Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
14541

<p>“the apologetic groups circling the wagons” is a bit dismissive, what’s the point?<br>
Of course much has slant or the potential for it. So we should recognize that and not pretend any one report we find is authoritative. Or representative. We should try to find both what the authors based their conclusions on and how they analyzed. It doesn’t do me much good to be referred to another report by the same guy, as if that bolsters his validity. Note they continue to use “suggests,” “may,” and “likely.” Etc.</p>

<p>Plus note the recent link was presented in July, 2013.</p>

<p>If you cannot “vet,” actingmgt, then you cannot use some article or study as some proof. It doesn’t make sense. At best, it’s just one take, </p>

<p>How many of you know what insurers in your state have asked for, in their rate hike filings?</p>

14542

<p>LF: I consider myself to have fallen into non-productive apologetic behavior on this thread. It was not meant to be dismissive. </p>

<p>Take a look at the second link. It’s the entire presentation given by the author and co-author. You’ll find links to their data sources. </p>

14543

<p>But it’s 2013. It’s like so much we looked at, early in this thread and its older sister, that had no grounding yet. </p>

<p>For citation, you mean this? Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2011; KPMG Survey of Employer-Sponsored Health Benefits, 1993, 1996; The Health Insurance Association of America (HIAA), 1988.
Help me, if there is something more.</p>

14544

<p>LF: Here is the updated May 2014 analysis…<a href=“http://www.washingtonpost.com/blogs/wonkblog/files/2014/05/ParenteAnalysis.pdf”>http://www.washingtonpost.com/blogs/wonkblog/files/2014/05/ParenteAnalysis.pdf&lt;/a&gt;&lt;/p&gt;

<p>Data sources:
<a href=“http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/March-2014-Enrollment-Report.pdf”>http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/March-2014-Enrollment-Report.pdf&lt;/a&gt;&lt;/p&gt;

<p><a href=“Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period | ASPE”>http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf&lt;/a&gt;&lt;/p&gt;

<p>IMO an important point is the report uses the data and micro simulation model from HHS in order to draw conclusions.</p>

14545

<p>I read the report…</p>

<p>I don’t get the angst.</p>

<p>It is annoying that heathcare cost premiums will continue to exceed increases on wages and income. This was going to happen with or without ACA. Hopefully it will happen less with ACA.</p>

<p>Looks like we are going to get more competition from insurance companies in many states. </p>

<p>From the paper…</p>

<p>Looks like the percentage increases of premiums are a little lower during the period 2015-2019 than the 2008-2013 period based on the researchers own past past numbers (more than 5 percent increases between 2008-2013) and the projections he is using for 2015-2019 ($1375 increase).</p>

<p>Also, when premium increases are compounded, of course the latter years can show larger dollar increases despite premium increases growing at a slightly lower rate.</p>

<p>Just compound $100 at 5 percent for 10 years. The latter 5 years are going to show larger dollar increases.
There were 7 years of compounding between 2008 and 2015. That is a lot of compounding.</p>

<p>The first highlight mentioning that dollar increases are higher in the far out years is misleading.</p>

<p>If the percentage increases are accurate from 2015 thru 2019, I may be pretty happy. They might be lower than my projections. I included increases for age. I am not sure hhs is doing that. Probably not. </p>

<p>I don’t know where the silver premium for 2015 comes from… Looks high. The higher the premiums used to make projections, the higher the dollar increases going forward.</p>

<p>The most popular silver plans were expected to be the second cheapest silver plans where the average cost of. 48 states is $328 before any subsidies. </p>

<p>I haven’t seen anything that says the second cheapest plan wasn’t the most popular. </p>

<p>Were there more popular silver plans?</p>

14546

<p>Annual increases of $23/mo for individual, $70 for family? (Straight math, not reflecting compounding- did I do it right?.) And of course depends on age. Exchange adds income considerations. My rates may go up because, while D1 will likely have employer coverage, D2 currently does not (and is earning.)<br>
Talking about possibilities-- need to look at the first increase (2015) as some indicator of how all this leaves the gate. Who is even looking at their real 2015 increases? Mine are still subject to public hearings and everyone believes the requests will be chopped. Plus, at least initially, the subsidies are supposed to keep costs in line. </p>

<p>It’s one thing to get analytical, from some stance. Especially when one’s also earning as a consultant, who wants to suggest authority. It’s different to actually track “what is.”</p>

14547

<p>LF, I did not look at the monthly breakdown of dollar averages.</p>

<p>I just find it interesting that projected percentage premium increases going forward are slightly lower than the period 2008-2013.</p>

<p>There also wasn’t this big spike in premium increase projections in 2017 like the researcher said.</p>

<p>We are going to see what the 2015 premiums are. They aren’t going to be a secret. :)</p>

<p>Right now some insurance companies are trying to raise premiums at double digit rates in some states or some regions in some states while other insurance companies are cutting premiums. </p>

<p>I don’t really see the big deal yet. Maybe I am missing something.</p>

<p>It is true that by definition if insurance premiums rise faster than income the premiums become less affordable.</p>

<p>What else is new?</p>

<p>We are already into June 2014. Sign ups for 2015 start in Nov 2014 for 2015.</p>

<p>I went outside today and looked up at the sky and nothing fell on me. </p>

14548

<p>The sky actually has fallen on some people, though. Sadly. Most of them have stopped posting on this thread because it gets annoying to be continuously told to suck it up for the greater good. </p>

14549

<p>Every time some naysayer quotes being told to suck it up for the greater good, I ask myself, who said that? I think the actual comments were less coarse, more a broad explanation- and then latched onto as heartless, magnified and re-purposed to make some different point. </p>

14550

<p>Hi dstark. :-)</p>

14551

<p>dstark: welcome back. Serious question…and I don’t have a solution…just a question…</p>

<p>Many of the new enrolled individuals are entering the Medicaid/Medical system. The report projects an ongoing growth of 2%-3% enrollment in this system. I previously posted a link to Medicaid reimbursement rates. I’ve personally tracked a number of my own EOB’s checking the actual $$ amount the provider received and what the corresponding Medicaid/Medical reimbursement would have been. My county is classified as rural for Medical reimbursement rates, so they are very low. I know other counties have higher rates. That said, the amount a provider receives from a Medicaid/Medical patient runs (based on my tracking) from 25% - maybe 75% of what they would receive from a traditionally insured patient.</p>

<p>How do you think this will work? To make their own practices viable, docs can only take on a limited number of Medicaid patients. If reimbursements are raised - where will the $$ come from? One place of course is higher reimbursements from the privately insured - which of course would mean higher premiums. Do you think providers will be forced to accept every patient - regardless of insurance type? It seems that this is a rather glaring problem, both from the financial end and from the patient access to care end.</p>

14552

<p>Dietz199, thanks.</p>

<p>Do I think providers will be forced to take everybody? No. I don’t.</p>

14553

<p>For all of you that sing the praises of the Canadian health care system, you might want to read this latest study from the leading think tank in Canada.</p>

<p>“In 2013, Canadians, on average, faced a four and a half month wait for medically necessary treatment after referral by a general practitioner. This wait time is almost twice as long as it was in 1993 when national wait times were first measured.”</p>

<p><a href=“Waiting Your Turn - Wait Times for Health Care in Canada, 2013 Report | Fraser Institute”>http://www.fraserinstitute.org/research-news/research/publications/Waiting-Your-Turn---Wait-Times-for-Health-Care-in-Canada,-2013-Report/&lt;/a&gt;&lt;/p&gt;

<p>Sounds a little bit like our VA system.</p>

14554

<p>Oh Oh - “Under Obamacare’s “Closed Formularies” Patients With Serious Chronic Diseases like MS Don’t Get Access to Vital Medicines”</p>

<p><a href=“Under Obamacare's "Closed Formularies" Patients With Serious Chronic Diseases like MS Don't Get Access to Vital Medicines”>http://www.forbes.com/sites/scottgottlieb/2014/06/13/obamacare-shortchanges-patients-with-chronic-diseases/&lt;/a&gt;&lt;/p&gt;

14555

<p>The bottom line is that severely restricting provider networks and excluding expensive life saving drugs is the only tool the insurance companies have to control costs since the law (combined with various grandfathered state laws) forces them to cover everything and the kitchen sink (mandated benefits) and every person with preexisting conditions. It is only a matter of time before everyone in the group market is forced into these niggardly plans.</p>

14556

<p>GP, I haven’t lived in Canada for more then a decade, and my family does report longer wait times. But let me give you an example of what they’re talking about, because frankly, I feel like slapping them when they whine about it ;)</p>

<p>My youngest sister is in her 30s and has a repetitive stress injury in her wrist that while painful, isn’t debilitating. It indeed took several months, not weeks, until she was scheduled for her “free” surgery, from which she recovered this month. In the interim, she was treated with medication, physio, etc.</p>

<p>By contrast, my friend who is the sole earner in his family was discovered to have a hole in his heart. He was immediately scheduled for corrective surgery at the province’s leading facility in Toronto – same place they invented the pacemaker. I mean immediately.</p>

<p>My mother’s common law husband had a major stroke in February. Again, he was treated immediately, intensively, and proactively in a specialized facility, and he has recovered partial, if not full use of his right side.</p>

<p>A friend of mine likes to golf and lift weights. She’s had knee trouble. She wanted to know why her knee hurt, and was pissed off that they wouldn’t give her an MRI for 12 weeks because, hey, she wanted to be golfing. Wearing heels was really uncomfortable :wink: I suggested she just pay the money and scoot over to the states for a full pay MRI. I guess her knee didn’t really hurt that much, because she preferred to save her cash for a vacation to Maui instead ;)</p>

<p>With my own facet joint syndrome, my wait time in 2001 to see a Harvard-trained world class osteosurgeon was less than three weeks after referral. In the interim I had immediate access to physio and pain relief.</p>

<p>By contrast, a dear elderly friend of mine had COPD and was in decline. She qualified for a full lung replacement, but had to both wait and prepare for this elaborate life-extending treatment. During her wait, which was almost a year on the transplant list, they put her on a supervised exercise regime to increase her cardio capacity in order to be in better condition for the transplant operation, which was successful. The cost of her Meds to avoid rejection of this lung would have sunk just about anyone financially, but in this case were covered.</p>

<p>Alternately, a routine cat scan (for migranes) of my young son in 2003 turned up a suspicious mass in the fourth vertical of his brain. He had an MRI and a meeting with a surgeon all within the next month.</p>

<p>What these people had in common is that while their wait times and conditions varied a great deal, generally according to medical necessity and quality of life, not one of them paid a dime, not one of them took food out of their families mouth, not one of them had to worry that they were decimating their savings or retirement or college funds in order to receive treatment. Some had been sick before, but did not have to worry that being sick before would exclude them from treatment.</p>

<p>YES, some of them had to wait to see a specialist. </p>

<p>And yet, the myth that they actually pay more in taxes for this on-tap access to healthcare is just that in the middle income range…the federal tax rate differential between countries in the $30-90k range is between 1-2% (though Canadians do have VAT tax on goods and services, much higher gasoline and “sin” taxes, and generally face a higher cost of living.)</p>

<p>So I personally don’t feel particularly sorry for Canadians who have to wait four months for some treatments. I would trade my monthly $979 premium for that in a heartbeat. I would Los be delighted to pay an extra 2% (or more in our case, maybe a whopping 5%) to the Feds in exchange for health delivery costs that are 30% less…a good bargain, to my mind.</p>

<p>But it is naive to compare Canadian wait times to ANYTHING about ACA…because ACA does not come anywhere close to creating the kind universal healthcare experienced in single tier counties.</p>

<p>Sadly, we may get the wait times, but we’ll still get to pay the fat insurance premiums. So really, its night and day!</p>

14557

<p>GP- what do you think the response would be if a Canadian pol stated he was going to attempt to go back to the US health care system prior to ACA for Canada?</p>

<p>By the way I think we should look at Canada as well as every other system and work together to form a universal system that works best for us.</p>

14558

<p>Getting back to dietz’ question: No, I don’t think providers will be forced to take anyone who walks in the door for a very practical reason. One-third of the doctors practicing today are close to retirement age. They graduated medical school at a time when overwhelming student debt was unknown. They are in a position to retire early if they choose, and many would do so if they were forced to spend their time treating patients while losing money. One-third of doctors gone would be untenable. </p>

<p>College graduates, seeing that the medical profession was a money losing proposition, would abandon it as a career goal. So there would be even fewer future doctors.</p>

<p>Further, it would likely be unconstitutional. What other profession is forced to take customers who won’t and never will pay enough to cover costs? Some say, well the state could revoke their medical licenses, But would the state revoke the contractor’s licenses, or plumber’s licenses, or lawyer’s licenses, or insurance agent’s licenses if they refused to take customers who lose them money. </p>

14559

<p>Both Texaspg and I noted our experience with our med schools expanding their classes. Perhaps someone would check that in their areas. There is a projected shortage in some fields- and med students are being encouraged to consider those directions. There’s a piece of Fang’s Razor that applies here. You can’t assume there is a growing problem and no one notices it or tries to take action. </p>

<p>Those older docs won’t retire without the funds to do so. They have been making good money for a long time. No one here has even begun to prove being a doc is a losing proposition, financially- (though we all know of some cases where docs do primarily non-profit work.) I work in part with med students. I don’t see the hand wringing. The docs who come in from their own practices to work with them (as mentors, sometimes as class teachers, but separate from full faculty,) are enthusiastic and encouraging.</p>

<p>And I’ll say it again: we don’t know that docs are “losing money.” We can quote that they want to full-bill at higher rates than reimbursements. But I still think one would have to look at the bottom line in more detail. </p>

14560

<p>Just a post on wait times: my fiance and I had the same PCP until I went on Medicaid. He is on a BCBS plan. He now has our old doctor (which he’s never met… this is his introductory appt) and I have a new one that accepts Medicaid patients. We called on the same day to schedule introductory physicals. I was able to get in within a few days. He couldn’t get in until the end of July. </p>

<p>I don’t know if this makes a difference, but my new doc is very young but was extremely thorough. Much better than my old doc. But he was established and has been in practice for at least two decades. Maybe this is part of the reason that she was able to get me in but he can’t for several weeks. </p>