<p>Dietz, CF is too far gone to change her views about Obamacare. It would take the death of someone close to her because of Obamacare before she would admit this law is terribly flawed. Even then she would probably find some imagined scapegoat to explain it. </p>
<p>She is doing the right thing to take the Cobra plan. You are right, of course, that Cobra has been generally much more expensive than plans on the individual market. Even though I agree with you about the hypocrisy of going on Cobra, she is making the correct decision for her family. </p>
<p>I would love to see a law that required every politician and public employee in Ca and all the board members of Covered Ca to enroll in an Obamacare plan in the individual market. Can you imagine the gnashing of teeth and the howling you would hear all over the state?</p>
<p>COBRA costs the same as what the employer was paying for your insurance (plus a tiny administration fee). GP, perhaps you and dietz would be good enough to explain how employers were paying more for my insurance than I could buy it for individually, if I was approaching 60 years of age? How could that ever be true? How could that ever make sense?</p>
<p>People our age get a bargain with COBRA. That is true now, and it has always been true. Younger people get hosed with COBRA, because the premiums are not age-adjusted, but the premiums not being age-adjusted helps us old folks.</p>
<p>Right now, under the ACA, a young person would be crazy to accept COBRA. Private insurance would be way cheaper. That’s why Fang Jr. is going on the exchange: the premiums that look good for me and Mr. Fang look awful for Fang Jr. </p>
<p>But I’m not 25 and neither is Mr. Fang, so we are going to take the bargain rates we get from COBRA.</p>
<p>The reason why Cobra is more expensive than most plans in the individual market is because most employer plans have far more generous benefits than individual plans, such as little or no deductibles and very low out-of-pocket maximums. Because the employer pays for most of the premium, the employee doesn’t see how much the policy really costs. With Cobra you will shoulder the entire premium.</p>
<p>This was true when many individual plans had caps, exclusions, and would not cover pre-existing conditions or in some cases even accept preexisting conditions.</p>
<p>However, this should generally not be as true NOW if the playing field of coverage is equalizing … Low deductibles and other group features excepted ;)</p>
<p>Well, Cobra would have cost us about twice what we what we paid with a family plan direct from the insurer. Sure, now we had a deductible. When I ran the numbers, worst case, the lower monthly premiums still made sense. For 2014, even meeting my deductible, the direct buy would still be less than Cobra would have been. </p>
<p>Please remember you have a California situation that may be hosing access to care. </p>
<p>Is the limited access to care a reflection of across the board problems with networks being too restrictive? Or are the problems limited to a few states? Most of the people on this thread seem to be from California I am not in California, and I don’t hear anyone complaining about access here. The two large physician groups, multi specialty, and the hospitals seem to take all the major insurance. Is California in the minority, or is my state?</p>
<p>Enable selling across state lines. Let the insurance commissioners compete among themselves about doing ‘their job’. Perhaps, just perhaps, the insurance commissioners in North Dakota or Texas maybe be more responsive to you, cf, than the insurance commissioner in California. But then will never know, will we. :D</p>
<p>I do believe many would like to see ACA collapse, but it is working in my state. Not because some dummy accidentally hit the right buttons, but because they planned and held all the right parties accountable. Perfect? No. I realize some don’t want to hear it can work. </p>
<p>At this point, thinking selling across state lines will be better is hypothetical. Maybe talking out of both sides of your mouth. </p>
<p>There are access problems elsewhere. I’ve read of people in Florida having to drive many miles to go to a physician in network. I read of people in the UP of Michigan having similar troubles. With many Californians on this thread, reading California news sources, it skews towards California problems. </p>
<p>But there were news stories posted here about the top hospitals being ‘narrowed’ out of many plans: Barnes-Jewish in St. Louis, Seattle Children’s, MD Anderson in Houston, Sloan-Kettering, Cleveland Clinic, etc. </p>
<p>Hahahaha, that’s funny. If insurance could be sold across state lines, every insurance company would immediately start selling all of their policies from the state with the least amount of regulation.</p>
<p>We’ll never know whether California or North Dakota or Texas would be more responsive to me, because if I could buy across state lines, I wouldn’t be able to choose a state to buy from. No policies from California would be available. All the policies would be from North Dakota (or some other small state that wanted to court insurers by removing regulations).</p>
<p>It’s not straw man. Workers compensation and auto can’t be sold across state lines. There’s a solid reason for this. If you don’t believe the post where I explained this, fine. But it is the truth nevertheless. </p>
<p>The limited access to care (the narrow networks) is widespread, and narrow networks are going to continue to exist. </p>
<p>It’s simple. Insurers want to limit costs-- of course they do. In the individual market, they used to be able to limit costs by refusing to insure expensive people. Now they can’t do that. </p>
<p>So instead they are trying to cut costs by squeezing providers. They are saying they won’t include a provider in their network if the provider charges too much. And they should do that! Expensive providers increase premium costs for everyone.</p>
<p>The serious issue in my mind is not narrow networks. Narrow networks per se are not a problem: Kaiser has had narrow networks for decades, yet Kaiser has enough providers for its subscribers. The issue is networks that are not adequate to handle the subscriber base, either because there are not enough doctors/hospitals in a specialty to handle all the patients for that specialty, or because the doctors/hospitals are in the wrong place.</p>
<p>Emily, you mentioned the unmentionable and the vet scandal makes the unmentionable unthinkable. Your take on the politics was just weird. imho. But, interesting. </p>
<p>Bluebayou, you accuse me of creating a straw man. A straw man argument is a caricature of the opponent’s argument, that is easy to defeat because it is not actually what the opponent is claiming.</p>
<p>So let’s be clear here. You say that if insurance were sold across state lines, insurance companies would continue to sell insurance under the regulations of all fifty states, or at least most of them, correct? That is, you say that insurance companies would continue to sell insurance from California under California’s regulations, and also sell insurance from North Dakota under North Dakota’s regulations, and from Texas under Texas’s regulations. You say that I would have the choice as a California to buy a North Dakota policy, or a Texas policy, or a Delaware or New Jersey or Montana policy, correct? I’m not trying to build a straw man here; I’m trying to accurately restate what I think your claim is.</p>
<p>Hayden: In my worldview, selling across state lines does not necessarily eliminate the local state regulatory oversight. (I have been with a Texas-domiciled auto/homeowners insurance company for years. They just seek approval to offer a policy in California, and have to demonstrate financial strength for approval.) Ditto my company’s workers comp and life carriers – neither is domiciled in California but they are both AAA rated by Best, and have approval to offer insurance to Calif employers. </p>
<p>A state regulator could easily require that OOS carriers be at least aaa rated, for example.</p>
<p>What I would envision would be for say, Blue Cross Oregon to be able to offer its plan to California residents, which may be of particular interest to those Californians that live near/at the OR border. Of course, there are dozens of other examples where a cross border town is really a suburb of a city in another state: think Vancouver, WA to Portland, or the Philly burbs in NJ…</p>
<p>And if the plan becomes unworkable, they could switch back during Open Enrollment.</p>
<p>Bluebayou, so you are saying that if I bought a Texas insurance policy, it would nevertheless have to satisfy California’s regulations? So the insurance company would have to be solvent, and the policy would have to offer acupuncture, and so forth?</p>
<p>This little tweaklet makes sense to me. It would be of very little utility to Californians in general, because the California border is thinly populated all around, but it could be useful to the people who live in the little Eastern states.</p>
<p>But this proposal does not seem to be what most people who talk about selling across state lines mean. GP, for example, has talked about cross-state sales as a method to improve the situation of Californians like me and himself. We would have no use for a policy with doctors only in Nevada, Arizona or Oregon, because we are far from those states. GP has to have some other proposal in mind.</p>
<p>“Emily, you mentioned the unmentionable and the vet scandal makes the unmentionable unthinkable. Your take on the politics was just weird. imho. But, interesting.”</p>
<p>The VA is a health delivery system. Medicare is health insurance. The two are vastly different. </p>
<p>You don’t have to believe me re the politics, but I wouldn’t hold my breath if I were you waiting for repeals or tweeks on the federal level - no matter how much you whine. </p>
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