<p>It is the situation every where else in the world</p>
<p>Actually, it’s not. It’s subsidized insurance. Who does that? Just curious.</p>
<p>Not supposed to post anything too bloggy, not supposed to mock each other, not supposed to predict the future or describe what we prefer. So we end up with GP doing that. Then suggesting we’re trying to censor HIM. ???</p>
<p>So anyway, let me just share one person’s story of the life-changing effects of ACA. I don’t know where my D would fit into that flood of statistics, but we are eternally grateful that she is able to have good insurance she can afford. Her case also illustrates the wisdom of de-linking insurance from employment.</p>
<p>At the beginning of the year, my D had just graduated and was living in Indiana. She was low income (rural Indiana has a very depressed employment market; she had a part-time job with no benefits, and was lucky to get it), so she signed up for insurance on the federal exchange. Indiana is one of the states that didn’t expand Medicaid**, so she was able to get an Anthem plan with subsidy through the marketplace. Before ACA, there’s no way in the world she would have been able to get affordable insurance, and very possibly she could not have gotten insurance at all due to a preexisting condition. Under ACA, she has had full coverage since Jan 1, at a premium she could afford even on her then-tiny paycheck.</p>
<p>Part II --She just moved from Indiana to Washington State, and since the employment market there is considerably better than Indiana’s, she quickly got two job offers. Job 1 is in an industry she believes in, but did not offer health benefits. Job 2 offered benefits, but she just wasn’t excited about the job or industry. This is the conundrum that millions of people faced before ACA, and for most, the choice was clear: Take the job which offered benefits. Under ACA, my D was free to take the job she really wanted, knowing that she could get affordable insurance through the Washington exchange. </p>
<p>**Indiana’s governor has seen the light about excluding 350,000 of his residents from healthcare, and [is</a> trying very hard to find a way to expand Medicaid without calling it ACA](<a href=“http://www.washingtonpost.com/blogs/wonkblog/wp/2014/05/15/another-conservative-governor-finds-a-way-to-expand-medicaid/]is”>http://www.washingtonpost.com/blogs/wonkblog/wp/2014/05/15/another-conservative-governor-finds-a-way-to-expand-medicaid/).</p>
<p>This thread is just weird. The two most recently posted examples of ACA success are an older woman managing to get a physical without much hassle and a low income young person getting a subsidy. Both completely ignore the posters with real problems caused entirely by the law. Just sayin’.</p>
<p>Not just getting a subsidy, actingmt. Getting insurance at all. My D was uninsurable prior to ACA. Maybe it means nothing to you that she can now get coverage, but it means a lot to us, and to lots of others who were in the same boat.</p>
<p>As we have said repeatedly, we understand that there are problems with ACA. But detractors should understand that before ACA, there were millions of people who also had “real problems.” Like not being able to see any doctor at all outside of an ER. Like bankruptcy due to medical bills. Little stuff like that. Just sayin.’</p>
<p>Detractors get that there were problems before Lasma. All detractors on this thread get that and some have experienced a variety of those problems themselves. None of them make this a sensible solution. But, whatever.</p>
<p>I wholeheartedly agree that there are many, many changes that need to be made. I’m not clear on whether we’re allowed to discuss them or not.</p>
<p>More insurance companies are signing up to offer exchange plans in 2015. From Wonkblog at the Washington Post:</p>
<p>"State health insurance marketplaces that offered consumers very few health plan choices in 2014 are starting to add more insurers — slowly, in most cases. But this is a sign that insurers are feeling confident about the second year of the Affordable Care Act’s coverage expansion.</p>
<p>"The development is important for a few reasons. For one, recent research suggests that more competition in the exchanges could help temper premium increases. Other new analysis shows that exchange plans, on average, are cheaper than individual plans offered outside the insurance marketplaces. And given the narrow networks in exchange plans, more insurers could mean better access to providers. "</p>
<p>The article specifically mentions New Hampshire, which I posted about a while back, plus West Virginia, Maine, and Washington State.</p>
<p>“Other new analysis shows that exchange plans, on average, are cheaper than individual plans offered outside the insurance marketplaces.”</p>
<p>Not in California.</p>
<p>Premiums were going up every year before ACA, so a continual upward trend of premiums does not represent a failure of ACA. The failure would be if post-ACA, the rate climb is considerably accelerated.</p>
<p>If the rate climb continues but stays about the same as before, then that would mean ACA has fallen short of its goals, but the tradeoff is many more people who are insured and insurable- so still a success as far as the goal of making insurance available to almost everybody. (The “almost” because people still have the right to opt out, and some people are still left out either because of the failure of some states to expand Medicaid,or various policy decisions impacting immigrants.)</p>
<p>In other words – rising costs + insurance for everybody isn’t the desired outcome, but it’s still an improvement over rising costs + no insurance for large swaths of the population.</p>
<p>If cost containment is one goal of ACA, I don’t see how that happens in year 1 of the program anyway. Year 1 is when all the people with treatable chronic conditions who have been without insurance for years rush in to finally get that surgery that’s been put off for the past 4 years, or to finally start to get regular care for their asthma or diabetes or whatever condition they have been trying to manage from one crisis to the next. So it seems to me that there’s a huge year 1 bump. </p>
<p>I’d expect any cost-savings that result from the preventive care benefits of ACA to take a few years to have any real impact. The benefits of preventive care are generally long-term, rather than short term. </p>
<p>Cost savings in health care are not going to come from treating chronic conditions. We should treat chronic conditions, because making people healthy is a clear way to improve social welfare, but we should not hope for cost savings there.</p>
<p>Rather, savings will come from better delivery of care: hospitals that don’t discharge people too early, or with inadequate support, so they’re back in the hospital ten days later; groups of doctors that coordinate care, so patients and doctors don’t waste time with duplicative tests or diagnoses that fall through the cracks; appropriate care providers, so that a more moderately priced nurse practitioner, rather than an expensively trained pediatrician, checks out well babies and sees kids with sore throats; science-based treatments, so people don’t have expensive and useless surgeries. </p>
<p>
That’s why I can already clearly see the benefit of my being shifted into the large group practice because of a “narrow” network rather than continue to see the more conveniently located small town doc. My new doc told me something about previous diagnostic testing results that my old doc never mentioned – why? because new doc was looking at computer records that were already in the system but apparently not readily available to the old doc. So “narrow” networks may be one way of of achieving better coordination of care overall. I don’t know if that is intentional on the part of the insurance company or not, but that might be part of their pricing and contract negotiation strategy. That is, maybe they are wiling to negotiate very favorable rates with the large,coordinated hospital-connected group practice that they won’t give to off-the-grid doctors precisely because down the line that will build more efficiency into the system.</p>
<p>From a recent Forbes article, detailing the cost and responsibility for chronic conditions.</p>
<p>The U.S. has one of the highest obesity rates for developed countries; about one-third of the population qualifies for this label. It is well known that obesity is a contributing factor to as many as one-half million deaths in the U.S. annually. Experts seem to agree that more than 75 percent of healthcare costs are due to chronic conditions and illnesses such as heart disease, high blood pressure, diabetes, arthritis, cancer and strokes. While chronic diseases are the most common and costly of all health problems, they are also the most preventable. Four common health-damaging, but modifiable behaviors – tobacco use, insufficient physical activity, poor eating habits and excessive alcohol use – are responsible for most of the illness, disability, premature death and healthcare costs.</p>
<p>Our point is that incentives, funds and programs should be directed at helping our population address the chronic disease epidemic through both individual responsibility and societal help and support to give individuals the ability to make healthy lifestyle decisions. Unfortunately, the recently passed ACA puts all of the responsibility on the providers of care, without a single mention of individual responsibility.</p>
<p>“So “narrow” networks may be one way of of achieving better coordination of care overall.”</p>
<p>LOL. This is fantasy thinking at best.</p>
<p>
</p>
<p>You think the law should fine people or put them in jail if they don’t stick to their diet?</p>
<p>It’s a LAW. You cannot legislate “individual responsibility” for lifestyle choices – although the law can and did legislate “individual responsibility” for buying health insurance. </p>
<p>
Yeah, they were, but Obamacare was sold as bending the cost curve down. Though, like a lot of the funding mechanisms, that little metric’s also likely been tossed off onto the shoulder of the road.</p>
<p>Given that the cost-savings of narrowed access is likely to be so unpopular, it’ll be interesting to watch how they sell it as being a good thing. </p>
<p>The bending of the cost curve is, and must be, a longer term thing. Also, the cost curve is the total cost, not insurance costs. A lot of the cost control mechanisms are for Medicare, not care for under 65s. Slowing the Medicare cost rate would be a good thing even if insurance rates continued to rise as they have been doing.</p>
<p>Much like the “$2500 less in premiums for the typical family” claim, I don’t recall it being explained so gravely at the time, CF.</p>
<p>Expectation lowering’s endemic when it comes to the ACA, and while dietz posted something about this a while back it didn’t get the discussion it deserved:</p>
<p>
<a href=“CBO Quietly Drops Forecast That Obamacare Will Cut the Deficit | The Fiscal Times”>http://www.thefiscaltimes.com/Articles/2014/06/05/CBO-Quietly-Drops-Forecast-Obamacare-Will-Cut-Deficit</a></p>
<p>Really interesting article, with a nugget directly bearing on our reading of the premium tea leaves:
With this sort of subsidization, what on earth would a non-accelerated premium rise actually mean about the wisdom of the ACA?</p>