<p>CF- guess one has to lose more than 10% of starting body weight (N=887.) I’d guess that’s where the big psychological drive plays. For fun, here’s the other link- I think it may be ok to post, in this context. <a href=“http://www.psychologytoday.com/blog/traumatic-dieting/201201/are-you-really-doomed-regain-your-lost-weight”>http://www.psychologytoday.com/blog/traumatic-dieting/201201/are-you-really-doomed-regain-your-lost-weight</a></p>
<p>Slightly off topic but if anyone is interested…</p>
<p>Debate on Single Payer Vs Private Insurance</p>
<p>I am listening to this debate right now on my pubic radio station (I think it’s a rebroadcast as the full program is already on their website.) Two doctors (one from GP’s favorite hospital) debate the topic at Albany Medical School. It’s 55 minutes long. It’s a real debate (debate rules apply, etc.) </p>
<p><a href=“http://wamc.org/post/great-debate-single-payer-or-private-insurance”>http://wamc.org/post/great-debate-single-payer-or-private-insurance</a></p>
<p>Well, singlepayer discussion is verboten…</p>
<p>Romani, medicaid expansion means that eligibility is determined based on projected annual income, so seasonal employment should not matter unless it will push the person above the FPL. (Actually above 138% of FPL). It’s possible actual implementation may vary in different states, but I think the system relies on voluntary reporting of income changes after the initial verification. That may sound like some sort of big loophole – for example, someone who is unemployed in January and gets a job with reasonable pay in March gets away with being on Medicaid all year long – but you have to add the administrative costs of continually rechecking eligibility and of people switching in and out of different plans during the calendar year to the equation. </p>
<p>The overall goal of the ACA is to get everyone insured – so from a policy perspective, the goal that every person has some source of insurance is more important than the goal that each person pays their fair share. (Also an important goal, just less important than the primary goal of insurance for everyone). We think of insurance as benefitting the policy holder – but the whole purpose of insurance, whether provided by the government or a private insurance company, is to provide a reliable source of compensation for medical service providers for their services. </p>
<p>So from that perspective-- it is better that someone who is hospitalized after a heart attack is on Medicaid even they earned too much money to qualify, than that the person be completely without insurance. </p>
<p>Presumably it will even out in the end, because those whose income increases on a permanent basis will go to the exchange during the next open enrollment period, if not before. </p>
<p>texas, I am not asking anyone to discuss it and I didn’t in my post offer an opinion. Just posting the link as I thought some people might be interested in listening to it. </p>
<p>You can delete if you want. </p>
<p>I left it up there so people have access to read it for a bit.</p>
<p>Re: romani’s question. Also, we’re much further along in the digital age, where some of one’s continued post-enrollment eligibility can be checked electronically. As it is, much verification is done behind the scenes. </p>
<p>Also, you are supposed to update your account when there are various changes. My notice starts: “This letter is a friendly reminder that you must report certain changes to us. Some changes, especially changes to your income or family size, will affect your eligibility for the benefits you are receiving.”</p>
<p>Since I’ve got two kids who have started major job hunts, it’s come up. When they get something, we go back to the exchange, not wait for the next enrollment. Same as losing a job.</p>
<p>The bit about seasonal or temporary does take a long view. 2014 income. </p>
<p>Emilybee, thanks.</p>
<p><a href=“http://news.coveredca.com/2014/03/covered-california-begins-countdown-to.html”>http://news.coveredca.com/2014/03/covered-california-begins-countdown-to.html</a></p>
<p>From dstark’s link, so far in California 923,832 people have enrolled on the exchange, and 85% (~785,000) have already paid.</p>
<p>OK, so what’s up with this:</p>
<p>
</p>
<p>The 968,500 people were transferred over from other health programs for low-income people. I’m wondering why Covered California is not telling us how many of those “likely Medi-Cal” people actually enrolled in Medi-Cal. Is this just because Covered California, under the no wrong door policy, redirected those 1.136 million people to Medi-Cal but can’t verify whether they enrolled? What do you have to do to enroll in Medi-Cal in California?</p>
<p>We have 1.136 million that are medicaid eligible that have enrolled or are in the process of enrolling. They signed up using Covered Cal.</p>
<p>An additional 968,000 were in temporary programs and are switching to medi-cal. I think that was always the plan.</p>
<p>The Calif numbers are great overall. I dont see the surge… at least not with private insurance.The March sign ups are running at a lower rate than Dec. Part of the reason is a majority of sign ups are previously uninsured and that was not the case in Dec. Still… I was hoping for bigger numbers so Calif could pick up the slack for other states and so I could continue to write 1 million Paid people signed up on an exchange. </p>
<p>Looks like 4 million newly insured to me. Maybe slightly less even. The arguing is going to continue. ;)</p>
<p>We’re seeing previously uninsured and previously insured people behaving differently, which I suppose should be no surprise. The previously insured people were much more likely to sign up for insurance by January, and pay; they were insured, and they wanted to stay insured. The uninsured are taking their time about signing up, and they’re taking their time about paying, too.</p>
<p>This statement by Peter Lee seems exactly right: “It’s both a short-term and a long-term, multi-year effort to change the mindset of the uninsured from a culture of coping into a culture of coverage.”</p>
<p>No, it’s no surprise. The uninsured were uninsured because they couldn’t afford insurance. In many cases this is more a question of priorities than poverty. And as has been discussed Obamacare is not necessarily cheaper than pre-ACA insurance. </p>
<p>I said from the beginning of the first ACA thread this is a multi year deal. It is. I was hoping for a surge that would get us to the original CBO projections because that would end the nonsense. :)</p>
<p>Medicaid, I think is going to see 8 million newly enrolled. So between every program, the uninsured is probably cut around 16 million people. That is a lot and we arent going back. Try and tell 16 million people you are out. I want to see how that plays out. :)</p>
<p>Things that dont add up bug me. I could never get the McKinsey survey to add up. 
This bugs me, CF. We see reports that there were 11 to 19 million people with individual insurance last year. So on a simple basis, if we take 15 million and add 5 million newly uninsured… That gets us to 20 million insured. (I know there are factors that change the numbers a little bit. I want to keep this simple). </p>
<p>An insurance company released its off exchange sign ups today. They are about 30 percent of on exchange signups. And the insurance company is happy. Looks like the insurance company is going to insure more people this year than last year.</p>
<p>Here is the problem for me. 15 million last year. If I add up 6 million people signing up on an exchange and 30 percent more off exchange… That gets me 7.8 million people. About half of those are newly uninsured. That gets us to 3.9 million people with previous insurance. </p>
<p>15 million last year. 3.9 million this year. Where are the 11.1 million people? I dont think they kept their plans. There are only about 500,000 people that kept their cancelled plans.</p>
<p>The insurance company is happy…</p>
<p>I am going to provide a link in a second.</p>
<p>This is the report that bugs me. </p>
<p>Are some previous insured not counted? </p>
<p><a href=“404-Page not found”>404-Page not found;
<p>
</p>
<p>US wide? That sounds low; where is that number coming from? And where are we counting the people who got the letter saying their insurance company was cancelling their plan and moving them to the new improved plan, and just said, OK?</p>
<p>McKinsey’s numbers are here: <a href=“Healthcare Systems & Services Insights | McKinsey & Company”>Healthcare Systems & Services Insights | McKinsey & Company;
Look at Exhibit 1.</p>
<p>19% of the people eligible for a QHP picked one; 29% renewed their old plan. I have a feeling that the 29% includes people whose plan was cancelled but who accepted the rollover to their insurance company’s new plan. </p>
<p>I also suspect that when that insurance company reported its off-exchange signups, they only counted new customers, not renewal customers and not rollover customers.</p>
<p>Dstark says:</p>
<p>
</p>
<p>Look again, dstark. They are about 30% of ALL signups.</p>
<p>From the Highmark link:
</p>
<p>(the numbers from the other two states are similar)</p>
<p>That is what I meant.</p>
<p>The Rand Corp did a study and came up with 500,000. I linked the study and this was discussed already. Plus … 2 of the 3 states said no to renewals of cancelled policies . :)</p>
<p>“I also suspect that when that insurance company reported its off-exchange signups, they only counted new customers, not renewal customers and not rollover customers.”</p>
<p>That would make things better but imperfect. I will check that out later.</p>
<p>I screwed the example up slightly. Took the wrong 30 percent. </p>
<p>We are are still short around 10
Million in my example. If the insurance companies dont report repeat enrollees, then there is no issue. </p>
<p>What Highmark doesn’t tell us is how many total customers they have so far, compared to how many they had last year. </p>