<p>So why would anyone ever admit to tobacco use, then? </p>
<p>Dietz, you’re lucky if they don’t audit you and you can keep your policy. In NJ all small groups have to re-certify every year, listing all employees whether covered or not and copies of NJ payroll proof (NJ forms or in my case W-2) and Schedule C. </p>
<p>We just received our paperwork for renewal in September, and it was totally changed, now stating that H or W are not counted as eligible employees. We do have a full time employee who waived since he is covered by spouse’s insurance and a few part timers. So we have 1 eligible employee and me. I called BCBS and she said we may be able to keep the coverage so I sent the paperwork in. Now it’s a waiting game until underwriting decides. </p>
<p>I really have no idea how this will pan out. It’s May, our renewal date is December. That’s a lifetime in terms of changes, political maneuvering (there is an election), CA regulation changes etc. What we are doing between now and then is a complete re-evaluation of our business structure; evaluation of which states are most beneficial for holding assets, evaluating potential partnership, evaluating the pros and cons of employees etc. At worst we will have to go into the individual market with Healthnet and pay a huge premium for the benefit of having a larger network and a huge deductible. We’d wait a year and see how that works. If we find it is awful, we should have all of the info and possible action paths in place to bring us back to group in 2016. But…that is two lifetimes away in this current environment.</p>
<p>Dietz, your mileage may vary, but if I had a choice between group insurance and more employees or the individual market I would take the individual market (which I have.) And we’re still eligible for group 
it’s just that employees are expensive overall and depending on turnover or other variables such as spousal coverage elsewhere, etc. it’s not a reliable strategy for maintaining compliance. (Eg if you were to bring on one employee to qualify and the best person for the job had spousal coverage from another employer, then what was the point?)</p>
<p>First off, our group insurance was actually more expensive than the individual market. Our deductibles did go up from 1,000 to 1,400 per person. The other difference is that pharma is now blended into the deductible, so there’s no copay (but there is negotiated discount rate) until you’ve met your deductible. Copay went up on hospital visits from 100 to 250. Both policies are PPO with allegedly the same network…so far that’s born out. No guarantee of course that it will all be smooth sailing.</p>
<p>So from an economic standpoint, paying 70% of a family policy just to have our own group policy would not have made sense. But throwing spouse OFF the policy would not have been kind, as she’d have been ineligble for subsidy since coverage available.</p>
<p>In our case, we didn’t really save money by going individual because tat wasn’t our intent (we gave employee cash value o former coverage via a raise). But it simplified our options and gave us more control over future costs and type of plan election going forward.</p>
<p>So to my mind, if your company would benefit from calculated growth via employees, groovy, the group policy may be a side benefit. Just not a driving economic reason to do so :)</p>
<p>The LAT wasn’t the first but if they’re reporting this, it must be true.
<a href=“Critics call Obama funding plan for health insurer losses a 'bailout'”>Critics call Obama funding plan for health insurer losses a 'bailout';
<p>Looks like nothing so much as tax-payer backed indemnification for those insurers keeping rate increases pleasantly low. Sweet.</p>
<p>That option-which-must-not-be-named is looking better and better. No profits to be protected, for one thing.</p>
<p>LasMa:
The way group insurance calculates who counts as an employee is not straight forward mathematics. If the employee has credible group coverage through a spouse then they can opt out of the plan your company offers. BUT, they still count as an employee towards the group requirement. Different carriers have different % participation levels.</p>
<p>
…like the VA model?</p>
<p>Ouch! Yes, the VA scandal is a big problem for those with the unmentionable goal. As it should be.</p>
<p>I don’t know that ‘profits’ are the word to describe what’s being assured. </p>
<p>It’s more likely losses that are in need of being covered. All for a good cause, though, like that non-existent back-end.</p>
<p>“like the VA model?”</p>
<p>More likely the Medicare for all model is what La Mas is referring to. </p>
<p>Yes, eb. It would also solve the problem of narrow networks which is causing so much sturm und drang.</p>
<p>actingmt, what’s going on at the VA is in no way related to the unmentionable option. Two entirely different things. </p>
<p>ETA-- As for profits, the insurers are doing very nicely indeed under Obamacare. </p>
<p>2015 filings are trickling in or due in roughly the next month. BCBS in my state has filed. I’m curious what posters would consider an acceptable increase. That may be a trick question because you’d need some sense of what they have been, say, over the past ten years. Or at least what they were for 2013 and 2014. Ie, what you dealt with, not your dreams.
This is interesting: “Individuals receiving federal premium tax credits are unlikely to see a material increase in the amount they pay for premiums because the federal government holds an individual’s contribution toward premium constant as a percent of federal poverty level, even as premium increases.” </p>
<p>
</p>
<p>Actually not. Under the risk corridors program, however it is funded, insurance companies who lost money still lose money. They just don’t lose as much money. The risk corridors limit risk, but they don’t eliminate it. </p>
<p>This is a fascinating problem if you look at it in game-theoretic terms, and you look at the motivations of the players. </p>
<p>Consider the insurers. Any insurer who thinks they will lose money offering a certain premium next year won’t offer it, no matter what HHS does. Insurers are not in the business of losing money. No amount of risk corridors will change that fact. They might offer a premium that has a smallish risk of losing money, but they will never offer a premium that they think is likely to lose money.</p>
<p>But insurers will always want to decrease their risk, so they will always, under any circumstance, be in favor of more money being in the risk corridors, just in case.</p>
<p>So the Administration can’t be adding backup just-in-case money to the risk corridors to persuade insurers to enter a money-losing market, stay in a money-losing market or set a money-losing price. That could never work.</p>
<p>Rather, the Administration has to be reassuring skittish insurers who think they’ll make money but don’t want to take a risk of losing it. I’m not saying the risk corridors change is a good policy or a bad policy, but it’s not a mere payoff to insurers-- that can’t be the explanation, because it wouldn’t work.</p>
<p>
</p>
<p>And a big increase in the Silver premium would mean a big INCREASE in the person’s subsidy. That increased subsidy could be applied to their Bronze or Gold premium, if they chose Bronze or Gold instead of Silver.</p>
<p>LF, our increases since the early 90s averaged in the mid to high teens. Anything in single digits is a welcome relief at my house. </p>
<p>Interesting article about some of the despicable things which Florida is doing to its uninsured, while blaming its own bad acts on that evil Obamacare:</p>
<p>[“Health Insurance” That is Too Good to be True]( <a href=“'Health insurance' that is too good to be true | healthinsurance.org”>http://www.healthinsurance.org/blog/2014/05/08/health-insurance-that-is-too-good-to-be-true/</a>)</p>
<p>I still see ads on TV for “health insurance,” stuff which is just more of this junk. The ads even refer to ACA, implying that the junk is part of the law, which is contemptible on a whole other level. But at least it doesn’t carry the imprimatur of the state of California. Of course, California hasn’t fought ACA hammer and tong the way Florida has. </p>
<p>
Fascinating if you’re not one of the numbnutts on the hook for the tab they run up.</p>
<p>Insurers most definitely aren’t in the business to lose money, Fang… not that anyone claimed they were. No, if they plan on losing any money, they anticipate making it back in spades down the road. That they’ve parlayed their special status with the ACA architects into a deal where the above ‘numb-nuts’ cover major losses frees them up to just take just a little trim, something off the sides, until the customer base is assured. </p>
<p>
It’s a lot closer to it than Medicare is and not much different at all.</p>
<p>The VA is health * care *. Medicare is health * insurance *. Detractors have tried to conflate the two, but they are not the same thing.</p>
<p>catahoula, you haven’t given me a reason to think there is likely to be any tab. An insurer paid by the risk corridors is an insurer who has ended up losing money and not being made whole by the risk corridors. The risk corridors pay a percentage of the loss, not all of it.</p>
<p>Do you want to be the person who tells your boss, “Hey, with the risk corridors we only lost 100 million dollars, not half a billion dollars?” </p>