<p>I understand that some things don’t scale, but I’m not understanding what you think doesn’t scale in this particular case. Community rating so everyone pays the same for a particular policy? Individual insurance mandate for citizens and non-citizen residents? Subsidies for people who can’t afford insurance? </p>
<p>Here’s an interesting chart. Physicians per 10,000 population. Note that Switzerland has 40 physicians per 10,000. The U. S. has 24.2. And Switzerland is tiny. If you live in a rural area there, you could easily see a doctor in one of the big cities. Here it would be harder to do that.</p>
<p><a href=“Message About Global Health Facts | KFF”>Message About Global Health Facts | KFF;
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<p>ObamaCare does not apply to employers with <50 ee’s.</p>
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<p>Here’s your reason: creating the mandated avoids attrition – it provides a disincentive to mid-size companies that have historically offered insurance to their employees, but may be tempted to drop it as their own costs go up and they realize that many of their employees are eligible for subsidies on the private market.</p>
<p>This is the exact same economic pressure that you have raised for your own small organization. You are realizing that you will save money by dropping insurance, and that many of your employees may be better off buying on the exchange, especially if you can pass on some of the savings to them in the form of increased salary. </p>
<p>Now imagine that you had to factor in a penalty of some sort into that equation: that is, let’s say you have 51 employees and dropping them ALSO means that if even one gets a subsidy on the exchange, you will have to pay a per-employee penalty of $2000 for all employees. (Or at least for 21 employees – it seems that there is a 30-employee exemption from the penalty calculation) In any case, the math changes – let’s say you have an 90% participation rate – so your company has been subsidizing insurance for 46 of your 51 employees. Let’s also say that your premium rates are going up by 15%. Dropping the coverage entirely, knowing that many employees will get exchange subsidies, means a $42,000 “shared responsibility” tax for your company. So now you have to really do the math: does the tax outweigh that 15% premium increase you are looking at?</p>
<p>Now let’s assume that you know that there will be a delay in implementation of the mandate. You won’t have to pay the penalty now, but you will need to do that down the line. If your business is really struggling financially right now - and/or you have a business with very high employee turnover - it might make sense to drop the insurance – but if business is good and/or employee retention is important to you-- then it is a poor financial decision – you are better off to look for cost savings elsewhere. </p>
<p>So let’s say, hypothetically that 75% of mid-size employers already offer insurance to their employees. (Maybe someone can look up real stats, I don’t have time). Let’s say that it is also projected that the mandate will result in 90% of employers offering insurance. Delaying implementation of the mandate doesn’t impact that 75% for reasons stated above - it’s just impacting the 15% of mid-size employers who don’t currently insure their employees.</p>
<p>CF: I PM’d you my answer since I think it violates the TOS.</p>
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<p>Your wish is my command. Check my message on the previous page. Roughly 69% of employees of firms with 50-99 employees are offered insurance by their employer. Some people who work for firms with 50-99 workers are part timers who wouldn’t be eligible for insurance even if their company offered it to other employees. Probably a million to a million and a quarter employees area affected by the latest mandate delay.</p>
<p>I’m not sure the delays have been so much as about the number affected as the news cycle. Another fresh million+ would probably generate all the headlines anyone couldn’t want, given how daintily implementation is being handled.</p>
<p>Keep in mind that a certain fraction of employers will choose not to buy insurance and pay the tax instead, even with the mandate. The “shared responsibility” payment is $2000 per employee-- let’s just assume for a moment that it costs the employer $4500 per employee to subsidize insurance. (I think that’s a very conservative estimate). Obviously it costs more money to insure than to pay the penalties. I think that an employer with a high turnover, low skill workforce might simply opt to pay the penalty. Mathematically it makes more sense – the element that shifts the balance toward insuring is the need to attract and retain good employees, and to keep up with competitors in the same business. </p>
<p>Again, I’m just guessing but it wouldn’t surprise me if 10-15% of the mid-size businesses covered by the law make that decision. They are going to sit down with their accountants and do cost benefit analysis – some of them are going to come down on the side of skipping the insurance and either raising their prices or perhaps cutting back on their workforce to compensate. </p>
<p>“it provides a disincentive to mid-size companies that have historically offered insurance to their employees”</p>
<p>I like this reason coupled with CF’s chart showing a few million are currently covered by such plans. So even if ACA can only pick up a million or less by mandating 50+ size companies, losing coverage for 5 million + already covered is not a good outcome.</p>
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<p>I’m sorry, could you explain this? Who is “they”, and why are the 5+ million already covered at risk to lose coverage?</p>
<p>Today I helped 2 employees enroll in healthcare.gov. It was an interesting experience and took a while because the process is very rigid (my impression). I also had a doctor next to me while doing this who was shocked to find he was not part of several of the plans that were available although he currently accepts those insurances!</p>
<p>If healthcare.gov has moved from brittle to rigid, that’s a big step in the right direction.</p>
<p>Michigan has finally started releasing details about their Medicaid expansion (which is due to happen at the end of the month?). It’s relatively hard to find and looking for “Michigan Medicaid” will not get you there. I hope they make a legitimate effort to get people enrolled but I’m not holding my breath. </p>
<p>I’m hoping they have the sign ups before I have to pay my next BCBS premium. </p>
<p>Are there any penalties if someone claimed to be at 100% poverty level and enrolls in insurance but does not make the money by the end of the year in a state like Texas without medicaid?</p>
<p>According to calmom, there is no way for penalties to be assessed on a person like that.</p>
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<p>According to this article, about 85 percent have paid in Calif. </p>
<p>I think that is pretty good. I would have written a different headline. :)</p>
<p><a href=“Obamacare: Fifteen percent of Covered California enrollees haven’t paid – The Mercury News”>Obamacare: Fifteen percent of Covered California enrollees haven’t paid – The Mercury News;
<p>I think the insurance companies are probably ecstatic over that payment rate – especially given the issues they have run into concerning their own billing processes. </p>
<p>The 15% non-payers would also include some fraction of people who signed up via the exchange but subsequently changed their minds, perhaps buying different policies direct from insurance-- and some who had other life changes, such as moving away, taking a job with employer insurance, etc. So an 85% payment rate is probably close to a best-case scenario – I’m sure one that fits well within expectations. </p>
<p>I wonder what the payment rate was last year, for insurance in 2013? I agree with you two that 85% is about as good as insurers could have expected. </p>
<p>I think historically the paid number is closer to 95 percent. However, Calif is blowing thru expectations. There could be around 1 million people paid when this is over. That is more than Cal expected to sign up on an exchange.</p>