Heeeeeeere's Obamacare!

[Unabogie]

I would like a source for that claim, Unabogie. 1% seems too low to me. Best estimates from Kaiser have about one-third of the population making over 400% FPL (so they don't qualify for subsidies). Internal data from my work indicates that between 40% and 43% of the people in the Individual Market in my three states have FPLs over 400%. The research done in 2 of my 3 states by Milliman and Wakely indicate between 25% and 35% of those people will have higher premiums. There is uncertainty, because it depends on what metallic level they choose, and whether some of those people buy down to a bronze plan from their prior coverage. So all told, in my markets, that's 10% to 15% whose premiums will increase due to ACA... which is an order of magnitude or more than the number you're tossing about.

I've posted this link many times.

http://www.motherjones.com/kevin-dr...hock-probably-affects-about-1-percent-country

So that means about 1.3 million people had their policies canceled and had to pay full freight for a new policy. Since the error bars on this estimate are fairly large, that comes out to somewhere in the neighborhood of 1-2 million people. In other words, less than 1 percent of the country, mostly made up of people with incomes that are higher than average.

You can decide for yourself if this is a lot or a little. My own take is that it's pretty modest given that Obamacare probably benefits about 20-30 million people. Any big new piece of policy is going to have winners and losers, and a ratio of 20:1 or so is about as good as it gets in the real world.

 

[Kestrel]

In nations like the UK where there are no charges for most medical services, they don't have an over utilization problem.

Here in the US, we implement systems of copays to discourage over utilization. There is some evidence that these cause patients to avoid visiting the doctor when they really should.

 

[MattusMaximus]

Love it or hate it, Obamacare is accomplishing its mission

http://finance.yahoo.com/blogs/the-...s-accomplishing-this-one-thing-165445642.html

... The upshot is that the number of uninsured Americans--which totaled around 47 million in 2013--is likely to drop sharply this year. The data is still incomplete, but there are three credible sources that all show the same trend, more or less:

Gallup. The polling firm found that the percentage of adults lacking health insurance—the uninsured rate— fell from 18% right before Obamacare went into effect last year to 15.6% so far this year.

Rand. The nonprofit research group estimates there was a net gain of 9.3 million people having health insurance from September 2013 to mid-March 2014.

The Urban Institute. This think tank has conducted polls showing the number of nonelderly adults lacking health insurance shrank by 5.4 million from September 2013 to mid March 2014. ...

Thanks, Obama!

 

[Emily's Cat]

Now that you've fully stated everything that is a problem with single payer, care to recap all the things that were wrong with the original health care? I understand that single payer doesn't have all the answers, but would it be considered the lesser of two evils? I think everyone knows that there is no "answer to every question" style health care, but it was horrible previously. At least there is change now, whether some people like it or not. I also find that your statement of at least 25% of people having increased premiums a bit overzealous. Can you actually source that? I know you're not keen on it and it's just "what you see at work", but call me skeptical. I find it tough to believe that a quarter of the population is seeing increased premiums from the ACA. Fox would be all over it.

FFS plague. Please learn to read:

Single Payer really only refers to who pays the bill. Yes, it would relieve the financial burden on individuals, and help ensure that everyone gets access to care. But that's not the only problem that the US is facing when it comes to health care.

...

Yes, Single Payer is probably Good Thing™. But not by itself. There's a lot more that needs to be considered and planned for.

I would like a source for that claim, Unabogie. 1% seems too low to me. Best estimates from Kaiser have about one-third of the population making over 400% FPL (so they don't qualify for subsidies). Internal data from my work indicates that between 40% and 43% of the people in the Individual Market in my three states have FPLs over 400%. The research done in 2 of my 3 states by Milliman and Wakely indicate between 25% and 35% of those people will have higher premiums. There is uncertainty, because it depends on what metallic level they choose, and whether some of those people buy down to a bronze plan from their prior coverage. So all told, in my markets, that's 10% to 15% whose premiums will increase due to ACA... which is an order of magnitude or more than the number you're tossing about.

 

[Emily's Cat]

I've posted this link many times.

http://www.motherjones.com/kevin-dr...hock-probably-affects-about-1-percent-country

# of people who had their policies cancelled <> # of people whose premium rates increased

You're also talking about the people whose policies were cancelled as a percent of ALL PEOPLE IN THE ENTIRE US which doesn't really make any sense for a bill that was aimed to predominantly target THE INDIVIDUAL MARKET.

A more appropriate measure would be the # of people whose premiums increased as a percent of the number of people in the individual market.

A few things from your own article's source, without the statistical cherry picking and bad maths:
18.6% of the people in the individual market had their policies cancelled

Beyond that, the rest of it is some guy's very shoddy guesstimates that you're presenting as "proof".

 

[Unabogie]

# of people who had their policies cancelled <> # of people whose premium rates increased

You're also talking about the people whose policies were cancelled as a percent of ALL PEOPLE IN THE ENTIRE US which doesn't really make any sense for a bill that was aimed to predominantly target THE INDIVIDUAL MARKET.

A more appropriate measure would be the # of people whose premiums increased as a percent of the number of people in the individual market.

Why not? Why should health policy not take into account the whole country? The bill was not aimed at the individual market anyway. It has provisions that affect people with employer sponsored plans, people with VA plans, people with Medicaid, and people with Medicare. It's a broad based policy change that affects not only how much insurance costs, but also what it covers and who can buy it and under what circumstance we can lose it, and I don't see why we should only count a small slice of the public to see who benefits and who doesn't. But beyond that, this poll sought to gauge the number of people who both had cancelled plans and then subsequently saw a rate increase. Those people largely were wealthier and amounted to about 1% of the total population. And for a law that benefits at least 35 million people (according to the CBO), plus the benefits accrued to everyone else who may someday get sick or lose a job, then only 1% of the population becoming a "loser" is actually pretty damn impressive.

 

[Emily's Cat]

http://finance.yahoo.com/blogs/the-...s-accomplishing-this-one-thing-165445642.html



Thanks, Obama!

While it is auspicious for ACA, the only problem I have with 2 of those 3 sources is that they're assuming that the decrease is due solely to ACA. That is, they're assuming that all of the decrease in the uninsured is because those people are going to coverage offered by ACA. They're ignoring the fact that at least some of those previously uninsured people gained coverage through employer plans. The Rand study is the only one that did a proper migration study. They're also the only one that looked at the newly uninsured as well, and calculated net change. I just wish their sample size were larger.

 

[Emily's Cat]

Why not? Why should health policy not take into account the whole country? The bill was not aimed at the individual market anyway. It has provisions that affect people with employer sponsored plans, people with VA plans, people with Medicaid, and people with Medicare. It's a broad based policy change that affects not only how much insurance costs, but also what it covers and who can buy it and under what circumstance we can lose it, and I don't see why we should only count a small slice of the public to see who benefits and who doesn't. But beyond that, this poll sought to gauge the number of people who both had cancelled plans and then subsequently saw a rate increase. Those people largely were wealthier and amounted to about 1% of the total population. And for a law that benefits at least 35 million people (according to the CBO), plus the benefits accrued to everyone else who may someday get sick or lose a job, then only 1% of the population becoming a "loser" is actually pretty damn impressive.

No it didn't. Did you even read the poll? That's not at all what it was aimed at. That is what the author of that blog is using the actual poll to guesstimate (poorly) on the back of his shirtsleeve! It's NOT what the poll was aimed at! Read your own links!

ETA: And for goodness sake take off your confirmation bias goggles! Just because some random guy on the internet writes a blog that confirms what you want to believe doesn't make it true! Use some skepticism. Use some critical reasoning. At least use some common sense and question whether what he's doing with his horribad math even makes sense!

 

[Unabogie]

No it didn't. Did you even read the poll? That's not at all what it was aimed at. That is what the author of that blog is using the actual poll to guesstimate (poorly) on the back of his shirtsleeve! It's NOT what the poll was aimed at! Read your own links!

ETA: And for goodness sake take off your confirmation bias goggles! Just because some random guy on the internet writes a blog that confirms what you want to believe doesn't make it true! Use some skepticism. Use some critical reasoning. At least use some common sense and question whether what he's doing with his horribad math even makes sense!

Exactly what do you think this horribad math is?

According to the link that Kevin Drum was using:

While our sample size of those with non-group health insurance who report that their plan was cancelled due to ACA compliance is small (N=123), we estimate that over half of this population is likely to be eligible for coverage assistance

So that's a pretty large percentage of the people whose plans were canceled (and me and my wife are among them even though we've bought better plans directly through Moda and saw a drop in our premiums)

Furthermore, here's Politifact on the question:

http://www.factcheck.org/2014/04/millions-lost-insurance/

In a March 3 posting on the website of the journal Health Affairs, two researchers from the Urban Institute analyzed findings from a nationwide poll and said, “Our findings imply that roughly 2.6 million people would have reported that their plan would no longer be offered due to noncompliance with the ACA.” And in this case, the methodology is made explicit.
In December 2013, the Urban Institute’s quarterly Health Reform Monitoring Survey of adults ages 18-64 included this question: “Did you receive a notice in the past few months from a health insurance company saying that your policy is cancelled or will no longer be offered at the end of 2013?” And of the 522 people polled who were covered by non-group policies, 18.6 percent said yes, their old plan would no longer be offered because it didn’t meet the new coverage standards that went into effect Jan. 1.
And if 14 million people were covered by non-group policies nationwide (as indicated by the National Health Information Survey of the U.S. Centers for Disease Control and Prevention), that percentage translates to 2.6 million non-group policies discontinued, the authors stated.

That's about 1% of the population as well.

So all of these studies seem to agree that the individual market consisted of about 14 million people, about 18% of those people had plans cancelled, and 50% of THOSE people qualified for expanded Medicaid or subsidies and therefore wouldn't be subject to "rate shock".

If you have different math, please show your work.

ETA: Just to put these numbers into the record:

18% of 14,000,000 is 2.53 million people.

If 50% of those people got subsidies, then the number of people who were:

A) In the individual market
B) Had policies cancelled
C) Didn't qualify for subsidies or Medicaid

Is 1.26 million people. In a country of 300 million people, and for a policy that will cover 35 million people by 2017, that's pretty good.

 

[Emily's Cat]

Exactly what do you think this horribad math is?

Horribad math is...

# of people who had their policies cancelled <> # of people whose premium rates increased

 

[Unabogie]

Horribad math is...

I thought it was quite clear that we were talking about the "rate shock" victims who allegedly had their plans cancelled and then found the new plans to be more expensive.

Looking back, I can see how that wasn't clear, but since we've been having this argument for five years, I used a little shorthand that I thought everyone understood. Apologies if that's not the case.

Again, for the record, the 1% number is about the alleged rate shock victims. The fact that rates went up for other people is addressing a different question, which is about medical inflation in general. After all, were premiums going up before the ACA? Are they going up now faster or slower?

And again, the news is good for Obamacare.

http://www.forbes.com/sites/rickung...s-actually-bending-the-healthcare-cost-curve/

A new Congressional Budget Office report out last week has the healthcare world scratching its head over the possibility that Obamacare might—in part—be responsible for what is being described as a significant slowdown in the growth of healthcare costs in America.

According to the report, hundreds of billions of dollars in federal spending for Medicare and Medicaid are being removed from government projections as federal healthcare spending is now expected to be full 15 percent less than what had been initially budgeted for 2012. The surprisingly low spending projections come as the growth in healthcare spending has hit a new low for the fourth consecutive year.

To be sure, a big part of the decline in healthcare spending is the result of the recession’s impact on people’s ability to lay out cash on health related expenditures. Indeed, up until this point, most analysts have agreed that the poor economy was pretty much the sole cause for the improvement we have seen in containing the explosion of healthcare spending.

Now, experts are beginning to recognize that the Affordable Care Act may, in fact, be contributing to the good news—a significant development as bending the cost curve was a primary goal of Obamacare.

 

[Emily's Cat]

I wrote all this out and it hung so I'm posting it anyway...


Because let's please remember that you're using this to support your claim:

Sheesh, of course there are some people who ended up paying more. But the best estimate is that it's about 1% of the total population, and they are people who make too much to get subsidies.

So your claim is that only about 1% of the population ended up paying more. The proof you give is someone else's extremely BAD reasoning.

He reasons that about 18% of the individual market had their policies cancelled. He does not have information about how how many people lost their employer coverage - only about the individual market, because that is the only thing that the survey asked about.

He then goes on to estimate that 50% of those people would get subsidies or be covered by Medicaid. That's fine. No biggie. Kaiser's estimates vary by state, but seem to land somewhere around 50% under 400% FPL. But here's the clincher: He then just out of his backside ASSUMES that if they qualify for a subsidy, then that means that their rate won't go up. Which is NOT a good assumption at all.

So - He's assuming that anyone whose policy was NOT cancelled didn't get a rate increase. He's assuming that if they qualify for a subsidy of any sort, then their rate won't go up. Both of those are terrible and unfounded assumptions that basically make this random internet guy's blog a worthless rag. And you should really stop quoting it as "proof" that only 1% of the people in the US saw their premiums go up for 2014 because it really makes you seem a bit silly.

 

[Unabogie]

I wrote all this out and it hung so I'm posting it anyway...


Because let's please remember that you're using this to support your claim:


So your claim is that only about 1% of the population ended up paying more. The proof you give is someone else's extremely BAD reasoning.

He reasons that about 18% of the individual market had their policies cancelled. He does not have information about how how many people lost their employer coverage - only about the individual market, because that is the only thing that the survey asked about.

He then goes on to estimate that 50% of those people would get subsidies or be covered by Medicaid. That's fine. No biggie. Kaiser's estimates vary by state, but seem to land somewhere around 50% under 400% FPL. But here's the clincher: He then just out of his backside ASSUMES that if they qualify for a subsidy, then that means that their rate won't go up. Which is NOT a good assumption at all.

So - He's assuming that anyone whose policy was NOT cancelled didn't get a rate increase. He's assuming that if they qualify for a subsidy of any sort, then their rate won't go up. Both of those are terrible and unfounded assumptions that basically make this random internet guy's blog a worthless rag. And you should really stop quoting it as "proof" that only 1% of the people in the US saw their premiums go up for 2014 because it really makes you seem a bit silly.

Do you have better numbers? Because even if every single one of those 18% saw their rates go up, even though we know some of them got onto Medicaid, but even if ALL of them did, then that's 2.6 million people, which is <1% of the total population. That's the upper bounds of the guesstimate that's got you so worked up.

No, I think my numbers are pretty solid here. Do you have other numbers you'd like to share?

 

[Emily's Cat]

Now that I said that, I see that you've said this:

I thought it was quite clear that we were talking about the "rate shock" victims who allegedly had their plans cancelled and then found the new plans to be more expensive.

Looking back, I can see how that wasn't clear, but since we've been having this argument for five years, I used a little shorthand that I thought everyone understood. Apologies if that's not the case.

Again, for the record, the 1% number is about the alleged rate shock victims. The fact that rates went up for other people is addressing a different question, which is about medical inflation in general. After all, were premiums going up before the ACA? Are they going up now faster or slower?

So you're talking about specifically RATE SHOCK VICTIMS WHO HAD THEIR PLANS CANCELLED?

But those are specific ONLY to the Individual Market, aren't they? Why would you use the entire US population as a divisor? That's cherry-picking math, Unabogie - it's lying through creative use of statistics. It's like like some evil scientist developing a genetically targeted virus that kills people with red hair... and when it only kills 20% of the red-heads in the world, claiming that it's no big deal because red-heads are only 5% of the population, so it really only killed 1% and that's not a problem... It killed 20% of the people it was aimed at!

Same deal here. You're talking specifically about rate shock in people with cancelled plans. Well, those are specific to the individual market. The population - the proper divisor for your calculation - is the individual market. Of those, 18% had cancelled plans. So even if 50% of the cancelled plans got assistance, then that leaves you with at least 9% who saw rate shock.

But that again is NOT the entirety of the story. You're ignoring completely the other 80% who did not have cancelled plans. Some of those would have seen significant increases in their premiums as well. What are you considering "rate shock"?

 

[Unabogie]

Now that I said that, I see that you've said this:



So you're talking about specifically RATE SHOCK VICTIMS WHO HAD THEIR PLANS CANCELLED?

But those are specific ONLY to the Individual Market, aren't they? Why would you use the entire US population as a divisor? That's cherry-picking math, Unabogie - it's lying through creative use of statistics. It's like like some evil scientist developing a genetically targeted virus that kills people with red hair... and when it only kills 20% of the red-heads in the world, claiming that it's no big deal because red-heads are only 5% of the population, so it really only killed 1% and that's not a problem... It killed 20% of the people it was aimed at!

Same deal here. You're talking specifically about rate shock in people with cancelled plans. Well, those are specific to the individual market. The population - the proper divisor for your calculation - is the individual market. Of those, 18% had cancelled plans. So even if 50% of the cancelled plans got assistance, then that leaves you with at least 9% who saw rate shock.

But that again is NOT the entirety of the story. You're ignoring completely the other 80% who did not have cancelled plans. Some of those would have seen significant increases in their premiums as well. What are you considering "rate shock"?

You keep saying this without providing any numbers at all. The only people you can directly attribute higher premiums to the ACA are those whose plans were discontinued as non-conforming. Otherwise, you're trying to blame ordinary rate increases on Obamacare without any evidence. In fact, you've provided exactly zero support of this aside from your own assertions. So now you must provide:

a) the percentage of people who saw these significant rate increase
b) the definition of "significant"
c) how those rate increases are the result of the ACA
d) how they differ from previous years

Otherwise your pronouncements are meaningless.

 

[plague311]

FFS plague. Please learn to read:

FFS Emily please learn to read.

I also find that your statement of at least 25% of people having increased premiums a bit overzealous. Can you actually source that?

Sorry if on a skeptics board I don't just listen to your random anecdotal evidence, which proves absolutely nothing. You require other people here to provide sources and backup the things they say, as evident in the last few pages, but expect everyone to just take you at your word. Other people might do that, I don't. What states? Where are you located? What cities are involved?

 

[Emily's Cat]

FFS Emily please learn to read.



Sorry if on a skeptics board I don't just listen to your random anecdotal evidence, which proves absolutely nothing. You require other people here to provide sources and backup the things they say, as evident in the last few pages, but expect everyone to just take you at your word. Other people might do that, I don't. What states? Where are you located? What cities are involved?

Did you note the red bits, plague? I didn't say 25%. I said 25% of 40% - and then went on to say between 10% and 15%

I was also quite clear that I was basing those estimates on internal company data... which I quite obviously cannot give to you.

As far as the 40% being over 400% FPL... that's readily available from Kaiser. It's 33% in the US overall; it's 38% in WA. That's for the whole population, including those enrolled in Medicaid, ESI, etc. The percentage over 400% FPL in the Individual market alone is somewhat higher than that, but I don't have a source I can give you.

 

[Emily's Cat]

The only people you can directly attribute higher premiums to the ACA are those whose plans were discontinued as non-conforming.

From this statement, I conclude that you are significantly ignorant of what the ACA actually entails with respect to plan design and the impact on the Individual Market. Not just ignorant, but willfully so.

 

[Unabogie]

From this statement, I conclude that you are significantly ignorant of what the ACA actually entails with respect to plan design and the impact on the Individual Market. Not just ignorant, but willfully so.

Please, enlighten us.

 

[MattusMaximus]

While it is auspicious for ACA, the only problem I have with 2 of those 3 sources is that they're assuming that the decrease is due solely to ACA. That is, they're assuming that all of the decrease in the uninsured is because those people are going to coverage offered by ACA. They're ignoring the fact that at least some of those previously uninsured people gained coverage through employer plans. The Rand study is the only one that did a proper migration study. They're also the only one that looked at the newly uninsured as well, and calculated net change. I just wish their sample size were larger.

Actually, at least one of them (cannot recall which) stated that the increase is also probably due at least partly to higher employment numbers. More people working equals more people with health insurance.