^I doubt they have. i would guess most large companies still self insure.
“For our discussion, it doesn’t matter. (Though it is interesting to know that NYS doesn’t self-insure. I wonder why. Maybe there’s a thought that it’s a possible corruption point. Or maybe giving the state’s lucrative insurance business to private insurers IS corruption.) Self-insuring is cheaper and a bit more risky, but from our point of view it works the same as insurance: insurers create a network by negotiating prices with providers.”
I just don’t like wrong info being put out so I posted the info about NYS and now @NoVADad99 has confirmed the Fed govt does not self insure, either.
I’d bet that most state govts don’t self insure.
“What was the MA plan that was in place pre-ACA? Didn’t that work relatively well and wasn’t Romney involved with it?”
There was a mandate that everyone have insurance in MA - which isn’t surprising since the mandate was a Republican idea going back to the Heritage Foundation proposal and it was in the health insurance bill first sponsored by then R Senator Lincoln Chaffee in the 90’s, iirc.
However, the structure of ACA has made insurance nothing more than a title on a piece of paper that is effectively no insurance. The high premiums coupled with the astronomical deductibles make it so that a single person or family without subsidies effectively have no insurance.
When I was at my company, I can tell you that less than 20% of people spent enough on healthcare annually to even qualify to claim insurance. The overwhelming majority did not even spend the full deductible each year.
Single people and families have figured this out and it took about 2 minutes of math for them to realize they are paying 3 to 4X more for supposed health insurance annually than they ever spent on healthcare out-of-pocket with their old policies. Thus, the need for a mandate because the product itself is useless for most and the red ink show that it is.
And, no, to is not rue that the pre-existing conditions can only exist if everyone has to buy insurance. That is only true if you drink the kool-aid that ACA is not only solution. But that is for another thread because people seem not to know that other more viable options exist.
Let me guess: nobody in your family has had a premature baby, cancer, car crash, severe asthma? No cystic fibrosis, no anorexia, no schizophrenia, no serious health conditions at all? Nobody has given birth to their dearly wanted baby, who turns out to have Downs? If anyone in your family had a serious health condition, you’d soon discover that “effectively no insurance” is actually quite a lot of insurance.
Sick people cost a lot of money. Healthy people don’t cost much. If you average it out, healthy people will pay more, and sick people will pay less. But-- healthy people can turn into sick people in an instant.
Congratulations! You have just discovered how insurance works. Everybody pays, and then people who are unlucky enough to have bad things happen get covered.
“And, no, to is not rue that the pre-existing conditions can only exist if everyone has to buy insurance. That is only true if you drink the kool-aid that ACA is not only solution. But that is for another thread because people seem not to know that other more viable options exist.”
Such a tease. Please enlighten us? But I think I’ve asked you before back on post #349 to lay it out for us but we never heard from you.
per wiki, (the font of all knowledge):
I work in accounting/financial reporting for a large health insurer.
The majority or our business is ASO (aka “self funded”). Mechanically, the way it works is this…we collect a fee from the employer group for claims administration and access to networks. A member visits a provider who submits a claim. We adjudicate and pay the claim. The employer group then funds an ASO bank account for claims paid on their behalf. It is correct that the bigger the employer group, the more likely they are to have an ASO funding arrangement rather than a traditional prospectively rated arrangement. Groups can purchase stop loss plans which limit risk at either the individual claimant level or at the aggregate claim level.
In any event, the funding arrangement type should be invisible to both members and providers.
@JustaMom5465 & @bluebayou – thanks! I did not think that things had changed that much since I left the industry.
I believe at one point we sold self-funded down to 250 lives, but even with stop loss @ 125%, the smaller self-funded clients did not love the volatility. They liked being able to include coverage for items that the fully-insured plans did not cover, but self-insurance @ 250 lives didn’t always save money.
My school district which had 140 fte teachers self funded their health insurance. Actually, a lot of of school districts in this state self fund.
In Post #503, I botched this paragraph with errors - I fixed the typos below.
And, no, [it is not true] that the pre-existing conditions can only exist if everyone has to buy insurance. That is only true if you drink the kool-aid that ACA is [the] only solution. But that is for another thread because people seem not to know that other more viable options exist.
I must have missed that Post 349. For the answer, See my next post when I respond to CF for the answer.
No other thread needed, @awcntdb. C’mon now. Let’s hear your viable options. If you want to use inflammatory language like “drink the cool-aid” further the discussion by laying out specifics.
I don’t see anyone here saying ACA is the only solution, BTW. ACA fixed some of the problems but we’ve talked about the imperfections as well. Many of us feel a single payor, universal system would work better.
I would like to hear your solution as to how we are going to convince current doctors, and aspiring doctors, to receive the huge pay cut needed to pay for a single payor/universal system.
Reducing pay + increasing demand seems like a recipe for trouble to me. Even France’s utopian healthcare system is struggling under its own weight.
http://www.bloomberg.com/news/articles/2013-01-03/frances-health-care-system-is-going-broke
No matter what you call it, the basic components of a successful universal plan will have to be similar. I’m pasting below a writeup someone else did that I think crystallizes it very well (I can’t properly credit them because it was an anonymous post on a different forum):
If you want health care for everyone and you insist that the free market remain involved (i.e., you’re still going to use private health insurance, private providers, etc.), then what you have is essentially a 3-legged stool.
Leg 1: insurance companies must be required to take people with preexisting conditions and to do so at non-ruinous rates. Remove this leg and you won’t have universal health care. If I’m an insurance company, for example, why on earth would I ever take someone who has cancer unless you force me to?
Leg 2: If you insist that insurance companies accept preexisting conditions, then you must have a universal mandate. If you don’t have this, then why would a health 28-year-old bother to buy insurance? They know that if they get into an accident or they get a serious illness, they can call up the insurance company that same day and get coverage. The only way this works is you have a sufficient pool of healthy people buying the insurance. It’s the way insurance works.
Leg 3: If you insist that everyone must purchase insurance, then you must have subsidies (and this must be actual cash subsidies, not tax credits). There is a reason that people don’t buy insurance: they can’t afford it. So if you’re going to require it, you have to help them.
You cannot remove one of those legs without causing the whole thing to topple over. And all three are required if your goals is to provide access to health care for everyone.
For years, lawmakers have been trying to find a way to remove either the second leg or the third leg or both, but they have repeatedly failed because it cannot be done.
One way to stop healthy people from gaming the system is to only allow people to enroll in the program during limited enrollment windows (once a year or less often), or when life situation changes (marriage, birth of children).
That won’t make any real difference, @NoVADad99. Too many young people would rather take the tax penalty than pay for insurance. It needs to be mandatory, period (in my opinion).
@fractalmstr I’m not sure that would be that big of an issue. It seems to work okay with the medicare system. There have already been changes to our healthcare system with much primary care being handled by NPs and PAs. It’s only anecdotal but I know many doctors who say its the way to go and have no personal issues with it. A program could be set up to forgive some student loans for x number of years of service into the system. I’d start by looking at what does and doesn’t work in other systems around the world.
I haven’t read the whole Bloomberg article you’ve linked yet about the failing French system but noticed this very first line: “Anita Manfredi got nine massages and 18 mud baths at a luxury spa in November.” I guess I’d suggest being much more restrictive on massages and mud baths in any US model, unless we also have a goal of bolstering the spa industry as well. 
We don’t have to replicate the french model.
Perhaps those who don’t believe in paying for insurance or taxes should find a private island somewhere and truly be free.
They will have no services, no medical care, no safety net. But no one could touch their money.
I love our country. And believe healthcare should be a right not a privilege. Covering preexisting conditions is a huge part of that.
I have not a clue what the above means because it is straw man that assumes everyone thinks and solves things the same way. Just because someone may have sick families members does not mean they expect or want government to charge others with high premiums and deductibles to pay for their family members. Not everyone who cannot get something screams for or depends on government to take from others so they can get it, as there are other ways.
Let’s get straight to the elephant on the room - the entire issue with ACA is that people want something for nothing. That is, people who knowingly will use more of “something” want to pay the same as people who do not. Hint - no wonder people opt out. If ACA were structured fairly and with market principles in mind, policies would be flexible and priced as to what people are using, not based on freebies, which it is now - resulting in larger insured pool.
For example, my company does have pre-existing insurance coverage for employees WHO WANT IT. It was set up via a private insurer pool which includes other companies and other groups. Here is the difference - the people who want this coverage do have a higher premium, some 45 - 60 % higher, but these people CHOOSE to pay it because they do have pre-existing conditions. These people are not trying to get it free by passing off THEIR increased costs onto someone else. Novel idea here - you pay fairly for what you want.
I also know a company that self-assures a portion of its healthcare and part of the self-insured pool is also pre-existing conditions/high risk pool and its rates are determined on a sliding scale based on condition, very similar to what private insurers did with smokers who had higher rates etc. Just like my car insurance charges me for having cars that do 215+ mph. I do not expect people driving regular cars to pay for me having these cars, so I pay my higher premium and my higher deductible. I also pay to have the cars replacement insured. And I do not expect others to pay for that either.
The free market will create a product (any product) that will service a VIABLE market, but the difference is the market expects you to pay for the product, as that is the only way it can remain VIABLE. With ACA, people want the product free, i.e., people with pre-existing conditions what to pay the same premiums as healthy people who are never sick - hence, the red ink. Well, duh, as heathy people and even intermittently sick people opt out.
This is not rocket science - others realize other people are riding on their backs and lowering their families’ standard of living. Now, if people want that system, then fine. However, clearly this has been rejected by the majority, and the only people complaining are the ones who want the services free and not having to pay if they use more services.
Specifically, ACA is structured in reverse of market dynamics. It charges paying users in order to GIVE pre-existing conditions coverage free to people who use the most healthcare. In a real market, the people with pre-existing condition would pay a higher premium and be responsible for that premium instead of expecting others to pick up that cost for them.
Bottom line #1 - ACA could work if people, in terms of premiums, paid a rate that was commensurate with what they want to purchase. This would then incentivize everyone to purchase insurance and increase the size of the insurance pool. Healthy people could choose a less inclusive policy and others can choose a policy covering pre-existing conditions with more robust services policy. Healthy people could then purchase cheap catastrophic insurance for the unforeseen, which would cover high cost emergencies and sickness.
Bottom line #2 - Since what people want is for others to pay their pre-existing conditions premiums and deductibles for them, let’s cut the games and call ACA what it is for the overwhelming majority of policyholders - ACA is one big transfer payment, not insurance. More than half of the citizenry rejected this arrangement, and we know this just based on how the law got put into place in the first place. And that majority got really pissed as we have seen lately.