<p>You think the law should fine people or put them in jail if they don’t stick to their diet?</p>
<p>The article said ‘incentives’. There should be incentives to lower the cost of these chronic conditions which are a prime mover of health care costs. All the onus on keeping patients healthy and keeping costs down should not be only on the shoulders of the health care providers. They can do nothing if the patient simply refuses to follow the doctor’s orders. </p>
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<p>The article doesn’t tell us what this little noticed rule change is, though.</p>
<p>Well, it does. But here are the details.</p>
<p><a href=“http://news.investors.com/politics-obamacare/053014-702827-new-hhs-regulation-raises-obamacare-cost-by-7-billion.htm”>Error - Investors.com;
<p>TatinG --can you give me an example of what such an incentive might be? A tax rebate for someone who loses weight? I just think that what you suggest sounds like a good idea as sound byte, but I have a hard time figuring out how it could be implemented. </p>
<p>TatinG, here is the full set of regulations: <a href=“Federal Register :: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond”>https://www.federalregister.gov/articles/2014/05/27/2014-11657/patient-protection-and-affordable-care-act-exchange-and-insurance-market-standards-for-2015-and</a></p>
<p>Could you point me to the one that “slows the growth of premiums on subsidized exchange plans”? What confuses me is that for 2014 (and, I thought, for future years as well) the premiums paid by people who get subsidies depend on the person’s income, the poverty level, the cost of the second highest Silver plan in their market, the particular plan the person picks, and nothing else.</p>
<p>The article says, “The regulation involves the method for determining the annual growth in average premiums for private insurance, a key variable influencing how the size of ObamaCare subsidies changes from year to year.” But where is that “key variable” used in the computation of the premium paid by the subsidized subscriber?</p>
<p>Investor’s Business Daily: <a href=“http://news.investors.com/politics-obamacare/053014-702827-new-hhs-regulation-raises-obamacare-cost-by-7-billion.htm#ixzz347NHs8nF”>http://news.investors.com/politics-obamacare/053014-702827-new-hhs-regulation-raises-obamacare-cost-by-7-billion.htm#ixzz347NHs8nF</a> </p>
<p>The first case of Obamacare ID theft.</p>
<p><a href=“http://www.cnbc.com/id/101739222”>http://www.cnbc.com/id/101739222</a></p>
<p>AmericanHopee, are Germans on the honor system? And who pays the bonus? Somehow I don’t think that the idea of taxpayers funding my gym membership would really fly in the US.</p>
<p>Blogs - The standard is that they are allowed when they are considered part of reputable news sources (we don’t treat liberal vs conservative outlets differently since any posted link will be debated for their content). </p>
<p>If the blog is from a website created solely to support or oppose ACA, it won’t be accepted.</p>
<p>CC cares about your health! I could see several people’s blood boiling from their various posts which is why it is better to put a hold on a discussion going nowhere for a day or two.</p>
<p>My BCBS offered this up through 12/31. I think it would be more feasible if attested to by a doc (eg, BP lowered x points, weight lost and kept off, etc,) or completion of some other program.</p>
<p><a href=“ERs seeing increase in patients under Obamacare”>http://www.courier-journal.com/story/news/2014/06/07/patients-flocking-emergency-rooms-obamacare/10181349/</a></p>
<p>ACA is NOT lowering the number of visits to the ER, but raising them. </p>
<p>And apparently some people think ER visits are free. Per an article on KevinMD (not linked due to rules prohibiting linking to blogs).</p>
<p>I’m still trying to track down the regulation that TatinG, relying on an Investor’s Business Daily report, said " slows the growth of premiums on subsidized exchange plans," thus costing the US government $7 billion over ten years. I asked TatinG for specifics on this claim, and got a link to an article which has the claim. The article gives, as its source, a link to the 115 page Federal Register guidelines issued May 27. That’s not exactly a specific cite.</p>
<p>I think I now understand what the relevant regulation is. It has nothing to do with slowing the growth of premiums on subsidized exchange plans. It has nothing to do with subsidies or the exchange at all.</p>
<p>Rather, it is a regulation about how the government will calculate the required contribution percentage. The required contribution percentage (RCP) is the percentage of income a person is required to pay to get insurance. If the cost of available insurance is higher than the required contribution percentage, then the person is exempt from the individual mandate and doesn’t have to pay a tax penalty if they don’t have insurance. </p>
<p>So for example, this year the RCP is 8%. If the cheapest insurance a person could buy would cost more than 8% of their income, then they don’t have to buy insurance and they don’t have to pay a tax penalty.</p>
<p>Health care costs are going up faster than inflation, so to allow for this, the RCP will go up every year. The HHS regulation spells out exactly how the RCP goes up each year. </p>
<p>The RCP is designed as a measure of insurance affordability. A higher RCP means more people will be deemed to be able to afford insurance. So with a higher RCP, more people who don’t buy insurance will face tax penalties and the government will make more revenue.</p>
<p>The new regulation computes the RCP in a different way than the Congressional Budget Office predicted, and in a way that tends to produce a lower RCP. This means that fewer people will be liable for tax penalties, and the government will take in less revenue, an average of $700 million a year less, says the Investors Business Daily. Notice that although $700 million would be a lot of money for a person, for the federal government, it’s pocket change. A change to health care subsidies would cost or save orders of magnitude more money than that.</p>
<p>Here’s the Federal Register that contains the new regulation (and a whole lot more):
<a href=“Federal Register :: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond”>https://www.federalregister.gov/articles/2014/05/27/2014-11657/patient-protection-and-affordable-care-act-exchange-and-insurance-market-standards-for-2015-and</a></p>
<p>Here is the relevant paragraph in the Federal Register:
<a href=“Federal Register :: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond”>Federal Register :: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond;
<p>This is TatinG’s Investors Business Daily link that inaccurately characterizes the change:
<a href=“http://news.investors.com/politics-obamacare/053014-702827-new-hhs-regulation-raises-obamacare-cost-by-7-billion.htm”>Error - Investors.com;
<p>Here’s a short explanation of what is happening (scroll down to Required Contribution Percentage):
<a href=“http://dmec.org/2014/05/30/exchange-and-insurance-market-standards-for-2015-and-beyond/”>http://dmec.org/2014/05/30/exchange-and-insurance-market-standards-for-2015-and-beyond/</a> </p>
<p>We shouldn’t be concerned about the raw number of emergency room visits increasing. People should go to the emergency room if they need emergency care. Emergency rooms are necessary and we should have them. If someone is insured, and now they can go to the emergency room if they have chest pains, they should go. It’s a good thing when people with health emergencies can get care and know they aren’t going to be facing immense bills they can’t pay.</p>
<p>Rather, we should be concerned about unnecessary visits to the emergency room. Are they increasing, decreasing or staying the same? Is there a difference between expansion states and non-expansion states?</p>
<p>“ACA is NOT lowering the number of visits to the ER, but raising them.”</p>
<p>To be expected as the previously uninsured don’t yet have a PCP and are use to going to the ER. </p>
<p>Also, see the problem with rural areas not having enough PCP. </p>
<p>At least the hospitals are getting paid for these services instead of not getting paid and those of us with heath insurance having to pick up the cost, allowing the hospitals to keep thier doors open. Hospitals in non expansion states, especially rural hospitals, are having to close because there is no one who can pay their bills. </p>
<p>The ACA was supposed to save money by getting people PCPs and keep them from using the expensive ERs. </p>
<p>CF, unless there is some epidemic one would expect the actual emergencies in the ER to be unaffected. People are still using the ER because they don’t want to make an actual appointment, and some believe that ERs are free. </p>
<p>If you look into the ER doc comments about ER visits rising they say it is a) a normal trend, not surprising, and b) they are saying the level of care needed is more appropriate to ER. They noticed.
Not going to link anything-- I looked at it last week or so when someone first mentioned it. </p>
<p>Oh, but the media digest said…<br>
Yeah.</p>
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<p>One would not expect any such thing. If a person went to the emergency room pre-ACA, they would be billed. And if they didn’t pay, they would be hounded by debt collectors. In that situation, some people without insurance failed to go to the emergency room when they should have. </p>
<p>If you wake up in the middle of the night with chest pains, and you know that if the chest pains turn out not to be anything, you’ll be stuck with a huge bill, you will be tempted to hope everything is OK and not do anything. Some people who make that decision will be fine. Others will wake up dead.</p>
<p>If your kid is gasping for breath with an asthma attack, and you can’t afford the emergency room, you’ll stay home and hope he gets better. He might get better. Or he might die.</p>
<p>It is naive in the extreme to assume that cost is not a factor in people’s deciding to go to the emergency room for cases we all would agree are genuine emergencies, like chest pains and serious asthma. </p>
<p>The article says that many of the ER visits are not emergencies, but are things that should be cared for in an urgent care facility, not the ER. </p>
<p>The vast majority of ER usage is non-payers using it as a clinic. It always has been. Now, it’s worse.</p>
<p><a href=“http://www.wwltv.com/news/health/Patients-flocking-to-emergency-rooms-under-Obamacare-262288521.html”>http://www.wwltv.com/news/health/Patients-flocking-to-emergency-rooms-under-Obamacare-262288521.html</a></p>
<p>Tatin, I looked further than that article.</p>
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<p>The article also says that those urgent care clinics don’t exist or don’t have appropriate hours for the Medicaid subscribers who, the article says, are making up the increase in ER visits.</p>