Health insurance options in the US' screwed up system?

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desy

Diamond Member
Jan 13, 2000
5,439
211
106
What makes you think if somebody is healthy they have value to the economy?
Lots of healthy people loafing about and on the other end you have Steven Hawking, best if we throw the shovel over him
You are incredibly naïve
 
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BlueWolf47

Senior member
Apr 22, 2005
653
0
76
I just turned 26 and signed up for private health insurance for about 230$ a month (BCBS TX) . It has a high deductible but is still a ppo.
 

Fern

Elite Member
Sep 30, 2003
26,907
173
106
2 possibilities (and certainly not the only ones):

1. Your small group renewed the plan in 4th quarter of 2013, allowing it to be in effect for pretty much all of 2014 without complying with the ACA. This is the first compliant renewal.

2. Your small group was getting insurance through a Chamber of Commerce or other association. In the past small groups and individuals could aggregate through associations to qualify as a large group, and generally get lower rates. The ACA uses the Public Health Service Act language relating to associations, which means that the Department of Labor is now involved in determining if an association is bona fide. Long story short, associations generally cannot qualify as a large group anymore, the constituent members are rated on their own merits. That means a small group that used to be rated as a large group must now be rated as a small group.

Another possibility, albeit quite similar to your first point:

Obama granted a waiver back in march for "skimpy" (nonconforming) plans:

The Obama administration decided this week that people with skimpy health insurance plans can keep them for up to three more years..
http://www.njspotlight.com/stories/...-compliance-with-aca-get-three-year-reprieve/

However some states are refusing the waiver:

More than a dozen states plan to cancel health care policies not in compliance with ObamaCare in the coming weeks, affecting thousands of people just before the midterm elections.

"It looks like several hundred thousand people across the country will receive notices in the coming days and weeks," said Jim Capretta of the Ethics and Public Policy Center.

The policies are being canceled because states that initially granted a reprieve at the request of President Obama are no longer willing to do so.

In coming weeks, 13 states and the District of Columbia plan to cancel such policies, which generally fall out of compliance with the Affordable Care Act because they don’t offer the level of coverage the law requires.

Virginia will be hardest hit, with 250,000 policies expected to be canceled.
http://www.foxnews.com/politics/201...ancel-health-care-policies-not-in-compliance/

He could be in one of those states.

----------------

Re: Your point #2. Redefining group coverage to make associations not qualify strikes me as intensely stupid.

Fern
 

lopri

Elite Member
Jul 27, 2002
13,211
597
126
Compared to other developed countries' system (a la single payer system) yes, our system is severely lacking.
 

Fern

Elite Member
Sep 30, 2003
26,907
173
106
Compared to other developed countries' system (a la single payer system) yes, our system is severely lacking.

Our problems go far beyond whose name is on the check for payment.

I've lived and worked in Europe and participated in their health care system(s). It's different in many ways people here don't seem to grasp. And many of those differences, not just who writes the check, is what results in their lower medical costs.

Fern
 

DCal430

Diamond Member
Feb 12, 2011
6,020
9
81
And to those with pre-existing conditions, screw 'em all. I know they can't get insurance because they'd be bad investments. The sooner they kindly die of their illnesses, the better it'll be for our economy.

And also screw those who are too poor to afford preventative healthcare. Preventing problems is more expensive than treating chronic illnesses after the fact anyway - or if they can't afford treatment, then they can just rot away, quietly. Fewer sickly parasites dragging down society.


(As you can tell, I don't like hearing the whining about "What, now someone has to make sure that people who are already sick will get care?" It really sounds like "Can't we just ignore them, and let the problem solve itself for free?" Or "Well then they shouldn't have been in a car accident or gotten cancer in the first place." Or "They should have saved up $500k to pay for unforeseen medical expenses. Not my problem."
Having a healthy population can easily lead to a stronger economy and better standard of living. But that doesn't show up on quarterly financial statements, so it doesn't really matter to anyone.)




We already pay much more than many other first-world nations do for healthcare, not only in taxes, but then we also have to pay inflated premiums on top of that, and in return we get service that is not close to the top. Meanwhile, healthcare mutual funds continue to do well.There is indeed a good time to be had in that industry, but it's not those who need to use the service. Someone's expecting a good return on their investment, and that investment is enhanced by sucking money out of a captive audience.





We were told that the cost to the company will increase by 50% over what they're paying our provider right now, and said "There are going to be some big changes. We don't know what they are yet, but it's coming."
If they do double our weekly contribution....well, I should be glad there. The contribution is about $2/week right now.




Ah, good, a progressive scale. I'm still going through that same site. Emphasis on "up to 9.5%," it would appear.

Just an FYI, That leaves out the fact that people whose income is below 100% of 130% (can't remember which) do NOT qualify for tax credit, there is a minimum income to get tax credits.
 

sactoking

Diamond Member
Sep 24, 2007
7,547
2,759
136
Obama granted a waiver back in march for "skimpy" (nonconforming) plans:

He could be in one of those states.

Of course I won't say this with 100% certainty but I am pretty sure the White House's "transitional" policy isn't in play; it doesn't make any sense for it to be.

We all know that the majority of the ACA provisions didn't take effect until 1/1/14, meaning that up through 12/31/13 plans existed as they always did (with some exceptions). Well, the 1/1/14 date wasn't a hard date, the actual effective date was 1/1/14 or the next renewal, whichever was later. What happened then, especially in the group market, was many plans were early renewed on 12/1/13 so they could legally exist until their next renewal (12/1/14) without having to comply with the ACA.

The White House's "transitional" policy, created after the "if you like your insurance you can keep it debacle", was wholly separate from the previous provision. The transitional policy stated that if a plan was issued or renewed before 10/1/13, then that plan could be renewed again in 2014 and 2015 without complying with the provisions of the ACA. In essence, a plan that wasn't early renewed (as above) could be kept longer than a plan that was early renewed.

CMS would accomplish this transitional policy by refusing to enforce the law, effectively choosing to look the other way. The White House and CMS could not force states and insurers to participate in the transitional policy, mainly because it is de facto illegal.

So, if the OP lives in a state that is participating in the transitional policy then the existence of such wouldn't be causing the cancellation and if OP is not in a transitional state then the absence of such doesn't directly cause the cancellation, that would technically be the renewal causing it.

Re: Your point #2. Redefining group coverage to make associations not qualify strikes me as intensely stupid.

Fern

Setting aside what I may or may not think of the policy personally, it does make some regulatory sense. Department of Labor is now involved more than they have ever been, and they use a different definition of employee than HHS did. Since there was no legislative authority to amend the DOL definition, they had to change the HHS definition.

Now the insurer has to underwrite on groups of employees. The associations do not employ the insureds so they cannot be underwritten at that level. This actually kind of closes a loophole where, previously, a bona fide association could not be formed solely for the purpose of obtaining insurance, but everyone knew that most companies only joined the various Chambers for the large group plans but we looked the other way. This has anecdotally been proven by the fact that the Chambers have been lobbying to overturn the rule on the grounds that nobody will join if it remains in place (confirming that they only ever joined for the insurance in the first place).

Just an FYI, That leaves out the fact that people whose income is below 100% of 130% (can't remember which) do NOT qualify for tax credit, there is a minimum income to get tax credits.

100% (with a 5% allowance), since the law was written with the Medicaid expansion being mandatory, there was no donut hole intended. It was the USSC's ruling that Medicaid expansion was an unfunded mandate and thus optional that opened the tax credit donut hole in states not electing to expand Medicaid eligibility.
 
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