<p>That’s not “a” problem, it’s “the” problem. It’s the fundamental problem with private markets for health insurance. It’s called adverse selection. The people for whom the best coverage will be most valuable are the sickest people, those with the greatest medical needs. They will always flock to the best insurance coverage. And because the sickest people will be drawn to the best coverage, the best coverage will become prohibitively expensive for most people–unless the insurers take measures to exclude the sickest people. </p>
<p>To keep from being swamped by claims from the sickest people, private insurers will try to find ways to exclude the sickest people. I don’t think we have a term for it, but it’s the mirror image of adverse selection: insurers will try to find ways to insure only the healthiest people. Pre-ACA, they could do that. They could deny coverage to people with “pre-existing conditions.” Or they could sell coverage that excluded pre-existing conditions, so that people thought they had good health insurance but if it turned out that their medical costs were the result of a condition that existed prior to the coverage (e.g., a congenital heart defect), their claims could be denied. Or they could be made subject to annual or lifetime caps, so that if it turned out that they became really sick, their coverage ceased.</p>
<p>Bottom line, the individual insurance market became a market in health insurance for the healthiest. I have no doubt that some healthy individuals like GoldenPooch grew fat and sassy, paying low premiums for nominally broad insurance coverage that the insurer calculated would likely never be invoked. And I have no doubt that GoldenPoooch and others similarly situated are made worse off by the ACA, because now they’re suddenly in a community rating pool where others of a similar age are, on average, sicker and incur greater medical costs than the pool of healthy people who were covered pre-ACA. </p>
<p>So many fallacies and so little time to knock them down. The first myth is that only healthy people had insurance pre-Obamacare. Many sick people had insurance with broad networks because once you became sick, the insurance company was prohibited from cancelling the insurance or raising rates based on your health. The only time you had to be underwritten is when you first applied for insurance. I had individual insurance for 25 years and only had to be underwritten twice. The second time was around 10 years ago when I changed insurance companies (which was a voluntary choice). So there were plenty of sick people with insurance. The percentage of people with preexisting conditions who wanted and couldn’t get insurance was probably less than one percent of the insured.</p>
<p>bclintock is correct about one thing: If you have only a few plans with broader networks, it would probably attract a sicker population. This wouldn’t be a problem if most plans had wide networks like we had prior to Obamacare. The way to keep the costs down is to allow consumers to choose what benefits they want and to give them more choices. Let consumers narrow their networks if they would like. One should be able to buy insurance from any state, allowing much more competition than we have now. </p>
<p>I just don’t understand the thinking that if a few (percentage-wise) were disadvantaged by the system we had heretofore, the way to remedy the problem is to drag millions of other people down to their level. </p>
<p>I would institute one other reform to prevent only sick people from choosing the most expensive coverage. Everyone would be allowed to sign up for insurance without underwriting, but if at a later date you decide to upgrade your coverage, then you must undergo underwriting. Also, if you let your insurance lapse and then decide to purchase insurance after a certain period of time, you would have to be underwritten. If we did these two things, you could get rid of the penalties for mandatory coverage.</p>
<p>There was a reason why only 17k people in all of NYS, which has had community rating and guaranteed issue since the early '90’s, had individual insurance. </p>
<p>Dstark, I will wait unti March 31 to accept congratulations. </p>
<p>LasMa, so sorry to hear about your dad. My condolences. </p>
<p>By my count, either GP is currently in Asia or has not slept all night. :D</p>
<p>I have heard there are Hope Diamond tier plans in some elite Houston hospitals. There are some private wings where some ultra rich foreign nationals get treated. It takes the kind of wealth where one flies in a personal plane and gets choppered onto the top of the hospital.</p>
<p>According to one poll only one in ten uninsured people signed up so far. However, far more interesting is that just over half of uninsured people said they had started to pay, compared with nearly nine in 10 of those signing up on the exchanges who said they were simply switching from one health plan to another. It seems like we were just shuffling people from one plan to another. To paraphrase Shakespeare: a lot of sound and fury, signifying nothing.</p>
<p>Observation is good- being aware of how some respond to their new plans. But you are conveniently skipping over the success stories, assuming this drags down everyone because you have a…pocketful of links.</p>
<p>My new plan is working swimmingly, no one drags me down to their level on this or other issues, in this or in real life. Btw, D needs a specialist near college, another state. Will be in-network. MSK is and I am not in NY. Speaking of, for fun, I checked and D could go to a specialist in Albany. But no Johns Hopkins.</p>
<p>No, it doesn’t drag down everyone, yet. It does definitely drag down some to lift others and that’s bad imho. It is also a smidgeon of what’s envisioned at this point. Glad to see there is beginning to be some agreement on this thread.</p>
<p>Did we cover how many secure folks are being “dragged down,” for heaven’s sake? Are we really equalizing everyone? Not by a long stretch. I’m not talking anecdotes. Note how the argument so often swings to things like “freedom of choice.” He wants his FoC and the rest of y’all be damned?</p>
<p>I am curious what people around here think about the ramification of employer mandate push out on the individual market. Let us say I work for a company which should be starting insurance but got a reprieve (it got moved to 2016 for 50 to 100?) but now I am required to buy it myself in order not to break the law.</p>
<p>What happens to those who need to buy it now but their employer will need to offer it next year or year after?</p>
<p>What happens is they have to buy individual insurance, just as if their employer was never going to be required to offer them insurance. I don’t see why this is a particular problem.</p>
<p>There are mentions in some articles which I will not post because of their political nature, that the individual mandate may be postponed, just as so many other mandates have been postponed, due to its unpopularity… And I doubt that with so many uninsured not signing up, the IRS will go after the tax imposed for being uninsured. Another way of postponing/not-enforcing the individual mandate. </p>
<p>An anecdote: A few days ago, I was in a large public building in a very large city center. Signs pointed to a room for Covered California information and sign-ups. The room was empty of customers. </p>
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