<p>Of course, the old policies did not include the cost of insuring millions and millions of additional people, either.</p>
<p>Look, I know there were some junk policies out there. We all do. Hopefully, we all know there were also some very good policies on the individual market pre-ACA… And, comparing any exchange policies to the best employer provided plans is apples to oranges. Dump all of those employees into the exchange and there will be some screaming.</p>
<p>Lots of people are missing lots of points in this entire discussion. </p>
<p>Flossy, you keep saying that the new insurance policies include the cost of subsidies. Let’s go over this one more time. Maybe putting it in bold will help.</p>
<p>Insurance premiums don’t include the cost of exchange subsidies. Subsidies and premiums are two different things. **Your insurance premium does not include the cost of anyone else’s subsidy. ** Under the ACA, insurance premiums pay for health insurance.</p>
<p>4 million people on mini-med policies that pay basically nothing is not a problem…but failing to include the very expensive Cedars-Sinai as an in-network provider is a terrible, grievous, indefensible choice? </p>
<p>“Can someone tell me if the normal delivery stay has been increased from the standard one day that busdriver had or standard 3 days for a C-section that my wife had.”</p>
<p>My niece just had a c-section, after 18 hours of labor, late Sunday evening (11:30pm) and was released from the hospital Wednesday. I do believe that for a time hospitals were kicking new moms out much earlier - sometimes the same day if it was a normal delivery. Then some state insurance boards slapped that down and stays for deliveries went back to what they had been before (like when busdriver had her children.) </p>
<p>Apparently, people used to be able to choose what type of coverage they wanted. Many probably had high deductible catastrophic coverage only which was pretty cheap. I can see how those people might be paying triple now. That doesn’t mean their old plan was bad. It may have been perfect for them. </p>
<p>BUT – that’s NOT responsive to the point that was raised about the junk insurance policies. The problem with the junk policies isn’t companies that limit the amount of a hospital stay for a given procedure – the problem is that those policies simply have a very low maximum payout for ANYTHING. They examples given are ones that would pay for ONE day in the hospital during the policy year, no matter what – or would pay a maximum of $2000 for hospital costs for the policy year – no matter what. Those policies simply don’t pay real benefits. One of the examples was a policy that did not pay for any hospitalization for anything, except that it paid fifty dollars ($50) for hospitalization for complications of pregnancy - and that was policy that was held by a 50 year old woman who was dismayed when her ACA compliant policy cost more. </p>
<p>Of course it is also a matter of payment when the insurance company won’t authorized an extended hospital stay – (and of course a 48 hour post partum stay really shouldn’t be seen as “extended”) – but that’s a different issue. </p>
<p>Bay, the “mini-med” plans that were discussed were NOT catastrophic plans – they were plans that were capped with very low maximum benefits. People would pay a premium of $75 per month for a plan with a maximum payout of $2500, or a plan that would reimburse patients a small per-visit fee - such as a plan that would pay $50 for doctor visits and $100 a day for a hospital stay, capped with a maximum number of days. That is actually structured similar to many dental plans – I had dental insurance very briefly for my daughter and dropped it after the first claim was submitted – it turned out that if my kid had a filling, the insurance paid $19 and I paid the rest. It wasn’t rocket science to figure out that I was better off saving my money by eliminating the premium for a worthless policy. </p>
<p>“Catastrophic” is a very different concept – it was either a combination of a high deductible and very high policy payment limits (measured in the millions of dollars), or a form of secondary insurance to supplement primary insurance with a lower payout maximum I structured something like that for my daughter when she was in college – the mandatory college plan had a policy of maximum of $5000, so I changed my daughter’s home plan to one with a $5000 deductible, but the highest maximum payout that the plans came with at the time. (I don’t remember if it was 2 million or 20 million, but it was however insurance was sold half a dozen years ago). My reasoning was that the California-based Blue Shield plan would kick in where the college plan left off-- but I found that in practice the college insurer wouldn’t pay anything until we had first submitted to Blue Shield. It worked but the college plan made claims processing very difficult and we had to get the college HR person involved to get them to pay out on specific benefits. </p>
<p>But that’s another story. </p>
<p>Did some people choose catastrophic because that was best for them? Yes.</p>
<p>But most of the people with the junk policies had no idea of what they were buying. The policies are not marketed as “catastrophic” – they were marketed as genuine health insurance, with lower premiums, and most buyers weren’t understanding what they were buying, especially as those policies were often offered to part-time or lower paid workers via their employers (with no employer subsidies). Those people would not have been in any position financially to cope with a high-deductible catastrophic plan in any case. </p>
<p>These so-called junk plans were 1.5% of the entire insurance market. Let’s destroy the individual market, cancel over 5 million policies, severely limit provider networks, significantly raise rates for middle class citizens and force them to have inferior coverage and upend the employer market in 2015 to take care of a problem which could have been dealt with without the carnage. </p>
<p>Get dstark to do it, I hear he’s really good at that math stuff.</p>
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<p>I think you meant Wellpoint, instead of Anthem, but they shouldn’t be in any trouble at all, what with most of their risk being indemnified by the feds. That they could accurately predict how many young (not necessarily healthy, mind you) would sign up does make them look pretty bright, though. At least, brighter than those who said they’d need at least some 67% more (16/24) to carry the older and sicker they insisted were going to get on board.</p>
<p>Not looking very bright at all are the young that signed up, that 24%. They’re going to carry the old people for a year, all by themselves, when they could have just taken a teeny little risk and gotten a better deal next year. Assuming dstarks right. [-O< </p>
<p>dstark, very effective deleting a post and making me wonder what your response was going to be. Leaving the post is far less potent than letting my imagination run wild. </p>
<p>Wellpoint is a publicly traded corporation in the health insurance business. One of it’s products is Anthem insurance. Also “Empire”. And a bunch of other stuff. </p>
<p>I’d also add that the young are not “carrying” the old. I’m old. My premium for a Bronze plan is close to $700 a month. I rarely get sick and hardly ever go to the doctor. So maybe the insurance company collects $8000+ from me in a year and pays out, say, $1000, in various preventive care benefits. And maybe the insurance company gets $2500 for a younger person – and pays out about $500. Who is “carrying” whom? </p>
<p>Mathematically with the 3:1 premium ratio, the younger people pay a somewhat higher percentage of premium dollars in relation to risk, but the premiums look pretty high up here in elder-land. </p>
<p>And the only people “carrying” others with their premium dollars are health people “carrying” the sick. </p>
<p>Which is what insurance is all about. I also “carry” drivers who are get into injury accidents for every year that I am paying for car insurance but never collecting, and I “carry” people whose houses bun to the ground every time I pay a premium for property insurance on my still-intact abode. The whole point of insurance is that risk is spread by having a large number of people pay into a common pool to cover the losses of a few. </p>
<p>Some young people will get sick or get into accidents and have high expenses, even extraordinary expenses. Many middle aged and older people won’t. The enrollment numbers, by age, give a rough proxy because young people tend to be healthier than old ones, but the overall issue is the need for healthy people to enroll. </p>
<p>People are posting making it sound like ACA addressed hospital stays in a major way.</p>
<p>What is the evidence outside of conjecture? Did they define anything in the law that states what the minimum length is for a specified condition? </p>
<p>If not, there should be no such claimed benefit of the law since that would be misleading the readers.</p>
<p>The ACA addressed hospital stays by making sure that people who have insurance were insured for hospital stays. Pre-ACA, people who had “insurance” might not be insured for a hospital stay.</p>
<p>Texaspg, the only posts I’ve seen that imply that ACA addressed length of stay are yours- and I think that was because of a misunderstanding of some other post. Perhaps you could point to the post(s) that led to your comments so that this can be clarified. </p>
<p>As far as I can tell, everyone else has been addressing the pre-ACA problem that many so-called “health insurance” plans did not cover hospitalization at all, or had such restrictive benefits as to be meaningless (such as a plan that pays $50 a day for hospitalization, or caps hospital benefits at $1500). </p>
<p>The issue isn’t how long a person stays in the hospital. The issue is whether the insurance pays and how much it pays for. Many so-called “health insurance” policies were written to only pay for routine doctor visits and to completely exclude hospitalization. It would be like having Medicare Part B without the Part A – except for those parts even the “Part B” was very restrictive with the insurance policies paying very little and total benefits capped very low. </p>
<p>One of the (many) problems with mini-med policies is that too often the people who have them have no idea of what medical charges run today for something like a day in the hospital. A policy that pays $250 a day for up to 3 days a year probably sounds ok, until you see that average hospitalization charges are somewhere around $2000/day in many states, and closer to $2700 a day in more expensive states. They thought they had coverage, but when they used it, they learned otherwise. The insurers certainly weren’t clearly explaining that this was likely to cover less than 10% of the costs associated with a hospitalization by the time you add in all the ancillary charges and physician fees.</p>