Ham,

Thank you for your last post.

Followup question, if the ACA were just ended, would insurers not just market cheaper policies to the healthy young people that have shunned Obamacare the next calendar year? Would they also cancel polcies due to no premium payment if the subsidies, however unlikely we both think it may be, were just turned off?

The sicker people are, by and large, not profitable for the insurers, thus wouldnt it make more sense to carve them in their own group and maximize their premiums. Sicker and older people are going to pay no matter the cost, whereas young healthy people are somewhat of an untapped market with growth potential, particularly if you can get them on a low cost HDHP.

I guess im a bit more negative than you are about insurers wanting to cover the sick ACA subs they do now when there is a more attractice alternative. As you stated, "They want healthy people to pay less and unhealthy people to pay more." Thus wouldnt it make sense to create a high risk group with incredibly high premiums?

(07-12-2019 03:58 PM)solohawks Wrote:  Here is a good article on the situation as it stands now
http://www.vox.com/platform/amp/policy-a...rict-court

Here is a great quote from the article
The Supreme Court specifically upheld the individual mandate as a tax. If ... the mandate doesn’t have a penalty, the attorneys general argue, then it’s no longer a tax — and thus unconstitutional.

I also want to correct myself. The mandate tax was lowered to $0 by Congress in the tax reform bill, not by executive order. Irregardless of that, the tax is still there on the books. It was not repealed, just lowered to $0 and can be raised at any time by future legislatures.

Ultimately, it comes down Chief Justice Solomon. If he wanted to throw out the law he would have when he had the chance. I dont think he would do it now on a cute technicality that i i believe is a major stretch

Saving it was a cute technicality that was a major stretch. That cute technicality is gone.

(07-14-2019 02:18 PM)solohawks Wrote:  Ham,

Thank you for your last post.

Followup question, if the ACA were just ended, would insurers not just market cheaper policies to the healthy young people that have shunned Obamacare the next calendar year? Would they also cancel polcies due to no premium payment if the subsidies, however unlikely we both think it may be, were just turned off?

Thank you for what sounds like we could have a good conversation....

Of course anything is possible.... My point was that the court doesn't turn off the subsidies. Legislators would.

My belief is that the individual market for insurance which doesn't exist anymore won't come back... at least not as a major player... It was started as a niche offering because most got benefits through work. Now a WHOLE LOT don't. My belief is that we could see three new categories of group insurance stem from the current one for those who don't get company insurance....

1 would be those who decline to get insurance
2 would be those who have no PECs and thus might accept some new offering of such a (relatively cheaper) product
3 would be those who have PECs which would of course include the high risk pool, but also many who are not really high risk, like people who take blood pressure medicine or insulin or Prozac or prilosec

1 and 2 would certainly push 3 higher, but not to make that pool uninsurable.

Certainly they could eventually do just as you suggest and create tier 4 which would not include prozac, but might include AZT, further splintering the market, and yes, this could eventually go all the way back to individual policies....

But it's not the courts that would take us there, but the insurers... which would potentially require a legislative solution... and I used COBRA as a framework because it is most like the current situation.

What if the government only offered subsidies for pool 3 policies? If an insurer wanted to further fragment the market, they could... but they'd miss out on all the expanded Medicaid, medicaid alternatives and any state or federal subsidies that remained? I find it highly unlikely that a state that expanded Medicaid would not do something like that.

I'd also note that once you're in a group, it's pretty hard to get kicked out of it unless you don't pay your premiums. It's not like when you turn 50 or get a disease, that you're generally cancelled from your group health insurance. They sort of assume you'll eventually need SOME care. This would be more of a 1 time election to 'no PEC's'. The market for people with current, but not lifelong or particularly expensive issues is just too big

(07-14-2019 02:31 PM)bullet Wrote:  

(07-12-2019 03:58 PM)solohawks Wrote:  Here is a good article on the situation as it stands now
http://www.vox.com/platform/amp/policy-a...rict-court

Here is a great quote from the article
The Supreme Court specifically upheld the individual mandate as a tax. If ... the mandate doesn’t have a penalty, the attorneys general argue, then it’s no longer a tax — and thus unconstitutional.

I also want to correct myself. The mandate tax was lowered to $0 by Congress in the tax reform bill, not by executive order. Irregardless of that, the tax is still there on the books. It was not repealed, just lowered to $0 and can be raised at any time by future legislatures.

Ultimately, it comes down Chief Justice Solomon. If he wanted to throw out the law he would have when he had the chance. I dont think he would do it now on a cute technicality that i i believe is a major stretch

Saving it was a cute technicality that was a major stretch. That cute technicality is gone.

Not gone, reduced to $0. I think that will be the logic he uses

(07-14-2019 02:58 PM)Hambone10 Wrote:  

(07-14-2019 02:18 PM)solohawks Wrote:  Ham,

Thank you for your last post.

Followup question, if the ACA were just ended, would insurers not just market cheaper policies to the healthy young people that have shunned Obamacare the next calendar year? Would they also cancel polcies due to no premium payment if the subsidies, however unlikely we both think it may be, were just turned off?

Thank you for what sounds like we could have a good conversation....

Of course anything is possible.... My point was that the court doesn't turn off the subsidies. Legislators would.

I always appreciate a good back and forth. Thats how we learn. When we are challenged we are forced to think.

I agree its unlikely, but a district court judge has thrown out the subsidies and the 5th circuit is being repeorted as likely agreeing with that decison. So i want to operate and project under the premise the district court decision survives appeal.

Quote:My belief is that the individual market for insurance which doesn't exist anymore won't come back... at least not as a major player... It was started as a niche offering because most got benefits through work. Now a WHOLE LOT don't. My belief is that we could see three new categories of group insurance stem from the current one for those who don't get company insurance....

1 would be those who decline to get insurance
2 would be those who have no PECs and thus might accept some new offering of such a (relatively cheaper) product
3 would be those who have PECs which would of course include the high risk pool, but also many who are not really high risk, like people who take blood pressure medicine or insulin or Prozac or prilosec

1 and 2 would certainly push 3 higher, but not to make that pool uninsurable.

I dont understand why the individual market wouldnt come back? With a bigger pool to market, these individual plans will be able to be marketed to the people you have placed in group 1.

Insurers will want group 1. I see things going like term life. A young person who signs up gets a health exam to verify health and a HDHP plan for dirt cheap, as the liklihood of any payout by the insurance company is minimal. While there will be plans and pools for your group 3, they wont be cheap or very affordable. Therefore someone with diabetes taking regular medicine will be paying out the waazoo. So perhaps you are right the individual market will not come back, but if you are not in the young, healthy group that will be offered a cheap HDHP that will likely never pay a dime, you will be in a tough spot.

HDHP plans began about 5 years before the ACA and didnt really grow until after ACA passage. Now that they are the norm for many people, there is no reason that young healthy people should be paying so much for a HDHP. Insurance companies know this and will make it a reality without the ACA, leaving those who need traditional health insurance outside there employer in a tough spot, especially if they have preexisting conditions.

Quote:Certainly they could eventually do just as you suggest and create tier 4 which would not include prozac, but might include AZT, further splintering the market, and yes, this could eventually go all the way back to individual policies....

But it's not the courts that would take us there, but the insurers... which would potentially require a legislative solution... and I used COBRA as a framework because it is most like the current situation.

What if the government only offered subsidies for pool 3 policies? If an insurer wanted to further fragment the market, they could... but they'd miss out on all the expanded Medicaid, medicaid alternatives and any state or federal subsidies that remained? I find it highly unlikely that a state that expanded Medicaid would not do something like that.

I'd also note that once you're in a group, it's pretty hard to get kicked out of it unless you don't pay your premiums. It's not like when you turn 50 or get a disease, that you're generally cancelled from your group health insurance. They sort of assume you'll eventually need SOME care. This would be more of a 1 time election to 'no PEC's'. The market for people with current, but not lifelong or particularly expensive issues is just too big

Operate under the premise that the District court ruling stands amd everything about the ACA including subsidies and expanded Medicaid gets thrown out. How would the immediate aftermath look?

(07-14-2019 10:14 PM)solohawks Wrote:  I always appreciate a good back and forth. Thats how we learn. When we are challenged we are forced to think.

Absolutely! :beer:

Quote:I agree its unlikely, but a district court judge has thrown out the subsidies and the 5th circuit is being repeorted as likely agreeing with that decison. So i want to operate and project under the premise the district court decision survives appeal.

I think it possible that the 'tax' could be thrown out... My point was that I didn't see the whole thing being thrown out. Remember that in the SCOTUS decision where the tax was upheld, they threw out the Medicaid expansion but still upheld the law. I don't think that the mandate was any more important to the overall bill than the medicaid expansion was... so I don't see the entire bill being thrown out.

There are three possibilities, not just two.
1) they uphold the whole thing
2) they strike down the whole thing
3) they strike down the tax and keep the rest.

I think 3 more likely than 2 by a big measure

Quote:I dont understand why the individual market wouldnt come back? With a bigger pool to market, these individual plans will be able to be marketed to the people you have placed in group 1.

Insurers will want group 1. I see things going like term life. A young person who signs up gets a health exam to verify health and a HDHP plan for dirt cheap, as the liklihood of any payout by the insurance company is minimal. While there will be plans and pools for your group 3, they wont be cheap or very affordable. Therefore someone with diabetes taking regular medicine will be paying out the waazoo. So perhaps you are right the individual market will not come back, but if you are not in the young, healthy group that will be offered a cheap HDHP that will likely never pay a dime, you will be in a tough spot.

HDHP plans began about 5 years before the ACA and didnt really grow until after ACA passage. Now that they are the norm for many people, there is no reason that young healthy people should be paying so much for a HDHP. Insurance companies know this and will make it a reality without the ACA, leaving those who need traditional health insurance outside there employer in a tough spot, especially if they have preexisting conditions.

Because they're already in a pool. Why create that much more work for themselves, especially in that just because you didn't have a PEC yesterday, you could have one tomorrow. Lots of active management of individuals health and constantly acquiring new customers is expensive... especially in that the problem is so obvious that a legislative solution similar to Cobra seems inevitable

Not that nobody would market actual individual plans, but that it wouldn't be as specific as it used to be... in part because as was noted, the market is much larger now.

Competition would keep margins in control.... would you rather make 3% of billions or 10% of millions?

The simplest solution seems to be to simply offer tiered pricing for the pool. If you currently have no PECs, the price is X. If your PECs are in 'this' range, your price is 1.2X. If your PECs are in 'that' range, your price is 3x... but the insurance coverage under the pool is all the same.

ICD-10 and EMR subsidies has made such things a whole lot easier to do than it was years ago.

Quote:Operate under the premise that the District court ruling stands amd everything about the ACA including subsidies and expanded Medicaid gets thrown out. How would the immediate aftermath look?

It's hard for me to do this because expanded medicaid was already decided by the scotus and is clearly something states can do... all the government did was subsidize them... so the federal subsidy might be gone, but that doesn't eliminate the ability for states who have decided to expand medicaid to continue to do so without the subsidy.... but I'll try and imagine it...

And I'll speak generally.... obviously there will be some specific issues....
The existing policies would remain in place until year end of whatever year this event happens. The government would find a serious budget surplus (perhaps unfunded but that's another issue) that would be available to be re-allocated somehow.... and no politician would be re-elected if they decided not to enact some sort of 'emergency' system to continue that spending of a budget that has already been approved and signed off on. It's too easy for them to just kick the can until the next election/budgeting cycle.

I think lots of people might cancel their coverage immediately... but not everyone.... and mostly people without meaningful subsidies who really aren't impacted by anything but the mandate. Especially young healthy and well employed people will cancel, which will mean that the sponsored pool will take in less than expected. I don't know if this will be a loss for the insurers or the government, but I suspect the court would similarly decide that the insurers acted in good faith and the government was unable to live up to their end of the contract and thus they are entitled to be paid the entire amount.

When these policies come up for renewal, they will be repriced based on whom remains in a few pools as I described. I can't really predict that other than 'somewhat higher'.

Given that we're now all used to paying more for insurance... and that most states have adjusted their budgets to pay more... and that companies have as well, I really don't think the net impact will be disastrous.

Bottom line is that there would ultimately have to be a legislative solution... likely a lot of them... at least 51 (states plus feds)... some would be minor and some would be major...

but again, I just don't see this as anywhere near the most likely outcome.

I see the most likely outcome as, the mandate is out... the rest remains but is now even worse fiscally than before and thus a legislative solution based on the new reality must be found in order to balance the budget.... or they somehow do nothing and just continue to balloon the deficit.



I'd like to hear your thoughts?

(07-16-2019 01:49 PM)Hambone10 Wrote:  

(07-14-2019 10:14 PM)solohawks Wrote:  I always appreciate a good back and forth. Thats how we learn. When we are challenged we are forced to think.

Absolutely! :beer:

Quote:I agree its unlikely, but a district court judge has thrown out the subsidies and the 5th circuit is being repeorted as likely agreeing with that decison. So i want to operate and project under the premise the district court decision survives appeal.

I think it possible that the 'tax' could be thrown out... My point was that I didn't see the whole thing being thrown out. Remember that in the SCOTUS decision where the tax was upheld, they threw out the Medicaid expansion but still upheld the law. I don't think that the mandate was any more important to the overall bill than the medicaid expansion was... so I don't see the entire bill being thrown out.

There are three possibilities, not just two.
1) they uphold the whole thing
2) they strike down the whole thing
3) they strike down the tax and keep the rest.

I think 3 more likely than 2 by a big measure

To be fair, Medicaid expansion was not thrown out, just the penalty for not expanding Medicaid, which was supposed to be no Medicaid funding at all and no subsidies for your ACA citizens. The Court took care of of both of those via the initial ruling and the "typo" ruling. The law was clearly not designed for states to opt out of expanded Medicaid.

I know you dont see the whole thing being thrown out, but that is the current ruling facing the 5th Circuit.

Quote:

Quote:I dont understand why the individual market wouldnt come back? With a bigger pool to market, these individual plans will be able to be marketed to the people you have placed in group 1.

Insurers will want group 1. I see things going like term life. A young person who signs up gets a health exam to verify health and a HDHP plan for dirt cheap, as the liklihood of any payout by the insurance company is minimal. While there will be plans and pools for your group 3, they wont be cheap or very affordable. Therefore someone with diabetes taking regular medicine will be paying out the waazoo. So perhaps you are right the individual market will not come back, but if you are not in the young, healthy group that will be offered a cheap HDHP that will likely never pay a dime, you will be in a tough spot.

HDHP plans began about 5 years before the ACA and didnt really grow until after ACA passage. Now that they are the norm for many people, there is no reason that young healthy people should be paying so much for a HDHP. Insurance companies know this and will make it a reality without the ACA, leaving those who need traditional health insurance outside there employer in a tough spot, especially if they have preexisting conditions.

Because they're already in a pool. Why create that much more work for themselves, especially in that just because you didn't have a PEC yesterday, you could have one tomorrow. Lots of active management of individuals health and constantly acquiring new customers is expensive... especially in that the problem is so obvious that a legislative solution similar to Cobra seems inevitable

Not that nobody would market actual individual plans, but that it wouldn't be as specific as it used to be... in part because as was noted, the market is much larger now.

Competition would keep margins in control.... would you rather make 3% of billions or 10% of millions?

The simplest solution seems to be to simply offer tiered pricing for the pool. If you currently have no PECs, the price is X. If your PECs are in 'this' range, your price is 1.2X. If your PECs are in 'that' range, your price is 3x... but the insurance coverage under the pool is all the same.

ICD-10 and EMR subsidies has made such things a whole lot easier to do than it was years ago.

What about weight, age etc. An obese person with no major medical history shouldnt pay thr same as a crossfitter?

There has to be some.form of.health exam like term life to assess risk

Quote:

Quote:Operate under the premise that the District court ruling stands amd everything about the ACA including subsidies and expanded Medicaid gets thrown out. How would the immediate aftermath look?

It's hard for me to do this because expanded medicaid was already decided by the scotus and is clearly something states can do... all the government did was subsidize them... so the federal subsidy might be gone, but that doesn't eliminate the ability for states who have decided to expand medicaid to continue to do so without the subsidy.... but I'll try and imagine it...

And I'll speak generally.... obviously there will be some specific issues....
The existing policies would remain in place until year end of whatever year this event happens. The government would find a serious budget surplus (perhaps unfunded but that's another issue) that would be available to be re-allocated somehow.... and no politician would be re-elected if they decided not to enact some sort of 'emergency' system to continue that spending of a budget that has already been approved and signed off on. It's too easy for them to just kick the can until the next election/budgeting cycle.

I think lots of people might cancel their coverage immediately... but not everyone.... and mostly people without meaningful subsidies who really aren't impacted by anything but the mandate. Especially young healthy and well employed people will cancel, which will mean that the sponsored pool will take in less than expected. I don't know if this will be a loss for the insurers or the government, but I suspect the court would similarly decide that the insurers acted in good faith and the government was unable to live up to their end of the contract and thus they are entitled to be paid the entire amount.

When these policies come up for renewal, they will be repriced based on whom remains in a few pools as I described. I can't really predict that other than 'somewhat higher'.

Given that we're now all used to paying more for insurance... and that most states have adjusted their budgets to pay more... and that companies have as well, I really don't think the net impact will be disastrous.

Bottom line is that there would ultimately have to be a legislative solution... likely a lot of them... at least 51 (states plus feds)... some would be minor and some would be major...

but again, I just don't see this as anywhere near the most likely outcome.

I see the most likely outcome as, the mandate is out... the rest remains but is now even worse fiscally than before and thus a legislative solution based on the new reality must be found in order to balance the budget.... or they somehow do nothing and just continue to balloon the deficit.



I'd like to hear your thoughts?

The mandate tax is at $0, so practically it is already out. So in terms of coverage decreasing because its gone shouldnt matter. It will ultimately come down to what can each individual afford. A person who has their subsidies go poof and must bear the full brunt of the policy will be in a tough spot. Again, i dont think that will ultimately happen, but that is what the district court has set in motion. I think such a decision would force legislators yo act but depending on the outcome of the 2020 election it might not be feasible as the odds of two parties to coming together after what is going to be a nasty 2020 election seasom is slim

(07-16-2019 06:22 PM)solohawks Wrote:  To be fair, Medicaid expansion was not thrown out, just the penalty for not expanding Medicaid, which was supposed to be no Medicaid funding at all and no subsidies for your ACA citizens. The Court took care of of both of those via the initial ruling and the "typo" ruling. The law was clearly not designed for states to opt out of expanded Medicaid.

I know you don't see the whole thing being thrown out, but that is the current ruling facing the 5th Circuit.

Yes, and for this very reason. The penalty for medicaid funding was thrown out because it wasn't a tax... it was a penalty... which was the argument about the mandate.

I understand that is the ruling facing the court, but the decision on the mandate in the first place (penalty vs tax) wasn't the question before them either.... They've already shown they're willing to go to some pretty great lengths to avoid unnecessary disruptions... I don't know why that would change. It's of course a guess, but that is my reasoning.

Quote:What about weight, age etc. An obese person with no major medical history shouldnt pay thr same as a crossfitter?

There has to be some.form of.health exam like term life to assess risk

That doesn't happen in group policies. It is somewhat assumed that while one 'company' may lose the good (or bad) risk and the other will pick it up, in aggregate things balance out.... so at least for subsidized policies, I don't see this happening. I just see the individual market in 2020 to be much more difficult to create than it was to maintain in 2008. The expectation from a whole lot of consumers and voters now is healthcare not tied to employment that covers PECs if you keep up your insurance.... just as it was the expectation under COBRA.

There are studies that show that an obese person with no major medical issues can actually be less of a cost than the crossfitter. They (the studies) are not without flaws, but crossfitters frequently have a higher incidence of fractures due to unreasonable risks (BMXers, free-runners) and things like hip and knee replacements later in life, while obese people often die from their first stroke at a relatively young age.

Again, these are opinions... not facts... but they're at least somewhat supported (as are yours)

Quote:The mandate tax is at $0, so practically it is already out. So in terms of coverage decreasing because its gone shouldnt matter. It will ultimately come down to what can each individual afford. A person who has their subsidies go poof and must bear the full brunt of the policy will be in a tough spot. Again, i dont think that will ultimately happen, but that is what the district court has set in motion. I think such a decision would force legislators yo act but depending on the outcome of the 2020 election it might not be feasible as the odds of two parties to coming together after what is going to be a nasty 2020 election seasom is slim

If the tax is zero and thus the revenue from the tax is zero and the tax is determined now not to be constitutional as a result and for some reason the court declares that Congress can't subsidize insurance (they already do but I digress) Those are current line items in the budget without the projected revenue... kind of goes to things like cigarette and alcohol taxes though... if they are successful and eliminate users, where does the money to fund the projects they previously funded come from? In other words, while I agree such an action would require intervention, the emergency funding of monies already included in the previous budget would certainly be a political hot potato, but I don't see it being a tough decision to make.

The money was already appropriated... we already weren't collecting the penalties... the law is struck down but we don't put millions against us merely by agreeing to spend money we already agreed to spend? No increase in the deficit etc etc etc etc

I agree with your premise... and this would be part of the legislative solution that would have to happen

(07-18-2019 09:00 AM)Hambone10 Wrote:  

(07-16-2019 06:22 PM)solohawks Wrote:  To be fair, Medicaid expansion was not thrown out, just the penalty for not expanding Medicaid, which was supposed to be no Medicaid funding at all and no subsidies for your ACA citizens. The Court took care of of both of those via the initial ruling and the "typo" ruling. The law was clearly not designed for states to opt out of expanded Medicaid.

I know you don't see the whole thing being thrown out, but that is the current ruling facing the 5th Circuit.

Yes, and for this very reason. The penalty for medicaid funding was thrown out because it wasn't a tax... it was a penalty... which was the argument about the mandate.

I understand that is the ruling facing the court, but the decision on the mandate in the first place (penalty vs tax) wasn't the question before them either.... They've already shown they're willing to go to some pretty great lengths to avoid unnecessary disruptions... I don't know why that would change. It's of course a guess, but that is my reasoning.

Quote:What about weight, age etc. An obese person with no major medical history shouldnt pay thr same as a crossfitter?

There has to be some.form of.health exam like term life to assess risk

That doesn't happen in group policies. It is somewhat assumed that while one 'company' may lose the good (or bad) risk and the other will pick it up, in aggregate things balance out.... so at least for subsidized policies, I don't see this happening. I just see the individual market in 2020 to be much more difficult to create than it was to maintain in 2008. The expectation from a whole lot of consumers and voters now is healthcare not tied to employment that covers PECs if you keep up your insurance.... just as it was the expectation under COBRA.

There are studies that show that an obese person with no major medical issues can actually be less of a cost than the crossfitter. They (the studies) are not without flaws, but crossfitters frequently have a higher incidence of fractures due to unreasonable risks (BMXers, free-runners) and things like hip and knee replacements later in life, while obese people often die from their first stroke at a relatively young age.

Again, these are opinions... not facts... but they're at least somewhat supported (as are yours)

Quote:The mandate tax is at $0, so practically it is already out. So in terms of coverage decreasing because its gone shouldnt matter. It will ultimately come down to what can each individual afford. A person who has their subsidies go poof and must bear the full brunt of the policy will be in a tough spot. Again, i dont think that will ultimately happen, but that is what the district court has set in motion. I think such a decision would force legislators yo act but depending on the outcome of the 2020 election it might not be feasible as the odds of two parties to coming together after what is going to be a nasty 2020 election seasom is slim

If the tax is zero and thus the revenue from the tax is zero and the tax is determined now not to be constitutional as a result and for some reason the court declares that Congress can't subsidize insurance (they already do but I digress) Those are current line items in the budget without the projected revenue... kind of goes to things like cigarette and alcohol taxes though... if they are successful and eliminate users, where does the money to fund the projects they previously funded come from? In other words, while I agree such an action would require intervention, the emergency funding of monies already included in the previous budget would certainly be a political hot potato, but I don't see it being a tough decision to make.

The money was already appropriated... we already weren't collecting the penalties... the law is struck down but we don't put millions against us merely by agreeing to spend money we already agreed to spend? No increase in the deficit etc etc etc etc

I agree with your premise... and this would be part of the legislative solution that would have to happen

It would be fascinating if the court did force the legislative branch to act start from scratch.

I like your theory about groups instead of individual policies. I think the public at large would prefer that

They have to figure out a way to lower the cost of HDHP plans for.young people. Those plans are good for the healthier segment of the population and allow them to invest and grow their own money tax free. If i didnt have a family i would have one.

(07-18-2019 10:40 AM)solohawks Wrote:  They have to figure out a way to lower the cost of HDHP plans for.young people. Those plans are good for the healthier segment of the population and allow them to invest and grow their own money tax free. If i didnt have a family i would have one.

I would think that would be relatively easy... and may be what replaces the individual market...

The insurance and pool is the same... so the same policies...
Your deductible determines your policy premium as a function of math, not health.

With minor variance for details of finance and loss, the premium for a 10k deductible would be 8k more than the premium for a 2k deductible. Pay for 10k and use 5k, you're a winner.

This is sort of how auto insurance is done

(07-18-2019 01:41 PM)Hambone10 Wrote:  

(07-18-2019 10:40 AM)solohawks Wrote:  They have to figure out a way to lower the cost of HDHP plans for.young people. Those plans are good for the healthier segment of the population and allow them to invest and grow their own money tax free. If i didnt have a family i would have one.

I would think that would be relatively easy... and may be what replaces the individual market...

The insurance and pool is the same... so the same policies...
Your deductible determines your policy premium as a function of math, not health.

With minor variance for details of finance and loss, the premium for a 10k deductible would be 8k more than the premium for a 2k deductible. Pay for 10k and use 5k, you're a winner.

This is sort of how auto insurance is done

I think that would be the best way to get people covered that are healthy and do not utilize medical services on a regular basis.

I think providers would need to better advertise cost to people with those plans because right now if you dont have a copay you have no idea what you are going to pay for a doctor visit until after the fact.

Those that are sick and high users of services would need more expensive plans with greater cost sharing. Making those affordable would be the biggest conundrum

(07-18-2019 01:55 PM)solohawks Wrote:  I think providers would need to better advertise cost to people with those plans because right now if you dont have a copay you have no idea what you are going to pay for a doctor visit until after the fact.

This

In our urgent care centers, we have 'what we charge your insurance' which is fairly standard and based on CMS. The different payers all pay something less than that rate and we write off the rest. We then have an even lower 'cash pay' rate for services

So despite trying to be as transparent as possible, we've still got half a dozen or more prices for the same services.

(07-18-2019 10:40 AM)solohawks Wrote:  

(07-18-2019 09:00 AM)Hambone10 Wrote:  

(07-16-2019 06:22 PM)solohawks Wrote:  To be fair, Medicaid expansion was not thrown out, just the penalty for not expanding Medicaid, which was supposed to be no Medicaid funding at all and no subsidies for your ACA citizens. The Court took care of of both of those via the initial ruling and the "typo" ruling. The law was clearly not designed for states to opt out of expanded Medicaid.

I know you don't see the whole thing being thrown out, but that is the current ruling facing the 5th Circuit.

Yes, and for this very reason. The penalty for medicaid funding was thrown out because it wasn't a tax... it was a penalty... which was the argument about the mandate.

I understand that is the ruling facing the court, but the decision on the mandate in the first place (penalty vs tax) wasn't the question before them either.... They've already shown they're willing to go to some pretty great lengths to avoid unnecessary disruptions... I don't know why that would change. It's of course a guess, but that is my reasoning.

Quote:What about weight, age etc. An obese person with no major medical history shouldnt pay thr same as a crossfitter?

There has to be some.form of.health exam like term life to assess risk

That doesn't happen in group policies. It is somewhat assumed that while one 'company' may lose the good (or bad) risk and the other will pick it up, in aggregate things balance out.... so at least for subsidized policies, I don't see this happening. I just see the individual market in 2020 to be much more difficult to create than it was to maintain in 2008. The expectation from a whole lot of consumers and voters now is healthcare not tied to employment that covers PECs if you keep up your insurance.... just as it was the expectation under COBRA.

There are studies that show that an obese person with no major medical issues can actually be less of a cost than the crossfitter. They (the studies) are not without flaws, but crossfitters frequently have a higher incidence of fractures due to unreasonable risks (BMXers, free-runners) and things like hip and knee replacements later in life, while obese people often die from their first stroke at a relatively young age.

Again, these are opinions... not facts... but they're at least somewhat supported (as are yours)

Quote:The mandate tax is at $0, so practically it is already out. So in terms of coverage decreasing because its gone shouldnt matter. It will ultimately come down to what can each individual afford. A person who has their subsidies go poof and must bear the full brunt of the policy will be in a tough spot. Again, i dont think that will ultimately happen, but that is what the district court has set in motion. I think such a decision would force legislators yo act but depending on the outcome of the 2020 election it might not be feasible as the odds of two parties to coming together after what is going to be a nasty 2020 election seasom is slim

If the tax is zero and thus the revenue from the tax is zero and the tax is determined now not to be constitutional as a result and for some reason the court declares that Congress can't subsidize insurance (they already do but I digress) Those are current line items in the budget without the projected revenue... kind of goes to things like cigarette and alcohol taxes though... if they are successful and eliminate users, where does the money to fund the projects they previously funded come from? In other words, while I agree such an action would require intervention, the emergency funding of monies already included in the previous budget would certainly be a political hot potato, but I don't see it being a tough decision to make.

The money was already appropriated... we already weren't collecting the penalties... the law is struck down but we don't put millions against us merely by agreeing to spend money we already agreed to spend? No increase in the deficit etc etc etc etc

I agree with your premise... and this would be part of the legislative solution that would have to happen

It would be fascinating if the court did force the legislative branch to act start from scratch.

I like your theory about groups instead of individual policies. I think the public at large would prefer that

They have to figure out a way to lower the cost of HDHP plans for.young people. Those plans are good for the healthier segment of the population and allow them to invest and grow their own money tax free. If i didnt have a family i would have one.

The issue with HDHP is that most people don't have the cash to pay for a heavy expense.

(07-18-2019 03:23 PM)bullet Wrote:  The issue with HDHP is that most people don't have the cash to pay for a heavy expense.

Thats why they should only go to younger healthy people who.can build up an HSa to pay for potential care

(07-18-2019 03:56 PM)solohawks Wrote:  

(07-18-2019 03:23 PM)bullet Wrote:  The issue with HDHP is that most people don't have the cash to pay for a heavy expense.

Thats why they should only go to younger healthy people who.can build up an HSa to pay for potential care

What would you consider a "High deductible"?

I pay as asss load per month as it is, and every year it goes up another 20/30/ maybe 40% effectively "cancelling" for me, OR, they just straight up "No longer offer that product", i.e. Yea, sucker it's been cancelled.

I think my family deductible is something like 12.5-14K annual.

You consider that high? Or is that just a starter for what you're talking about. Honest ???

(07-18-2019 04:59 PM)JMUDunk Wrote:  

(07-18-2019 03:56 PM)solohawks Wrote:  

(07-18-2019 03:23 PM)bullet Wrote:  The issue with HDHP is that most people don't have the cash to pay for a heavy expense.

Thats why they should only go to younger healthy people who.can build up an HSa to pay for potential care

What would you consider a "High deductible"?

I pay as asss load per month as it is, and every year it goes up another 20/30/ maybe 40% effectively "cancelling" for me, OR, they just straight up "No longer offer that product", i.e. Yea, sucker it's been cancelled.

I think my family deductible is something like 12.5-14K annual.

You consider that high? Or is that just a starter for what you're talking about. Honest ???

To me anything over $1000 for an individual is a high deductible

To the Feds a high deductible is a minimum of $1350 for an individual or $2700 for a family.

The Feds cap a deductible under the ACA at $6750 for an individual or $13500 for a family.

It sounds like you have a bronze level plan. You shouldn't be paying that much for it because the liklihood of payout is slim, but under the current system its not about health or probability of payout its about income. So you are subsidizing others by overpaying for crappy insurance

(07-18-2019 06:23 PM)solohawks Wrote:  

(07-18-2019 04:59 PM)JMUDunk Wrote:  

(07-18-2019 03:56 PM)solohawks Wrote:  

(07-18-2019 03:23 PM)bullet Wrote:  The issue with HDHP is that most people don't have the cash to pay for a heavy expense.

Thats why they should only go to younger healthy people who.can build up an HSa to pay for potential care

What would you consider a "High deductible"?

I pay as asss load per month as it is, and every year it goes up another 20/30/ maybe 40% effectively "cancelling" for me, OR, they just straight up "No longer offer that product", i.e. Yea, sucker it's been cancelled.

I think my family deductible is something like 12.5-14K annual.

You consider that high? Or is that just a starter for what you're talking about. Honest ???

To me anything over $1000 for an individual is a high deductible

To the Feds a high deductible is a minimum of $1350 for an individual or $2700 for a family.

The Feds cap a deductible under the ACA at $6750 for an individual or $13500 for a family.

It sounds like you have a bronze level plan. You shouldn't be paying that much for it because the liklihood of payout is slim, but under the current system its not about health or probability of payout its about income. So you are subsidizing others by overpaying for crappy insurance

That is how all of Obamacare works.
Higher premiums +high deductibles (you get nothing covered) = paying for someone else's coverage and care.

(07-18-2019 03:23 PM)bullet Wrote:  The issue with HDHP is that most people don't have the cash to pay for a heavy expense.

True, if you routinely play a losing game... i.e. you're a relatively high user of care and you keep getting an HDHP at a multiple of what you can afford.

If you have one major incident every 5 years and a 5k deductible, I can't think of many healthcare organizations that wouldn't be willing to accept $1000 per year... but an individual provider probably can't accept that.

Insurance is really only finance...

Here is a good article about why change is inevitable
https://www.bakersfield.com/ap/news/risi...8227f.html

(07-20-2019 06:35 AM)solohawks Wrote:  Here is a good article about why change is inevitable
https://www.bakersfield.com/ap/news/risi...8227f.html

Dude... MOST of what this guy is saying about the ACA I've been saying since 2008... and I specifically took a job in that very area to try and address these issues.

It's a pretty good article for 'Why the ACA doesn't remotely do what it claims to do 101'... We're talking about Advanced Healthcare 436.

I said 10 years ago... the biggest problems with the aca are:
1) it (like many subsidized programs) often discourages people bettering themselves when they lose their subsidy, especially in states like Cali that expanded Medicaid to cover (as an example) single males with no kids earning under about 30k.
2) it taxes the healthy, not the wealthy
3) it doesn't meaningfully change the risk of bankruptcy for high utilizers... it just transfers some of the write-off to other insured rather than the government

the article however does reveal its LA TIMES liberal slant when it notes that the ACA in 2008 has caused deductibles to triple, and then it blames Republicans in 2003 for HSAs, which MAY have been enough to cover people's OOP in 2003, but can't come close in 2008, after the ACA tripled them.