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Heeeeeeere's Obamacare!

thrombus29 said:
Stony Brook now taking one Exchange insurer, in negotiations with 5 others.

http://www.newsday.com/long-island/...-to-take-insurance-from-ny-exchange-1.7091438

They didn't even take Empire for a while a few years ago (No way to blame Obama for that) I think it's just how they negotiate.
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I worked for 15 years in the finance department of a major Midwestern hospital system. My job was extracting financial data from daily/weekly reimbursement statements from insurance providers for the purpose of statistical analysis. This was used in conjunction with cost reports to determine our marginal basis.

While I was never involved in direct negotiations with insurance carriers, the data I provided was extremely important to those negotiations. I can assure you one thing. The insurance companies want to negotiate the lowest they can get away with paying and the hospital wants to negotiate the highest rates possible. Simple business deals.

The insurance companies would use any info they can to make their case (ACA being the present bugaboo) and the hospital using what they could (new technologies cost big bucks). It's all still negotiating tactics and I would take what both sides claim during negotiations with very large grains of salt.
 
AlBell said:
That's the aspect that seems to lack numbers from verifiable analysis.

And certainly the cost of dr visits includes a premium over what it could be to pay for malpractice ins.
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Yes, it lacks verifiable numbers. What I recall is based on surveys and somewhat more anecdotal evidence about how doctors choose to practice medicine.

A best guess might be a comparison of most practitioners to something akin to Milliman's Health Cost Guidelines; see where they fall on the Loosely Managed versus Well Managed scale. Theoretically, Well Managed should represent best practices with virtually no waste, and no defensive medicine... but it's all based on nationwide aggregate data so it's not exactly something that can be looked at on a clinic-by-clinic or doctor-by-doctor basis.

I don't really know how you'd go about measuring it, to be honest.
 
Looks like we're at about 5.5 million enrolled through the private exchanges, with a little over one week to go until the 3/31 deadline. I'm guessing the final numbers will at least break 6 million, if not more; not sure if it'll hit 7 million, though.

Also, an anecdote: I found out today that my heavily conservative Republican brother-in-law, who absolutely despises Obama (as in, "Obama wants to ban guns and the Bible" kind of despising), just signed up for coverage for his family through the ACA (which he knows is Obamacare). Before, when shopping on his own, the best he could find was $2400/month with an insane deductible; after finally shopping through the federal exchange, he was able to get a solid insurance package for $1200/month and a very doable deductible.

I'm sure buying the better deal felt like ashes in his mouth.

Damn you, Obama! :mad:

;)
 
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Stipulated: there will be big "winners" under Obamacare. Lots of them.

But can you stipulate there will be, and already have been, big "losers"? Maybe lots of them?

Let's hope that the former substantially outnumber the latter, and years down the road we have a more equitable system than what came before.

But anecdotes don't move us very far in that direction.

If "a typical American family" ends up saving the promised $2,500/yr, I'll be overjoyed - and quite shocked, really, because it's hard to see how.

If "a typical American family" ends up saving a little, but less than the promised $2,500/yr, I'll be pleased - clearly a step in the right direction, and worthy of credit if sustainable.

If "a typical American family" ends up paying more than before for comparable benefits, or for benefits they would not have chosen voluntarily, then it will be time for the supporters to stipulate there was something very flawed in Obama's projections, and perhaps the overall tack the program took.

But I don't see that happening. From my experience in the past, it will somehow be the Republican's fault. Or even Bush's.

We'll certainly have a better idea a few years from now.

At the very least, it's an interesting experiment.
 
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$2,500 is an estimate of how much medical cost shifting added to the annual cost of insurance and medical care for a typical American family prior to the Affordable Care Act.

As more Americans are covered by comprehensive insurance, the need to shift medical costs to paying customers will decrease. The ACA will not eliminate all cost shifting, nor should we expect all of the savings to be passed directly to consumers. Medical providers may raise profit margins instead of passing the savings on to their customers. Consumers who live in states that expanded Medicaid should see lower costs than those in states that rejected expansion. States with low rates of compliance with the individual mandate should also see higher insurance rates.
 
Discussing the ACA on other forums, I keep running into people who claim they had a great insurance policy canceled due to Obamacare. When asked for details, they seem unfamiliar with basic insurance terms like deductible, out of pocket limits and coverage caps.

Few seem to understand that the real test of an insurance policy is not a low copay to see your doctor, but how well the policy covers a heart attack that runs up a six figure medical bill.
 
Tsukasa Buddha said:
Anyone have the original protected enrollment figures handy?
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The CBO originally projected 7 million. It looks like it will hit 6 million. Over time, this will smooth out.

http://www.washingtonpost.com/blogs...d-and-ugly-of-cbos-new-obamacare-projections/

The Congressional Budget Office isn't changing its long-term outlook on the number of people that Obamacare will cover; it essentially expects, over the next decade, that the people who didn't get signed up in 2014 will work their way into coverage. "Over time, more people are expected to respond to the new coverage options, so enrollment is projected to increase sharply in 2015 and 2016," CBO analysts wrote. "Starting in 2017, between 24 million and 25 million people are expected to obtain coverage each year through exchanges, and roughly 80 percent of those enrollees are expected to receive subsidies for purchasing that insurance."
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Fast Eddie B said:
Stipulated: there will be big "winners" under Obamacare. Lots of them.

But can you stipulate there will be, and already have been, big "losers"? Maybe lots of them?

Let's hope that the former substantially outnumber the latter, and years down the road we have a more equitable system than what came before.

But anecdotes don't move us very far in that direction.

If "a typical American family" ends up saving the promised $2,500/yr, I'll be overjoyed - and quite shocked, really, because it's hard to see how.

If "a typical American family" ends up saving a little, but less than the promised $2,500/yr, I'll be pleased - clearly a step in the right direction, and worthy of credit if sustainable.

If "a typical American family" ends up paying more than before for comparable benefits, or for benefits they would not have chosen voluntarily, then it will be time for the supporters to stipulate there was something very flawed in Obama's projections, and perhaps the overall tack the program took.

But I don't see that happening. From my experience in the past, it will somehow be the Republican's fault. Or even Bush's.

We'll certainly have a better idea a few years from now.

At the very least, it's an interesting experiment.
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You keep posting the same general comment, but I'd like to know what you mean by "losers"? If you can define what a loser is, and what a winner is, then we can see if the stats exist. So far, premiums have risen more slowly under the ACA than they did in the years before it passed. That's a fact. So far, the CBO says only about 1% of the public has been hit with the "canceled plan, coverage is more expensive and worse" horror story. The vast majority of people on the individual market are lower income, and this problem primarily hits self-employed people making too much to earn subsidies, which is already a fraction of the population, not the norm. And for most of these people, the coverage they had before was worse, which is why any new coverage would cost more. And let's not neglect the simple fact that young, well off people who self-insure will soon be middle aged, well off people who self-insure, and then they'll be on the other side of the equation and happy to be protected as they age and encounter life's health issues.

Again, let's start with what a loser is, and work from there, ok?
 
How many have paid? How many are trying to cancel their coverage? How many were uninsured before last year?
 
Kestrel said:
$2,500 is an estimate of how much medical cost shifting added to the annual cost of insurance and medical care for a typical American family prior to the Affordable Care Act.
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Really?

Is that really what you took from what Obama said?

It sounds like really tortured parsing to me - "Under my plan, the typical American family will save $2,500 a year." Just does not seem that open to interpretation.

I just took it at face value - and I don't think I'm alone.
 
Unabogie said:
The CBO originally projected 7 million. It looks like it will hit 6 million.
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It would easily surpass 7 million if State Pubs weren't still blocking Expanded Medicaid (as they are in Indiana). Hospitals are getting hurt by this so it can't continue. But, we know that Pubs have to scream and stamp their feet, trying prove that they are big boys. They may hold out until after the election this Fall or they may even hold out until after the 2016 election. But, every State will pick up Expanded Medicaid just like every State will eventually recognize gay marriage.
 
Unabogie said:
Again, let's start with what a loser is, and work from there, ok?
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Maybe it's like the Supreme Court justice's take on pornography...I may not be able to define it, but I know it when I see it.

How about: Obamacare loser: an individual or family that ends up, as a result of Obamacare, with significantly higher health insurance premiums, significantly higher deductibles, or significantly reduced choice in doctors or hospitals, affecting quality of care. Or a combination of the three.

Devil in the details, of course. We would need to define "significantly". How about an increase in premiums or deductibles in excess of 20%? Or provider decrease of a similar amount?

For newbies, my "family" currently pays $363/mo for a high deductible plan with Aetna. Since we're in a position to afford that deductible*, and since in an average year our health care costs are low, it makes the most sense for us financially.

The healthcare.gov site lists our cheapest premium at over $1,100/month. It offers slightly better coverage, but still not great. If we were forced to pay $700/mo more* in premiums (a 300% increase), it would seriously dent our discretionary spending.

As it is, we're breathing easier...

1) Because I hit Medicare age in August, and,

2) For now, our current plan qualifies under the ACA.

But I believe Aetna is pulling out of GA, and I think in August we'll have to start shopping for an individual plan for Karen. I believe, but do not know, that Aetna's decision was not out of the blue but the result of Obamcare.

So, for now, status quo - neither winner nor loser. Again, anecdotes do not inform us of much. We'll know a lot more in a few years about the winner/loser ratio.


*In the time we've had this policy, we have never come close to hitting our deductible.

**For $700/mo, we could make payments on a freakin' Tesla instead! Just making the point that money spent on increased premiums for unwanted or unneeded coverage will be money not spent elsewhere in the economy. Good for insurance companies and their investors, I guess. Not so great for Tesla (and thousands of other companies, large and small).
 
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