"Affordable" Care Act - Yeah, Right.

[Emily's Cat]

I do find it fascinating and hard to explain why costs are going down so much in Oregon but increasing by so much elsewhere?

This isn't an easy question to answer, as there are a lot of moving parts. In Oregon, there's a fairly large individual market compared to other states. There are also a lot of carriers competing for business. The state has also been very cooperative in doing advance research on how many people are expected to enter the market, how healthy they are likely to be, and how healthy the current individual pool is.

The result of these things is that we have better information and less uncertainty in Oregon than may be the case in other states. And with so many carriers and new insurers in the marketplace, there's more of a competitive environment, and more carriers are willing to price low to try to buy market share in the first few years.

For carriers in states with less information and fewer competitors, there may not be as much pressure to take a loss, and they may be more inclined to take less risks on it.

ETA: It's also impacted by the fact that OR has had an adjusted community rate environment for many years - we haven't been able to risk-rate in OR in ages (I don't know how long, it predates my work in this field). States that previously had full risk-rating will be more likely to see larger overall increases.

There's also the overarching fact that the department of insurance in Oregon has rate approval authority. In very many cases, they dictated what costs the carriers could charge. For example, Family Care was approved with rates 35% lower than what they requested; they decided to not participate this year because of it.

If you're interested in that level of detail, the rate decisions in OR are a matter of public record:
http://www.oregonhealthrates.org/
Select "I want to see all companies",
Then select "2014 Individual (Major Medical),
Then select "I want to see all requests".

After that, you can browse through the "Our decision" links under each carrier, or you can hit the "More Info" button and wade through tons of rate filing information until your eyes bleed

 

[Emily's Cat]

This is a lie. I'm in the process of buying new insurance at a considerable cost decrease here in Oregon. I went directly to the MODA website.

I wouldn't be so quick to call it a lie, Unabogie. Oregon has a home-grown site; not all exchanges work exactly the same. Additionally, the rules around network contracting may not be the same in all states. Beyond that, each carrier's website is going to operate differently - not all of them may have full network information available yet.

 

[Emily's Cat]

Nobody is praising "King" Obama for all his awesomeness. That's ridiculous.

And if you're serious about this -- if this isn't just a I Hate Obama mini-rant -- then you need to provide some evidence that your increase IS related to the AHCA.

REally nitpicky: There's no H in there. It's just ACA. It's the Affordable Care Act. There's no "health" in the title

 

[Emily's Cat]

Which is one reason why the exchanges are doomed. It's an adverse selection death spiral just waiting to happen.

Actually, this isn't the case. The exchange, from the carrier's perspective, is mostly just a new distribution channel. The experience from all business sold in the exchange and outside of the exchange is pooled, and the community rating is done on an aggregate basis. In addition, there is a risk-adjustment mechanism in place that is surprisingly well designed. It should mitigate uneven risk attraction between different carriers fairly well.

That said, there may end up being some adverse selection spirals... but if so, it won't be caused by allowing selection between on-exchange and off-exchange plans.

 

[Emily's Cat]

It's not your income that matters as far as subsidies goes, it's what the household income is. So Person A who makes just $15,000 a year doesn't qualify for a subsidy if his roommate makes $55,000. Not that the roommate is going to kick in for the health insurance, Person A probably just goes without and gets penalized on his taxes.

"Household", in the context of subsidies, doesn't refer to any people who live in your house; it refers to your family. It is "household" substantially as defined by the IRS - the collection of dependents in your family unit for tax purposes (but including children up to age 26, even if they don't count as traditional dependents for taxes). So in short, mere roommates don't count toward your household for subsidy purposes.

 

[Emily's Cat]

all of which are better than the crap insurance you could buy before the new law

This isn't necessarily true. Not all of the new plans are better than all of the old plans. Some will be better than what one had before, but in at least some states, it will be equal to or worse than what one might have had before.

Under the new law, it doesn't matter if you're sick or not, as cost is no longer dependent on your health.

This is also not completely true. The experience of any individual carrier won't substantially reflect the degree to which their members are healthier or sicker than another carrier... and your individual rates won't reflect how healthy or sick you are (although for you, in OR, they haven't in ages and ages anyway). But the average level of the market price is very heavily dependent on the healthiness or sickness of the total pool. And since a good portion of the new entrants (previously uninsured, high risk pool people, etc.) are expected to be sicker than the prior individual pool was, we do expect the water level to rise. Over time, we expect it to stabilize... but where that water level ends up at is dependent on many, many variables. There is a definite and acknowledged risk that the overall cost in the individual market will end up being higher on average than it was before, even after accounting for the change in benefit rates.

And the individual mandate means that almost everyone will participate, which is the opposite of adverse selection.

This also, is not entirely true. There's considerable debate about how much of the current uninsured population will actually participate. In the first year of Operation, the MA plan only got 5% of the uninsured enrolled. We're expecting no more than 20% to participate in the first year, regardless of the mandate. And unfortunately, we expect that it will be those with the most need (and hence the highest cost) who will be early adopters.

Within that, there is still some risk of adverse selection. The risk adjusters aren't perfect - they're very good, all things considered, but they still aren't perfect. An adverse selection spiral is still (and likely will always be) a risk for carriers. It just may not be driven by quite the same risks that drove it in the past.

 

[Newtons Bit]

C-c-c-combo breaker!

 

[Emily's Cat]

(1) Yes, it's individual.
(2) No, I still don't qualify.

See this page. If I make $34,470 a year, I would only get a subsidy on health insurance premiums that are over 9.5% of my income (or $3,274/year).

Thanks Newtons Bits

It's actually a more complicated calculation than that. The subsidy doesn't vary by plan - it's a "bucket of money" calculation.

The intention of the rule is that you shouldn't be expected to pay more than 9.5% of your income for "average coverage". The ACA defined "average coverage" to be the second lowest priced silver plan offered to you.

So the calculation will take the annual cost of the second lowest priced Silver plan that is available to you through the exchange, and it will subtract from that 9.5% of your income (but won't allow it to go negative). That fixed dollar amount, that "bucket of money" then becomes your subsidy. The same fixed amount will be applied to any plan that you choose through the exchange, whether it is the silver plan or not.

So using your example... the maximum amount you can be expected to pay per year is $3,274. If the second lowest priced silver plan on the exchange for your family composition in your region of the state costs $500 per month, then your subsidy would be ($500 * 12) - $3,274 = $2,726. You then would have access to a subsidy of $2,726 per year to apply to any plan, regardless of that specific plan's cost. It would effectively reduce any premium that you purchase through the exchange by $227 per month. If you choose a lean Bronze plan that only costs $250 per month for you family, you would end up paying only $23 per month. If you choose a rich gold plan that costs $700 per month, you would end up paying only $473 per month.

That said... I recommend going through the actual exchange calculators to be certain about the amount of subsidy that you qualify for. You might be surprised

 

[Emily's Cat]

C-c-c-combo breaker!

Darn, and I was on a roll too!

 

[Ziggurat]

Wants or needs has nothing to do with it though.

What I want and need is very important to me. What you want and need is, I expect, very important to you. The indifference of politicians to the wants and needs of citizens is not some irrelevancy here. It's at the center of the problem.

you're going to get something that is ACA compliant whether you want it or not.

Which means that for many people their premiums will go up.

Hmm. I think this might vary by state...

I'm sure it does.

It's also potentially a matter of interpretation and misunderstanding. I have heard that many states don't have the provider information loaded into their exchanges yet (this is true for one of my states).

No, it's not just a matter of interpretation, though the problem you describe is also an issue.
http://www.forbes.com/sites/bruceja...r-practices-unsure-about-obamacare-exchanges/

Two in five physician practices are unsure about whether they will participate on the government-sponsored marketplaces known as exchanges, according to new research from the Medical Group Management Association.
...
“Some insurers want practices to sign contracts for less than their current commercial rates, but are unable or unwilling to provide detailed information to physicians about how the exchange products will be administered,” Turney said.​

 

[tyr_13]

C-c-c-combo breaker!

I lol'd

 

[newyorkguy]

There are big differences between states. Certain states (mostly Red) are changing policies so that some low-income people will actually lose their health care under the AHC. The net effect is that post-AHC fewer people will have health care in those states.

Missouri and 20 other Republican-led states aren’t participating in Obamacare’s Medicaid expansion, fearing the cost would require state budget cuts in other areas. The remaining states are still debating the expansion.

That leaves Erika Neal [whose job-based health coverage was being eliminated by her employer] and 5.5 million others in those 21 states to fend for themselves in the “coverage gap,” a bureaucratic twilight zone where people with poverty-level incomes don’t qualify for Medicaid and can’t get tax credits to help buy coverage on the new insurance marketplaces. Link

 

[Upchurch]

C-c-c-combo breaker!

I lol'd

Me too. I want this to become a thing.

 

[DGM]

Just got my packet for my 2014 health care.

Premiums are increasing by $1,200 for the year.

Co-Pays are also increasing. Well-visits are no longer free.

So much for "affordable". Biggest misnomer in history.


It's a pile of horse crap and Obama is big *********** liar.

Don't worry about it. Eventually you'll go broke and you can get subsidies.

I'm waiting for the people that are happy to pay $50 a month to realize it's every month and default and we have to bail out the insurance companies for the bills they ran up.

 

[plague311]

Don't worry about it. Eventually you'll go broke and you can get subsidies.

I'm waiting for the people that are happy to pay $50 a month to realize it's every month and default and we have to bail out the insurance companies for the bills they ran up.

Didn't Republicans have a hand in bailing out the banks not too long ago? Is this different since it's democrat?

 

[Corsair 115]

Far being it for me to defend Wildcat, but for what it's worth, here is the definition of household as used by the U.S. Census Bureau:

A household consists of all the people who occupy a housing unit. A house, an apartment or other group of rooms, or a single room, is regarded as a housing unit when it is occupied or intended for occupancy as separate living quarters; that is, when the occupants do not live with any other persons in the structure and there is direct access from the outside or through a common hall.

A household includes the related family members and all the unrelated people, if any, such as lodgers, foster children, wards, or employees who share the housing unit. A person living alone in a housing unit, or a group of unrelated people sharing a housing unit such as partners or roomers, is also counted as a household. The count of households excludes group quarters. There are two major categories of households, "family" and "nonfamily". (See definitions of Family household and Nonfamily household).

Source

 

[Unabogie]

Don't worry about it. Eventually you'll go broke and you can get subsidies.

I'm waiting for the people that are happy to pay $50 a month to realize it's every month and default and we have to bail out the insurance companies for the bills they ran up.

How do you default on insurance premiums and how is that different from car insurance, home insurance, or for that matter, health insurance as it used to exist?

 

[Unabogie]

Far being it for me to defend Wildcat, but for what it's worth, here is the definition of household as used by the U.S. Census Bureau:

Nope.

http://kff.org/interactive/subsidy-calculator/

The calculator allows users to enter household income in terms of 2014 dollars or as a percent of the federal poverty level. Household income includes incomes of the taxpayer, spouse, and dependents. In determining eligibility for exchange subsidies, income will be based on your attestation of your expected income in 2014 and will be verified by the exchange with documentation from your most recent tax return, with consideration of reasonable changes you expect. Exchanges will calculate enrollees’ household incomes using Modified Adjusted Gross Income, or MAGI. The MAGI calculation includes such income sources as wages, salary, foreign income, interest, dividends, and Social Security. MAGI calculation does not include income from gifts, inheritance, and Survivors Benefits, and some other income sources are partially excluded. More information on MAGI is available here.

So unless you listed your roommate as a dependent and then named them in your tax return, your roommate doesn't affect your healthcare subsidies and it would be silly to even think otherwise. Wildcat was just retrieving that from an orifice that receives little sunlight.

 

[Magyar]

No matter what, my costs increase when we were told that wouldn't be the case. But you go ahead and praise King Obama for all his awesomeness.

I don't know why your cost went up. The reality is that there are always going to be some people at the margins of cutoffs that are not going to realize a benefit or it will even cost them. Perhaps that's you. But frankly the total dishonesty and partisanship that is blatant in your post makes me question the accuracy of anything you say.

As has been stated over and over again, but right wing loons seems to conveniently ignore is that ACA is 100% right wing creation and total gift to the insurance industry. It was brilliant right wing response to uhc. Remember, it was sold a personal responsibility right next to when the shrub tried to do the same thing with social security.

So, if you don't like aca you can thank a republican. As a "lefty" im not a fan because i believe that we should have uhc which is a far better option and cost far less per capita as has been proven in dozens of other countries. But because it gives people with previous conditions an opportunity to get coverage and millions who could not get insurance i can live with it instead of the sociopathic right wing "things are just fine as they are".

 

[Emily's Cat]

ACA is ... total gift to the insurance industry

Being part of the health insurance industry, I've never been able to figure out why so many people have decided ACA is somehow a great thing for us.