a typical scenario:</p>
<p>My dad goes to ER for [fill in the blank, he had multiple serious health problems]. After 8-12 hours in ER, he’s admitted. In a few days, they get the problem under control, and call me to tell me to come pick him up. I have a long conversation with the discharge planner, explaining that he cannot do any of his own aftercare, and cannot understand much less carry out discharge instructions. I point out that while the average patient may be able to go home in the condition he’s in, he cannot. I call their attention to his history of re-admits. I once cried while begging them to keep him longer. I once said to a discharge planner as I took him home, “See you tomorrow” (and I did). It doesn’t matter. It’s a numbers game. The vast majority of people with his health status don’t need to be in the hospital, so they take the chance that he won’t either. There was little downside to kicking him out too early. They were willing to tolerate the few cases in which it really was too early. The matrix says he’s ready for discharge, so out he goes. </p>
<p>Fast forward a few hours (always within 12 hours, once in as little as 3). Dad’s health has collapsed without medical support, and back he goes to ER. We again have 8-12 hours in ER, very distressing for my father who is sick and confused and scared, time-consuming and distressing for me, expensive for Medicare, a waste of scarce ER resources – and completely avoidable if they had listened to me. After which he’s re-admitted for the same problem he had three days before.</p>
<p>Re-admits are a big issue for the elderly, and a big unnecessary cost which is borne by the rest of us. I for one am glad that hospitals finally have some incentive to make sure that an individual patient is actually ready for discharge.</p>
<p>“Actually California gave age information for the November update: 22% of enrollees were 18-34 years old.”</p>
<p>They need to do a lot better than this to prevent significant premium increases in 2015.</p>
<p>
I’m thinking roughly 1/3 to 1/2. Basically the system is set up so that roughly 1/3 of American families have incomes within subsidy range; 1/3 are poor enough to qualify for Medicaid under the expansion provisions, and 1/3 have incomes too high for either subsidies or Medicaid. However, among those who were previously insured, the incomes probably trend somewhat higher – after all, they could afford to pay their old policies.</p>
<p>I think Kaiser foundation projected some specific percentage but I don’t have the energy to go look it up right now.</p>
<p>My dad was discharged from the hospital after gall bladder surgery. They KNEW that people in his condition were at risk to have a heart attack during recovery. But they did nothing to tell his care providers (my mother and me) how to recognize a heart attack in an old sick man who was already in pain and recovering from surgery.</p>
<p>So when he had a heart attack, we didn’t realize, and we didn’t bring him back to the hospital soon enough. Eventually we brought him back, and he spent the night in the emergency room, which was awful for an old sick man, before he was re-admitted. And he had congestive heart failure for the rest of his life. I feel awful that I didn’t recognize the symptoms, but dammit, I’m not a medical professional; I did everything I knew to do, and followed their instructions to the letter. They could have sent a nurse around to check him or something. But no, they just turfed him out, and he ended up with congestive heart failure because of it.</p>
<p>CF, sorry to read about your dad. It wasnt your fault.</p>
<p>There are estimates of approximately 5 million who couldn’t get Medicaid or subsidies and will lack coverage. </p>
<p>[Medicaid</a> growth creates gap of 5M without coverage - Yahoo Small Business Advisor](<a href=“Turbify.com | Buy a Domain | Websites & Domains | Purchase a URL - Turbify”>Turbify.com | Buy a Domain | Websites & Domains | Purchase a URL - Turbify)</p>
<p>Goldenpooch, may I point out that that number is for November, Month 2 of the 6-month enrollment period. I hardly think we can extrapolate that figure. It’s logical to assume that the first people to sign up – the people willing to endure the problems the website was having at that point – are older and sicker people who’ve been hanging on by their fingernails to get insurance. Those people, I predict, are over-represented in the early sign-ups.</p>
<p>May I also point out that young people are notorious procrastinators. Especially healthy young people who have a nagging feeling that they should do it, but are busy with other more pressing things, and who aren’t going to do it until it rises to urgent status right before the deadline. Case in point, both my D and her boyfriend waited until the night before the deadline to sign up. I think we’re going to see an influx of the young and healthy right before each monthly deadline, and perhaps especially right before March 15.</p>
<p>It’s a little too soon for your celebration dance.</p>
<p>
I also think that particular demographic is highly unlikely to be early signers onto the exchanges – though as you noted, a significant proportion are probably Medicaid-eligible. </p>
<p>But among those with enough money to buy insurance who are not enthusiastic about buying or paying for insurance… I think those people are more likely to sign up close to the March 31 deadline, if they sign up at all. If you don’t think you need insurance and you don’t want to pay for it, what’s the hurry?</p>
<p>LasMas, I am reading this much differently than you. Under ACA, your father would probably still be discharged from the hospital, but your difficulties in readmitting him would be even more pronounced since the hospital would have to pay a penalty. It would still probably cost the hospital much more to keep him rather than discharge him as soon as possible. The only difference now is that they will be much more reluctant to readmit him.</p>
<p>Also, LasMa, turns out the age of the enrollees is not overwhelmingly important. Young people pay a little bit more than their actuarial cost, but not very much more.</p>
<p>[The</a> Numbers Behind ?Young Invincibles? and the Affordable Care Act | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/]The”>The Numbers Behind “Young Invincibles” and the Affordable Care Act | KFF)</p>
<p>The important issue is the health of the enrollees. If healthy people, of whatever age, decide to go without insurance, and expensive people sign up in great numbers, that will make premiums go up.</p>
<p>Goldenpooch, have you had any experiences like the one I describe? I’m guessing you haven’t, or you wouldn’t have made your last post. </p>
<p>Maybe your fancy-pants hospitals in LA would turn him away, but my – what was your disparaging term? “community hospital”? – would not. They would have taken him back, and they knew that when they discharged him. That’s why they would now have to think twice.</p>
<p>Fang, point taken. Healthy middle-aged people are probably also more likely to procrastinate until the last minute, compared to sick people who haven’t been able to get insurance.</p>
<p>“I don’t have good data on this”</p>
<p>The reason for this is because the federal govt and most states (including Ca) have not released any identifying or demographic info about the people who have signed-up or enrolled.</p>
<p>Those of us dealing with aging parents get to see the US health system with all its warts.</p>
<p>Another ACA pilot initiative I like a lot is “medical homes.” The idea is someone has one person who is responsible for coordinating all their care. Doesn’t sound very important for me, because I’m healthy, but I sure wished there had been one person in charge of all my dad’s care. He had a lot of things wrong with him, and it seemed like the doctor in charge of the heart failure didn’t communicate with the doctor in charge of the cancer who didn’t communicate with the person in charge of the gall bladder. All the doctors were kind and, as far as I know, competent, but it was so confusing.</p>
<p>A lot of elderly people see a bunch of different specialists and take a handful of pills every day. They’d benefit from one person making sure all the drugs play nicely with each other. And they’d benefit from one doctor who was in charge of the whole person, who could help the patient and the family determine whether certain treatments which one specialist recommended would really make sense, given the person’s entire medical profile.</p>
<p>Goldenpooch, why are you so eager to declare it a failure when we only have data from October and November, which will surely be the least-representative two months of the 6-month enrollment period? Why is it that you can’t wait until we actually know what the numbers are, before you pronounce the whole thing a failure?</p>
<p>ETA – Fang, I also really like the “medical home” concept, and I hope it’s one of the lasting legacies of ACA. Besides the many benefits you mentioned, it could also be a big cost-saving measure.</p>
<p>Just want to address a point some of you are making that I am a cheerleader for the demise of ACA. Although it may sound like that for those who continually rationalize all the bad news regarding this law, I would like nothing better than to see the law work for the majority of Americans. However, recent polls show that 65% of Americans are experiencing the law the same way I am. I deal with the reality; I don’t try to whitewash all the stuff that may not correspond with my particular biases.</p>