Never mentioned by reporters, but always there, is the McCarren-Ferguson Act that exempts all insurance companies from federal Anti-Trust laws. Shielded from racketeering and RICO statutes the insurance cartels are free to collude and fix prices among themselves. Investigate the McCarren-Ferguson Act. There is no "free market" healthcare in the U.S.A.
4
It's a good start. We'll be able to test the theory directly here as Medicaid expanded on 7/1/16. but we still have plenty of folks who are driving claims costs who are either in 3rd party payer arrangements (no subsidies from www.healthcare.gov) or high income and very ill.
But we've started a real-life, boots on the ground experiment here. Let you know how it goes.
WR
But we've started a real-life, boots on the ground experiment here. Let you know how it goes.
WR
Considering that something on the order of 5% of the population consumes 50% of medical costs, it would seem a policy that shifts individuals with multiple chronic conditions and/or a cancer diagnosis (or other expensive long-term diseases) would go a long way to lowering the costs for the remainder of the population. This might also mitigate the need to lower the medicare age as is currently being proposed given the employment situation for millions of 50-65 years olds (since premiums for healthy adults would be much better controlled. Moreover, while systemwide it could potentially more expensive, the costs of insurance to businesses could be greatly reduced.
Finally, it is time in an allegedly compassionate and christian society that a cancer diagnosis does not become a death sentence depending on the quality of a persons insurance coverage, because that is where we are now.
Finally, it is time in an allegedly compassionate and christian society that a cancer diagnosis does not become a death sentence depending on the quality of a persons insurance coverage, because that is where we are now.
8
I would have trouble believing this. I do not even bill medicaid because the payments are abusively low.
Expanding medicaid means I do much more free work, which means I bill private patients much more to make up the deficits, thus their insurance costs will be higher.
The goal should be about reducing poverty and mandating the end of 'off the books' employment and abuse of the disability system. You might see a lot more money coming into the system for those who truly are in need that way.
Expanding medicaid means I do much more free work, which means I bill private patients much more to make up the deficits, thus their insurance costs will be higher.
The goal should be about reducing poverty and mandating the end of 'off the books' employment and abuse of the disability system. You might see a lot more money coming into the system for those who truly are in need that way.
5
What on earth makes you think that the insurance companies will accept your higher billing rate? You can ask if you like, but you can ask now, even while having fewer Medicaid patients. The insurance company isn't going to give you a raise for each procedure you do, just because there are more people around whose care is reimbursed at a rate that makes you decide you don't want to pay your billing staff for the time it takes to process the paperwork.
2
The are already paying it, double Medicaid in almost all of our markets (sometimes triple at certain highly respected hospitals) or they refuse to join any networks. Oh, carriers are paying, big time. Especially on the richer products employers purchase.
1
This is not a news flash. Making Medicare available to everyone who needs insurance, with a dedicated tax to pay for it, would have been far preferable to Obamacare, which is already coming apart at the seams. Obamacare amounts to national health insurance implemented through private companies. Such public-private hybrids are always disastrous (witness the current Postal Service). On the other hand, single-payer would lead to rationed care. Keeping the private system while expanding Medicare to cover all the uninsured is the only sensible way to ensure coverage for everyone at a cost that, although high, we can afford.
1
"Everyone who needs it?" Does that include all the people who do not report income and work off the books; all people I take care of who can afford fancy motorcycles but not an insurance premium; all the people who have way too many kids that they cannot afford???
There are many who need medicaid. But before expanding another benefit, how about do something to stop the abuse of the people who do work by mandating that everyone contribute to the system and take some responsibity.
There are many who need medicaid. But before expanding another benefit, how about do something to stop the abuse of the people who do work by mandating that everyone contribute to the system and take some responsibity.
3
Care is rationed by private insurers. The question becomes who decides
3
You realize that Medicare has no maximum out of pocket limits in its native form. That is, you are on the hook for 20% of all costs from the first dollar to the last $million. Private coverage, on the other hand, is tightly regulated with maximum annual out of pockets of no more than $6850 single, $13,700 family.
Why is "Medicare for All" so popular? Or should the really be saying "Private Medicare for All"?
WR
Why is "Medicare for All" so popular? Or should the really be saying "Private Medicare for All"?
WR
Is it possible that the savings in health care costs is due to the reduced use of the emergency room by people without coverage? Previously uninsured patients now have an alternative to emergency room visits reducing hospital costs which otherwise would be passed on to insured patients.
3
Believe it or not, Bob, it is people with Medicaid, not the uninsured, who overuse the ER for routine health care. True before the ACA, true now.
It is understandable. Many health care providers either will not accept Medicaid or already have as many Medicaid patients as they can handle and not go broke. ER's have to accept anybody who shows up and the Medicaid covered person can produce his card and walk out usually without a bill. An uninsured person can be billed at a higher rate than an insured person, get their bill turned over to a collection agency if they can't pay it, and have their credit - and thus their employment prospects - ruined.
What we aren't seeing in the MSM are frank articles about how a number of hospitals in states w/Medicaid expansion like KY are struggling because their ER's have been badly hit in this way - the worst compensation (Medicaid) being used unnecessarily in one of the most expensive areas (ER) which cannot turn them away and has to have expensive care/services/personnel because of the nature of its services.
Meanwhile, I am hearing over and over from people who have subsidized ACA coverage but can't afford to get routine care because their deductibles are so high that they'd have to spend thousands of dollars before coverage kicks in so they don't see a doctor. For the average person in fairly good health , the ACA is largely a transfer of his and the taxpayers' money to the insurance industry.
It's not what was promised.
It is understandable. Many health care providers either will not accept Medicaid or already have as many Medicaid patients as they can handle and not go broke. ER's have to accept anybody who shows up and the Medicaid covered person can produce his card and walk out usually without a bill. An uninsured person can be billed at a higher rate than an insured person, get their bill turned over to a collection agency if they can't pay it, and have their credit - and thus their employment prospects - ruined.
What we aren't seeing in the MSM are frank articles about how a number of hospitals in states w/Medicaid expansion like KY are struggling because their ER's have been badly hit in this way - the worst compensation (Medicaid) being used unnecessarily in one of the most expensive areas (ER) which cannot turn them away and has to have expensive care/services/personnel because of the nature of its services.
Meanwhile, I am hearing over and over from people who have subsidized ACA coverage but can't afford to get routine care because their deductibles are so high that they'd have to spend thousands of dollars before coverage kicks in so they don't see a doctor. For the average person in fairly good health , the ACA is largely a transfer of his and the taxpayers' money to the insurance industry.
It's not what was promised.
4
Medicaid is a pretty shabby blanket at the edges, frayed and lost its color, but it's way better than no blanket at all.
As Medicaid populations swell, if payments do not increase to docs/hospitals, the Medicaid card will rapidly lose its value, and it's "Back to the ER" we go.
WR
As Medicaid populations swell, if payments do not increase to docs/hospitals, the Medicaid card will rapidly lose its value, and it's "Back to the ER" we go.
WR
1
I support medicaid expansion. It is the humane and moral choice. One only has to look at a map of the states where Medicaid hasn't been expanded to get an idea of why the decision not to expand has been made.
My concern is over how to handle the corporate greed that it spawns. Take, for example, the Epipen case. I cannot help but think that part of the rationale for the dramatic price increase was that the feds, with their unlimited resources, would be picking up the tab.
My concern is over how to handle the corporate greed that it spawns. Take, for example, the Epipen case. I cannot help but think that part of the rationale for the dramatic price increase was that the feds, with their unlimited resources, would be picking up the tab.
12
Believe me, drug prices are not skyrocketing because Medicaid has expanded. Private insurance is buying way more drugs than Medicaid anyway, through employer plans, individual plans, and private Medicare Part D plans. Way more.
It is ridiculous that states in this country can deny Medicaid to their residents. Health care is a human right and certainly a national right.
Insurance companies are showing themselves to be more and more outmoded. It is time, past time, to get the profit motive out of health care.
We need single payer and price controls now.
Insurance companies are showing themselves to be more and more outmoded. It is time, past time, to get the profit motive out of health care.
We need single payer and price controls now.
11
Exactly right! What is added value of having a middle man in our health care system?
Let's get with the rest of the world!
Let's get with the rest of the world!
8
Single-payer is absurd. The problem is overutilization. We keep 95 year olds with dementia in ICUs, fix shoulders so people can play golf, futile cancer care for people who are dying.
And deny medicaid??? How about some people stop working 'off the books' and pay their fair share off taxes; how about not having children that you cannot afford?
Is there anyone on welfare who shouldn't be there in your book?
And deny medicaid??? How about some people stop working 'off the books' and pay their fair share off taxes; how about not having children that you cannot afford?
Is there anyone on welfare who shouldn't be there in your book?
2
I'll answer that: corporate welfare e.g. subsidies for oil companies, the bail out, without any penalty, of our largest banks after the the Great Recession they caused in 2008, the non-negotiable Medicare drug prices to name just the no-brainer, famous ones. Let's get them off the welfare books; they're a lot more expensive and destructive than the working poor. And now I'm reminded of employers like Walmart that use part time workers to avoid worker benefits. Guess who subsidizes Walmart? Us.
Technical point: remember, corporations are people.
BTW, I also am a physician. And I find providing care, saving a life here and there more than reward enough. I'm satisfied with an income that prevents financial worries. That's enough.
Technical point: remember, corporations are people.
BTW, I also am a physician. And I find providing care, saving a life here and there more than reward enough. I'm satisfied with an income that prevents financial worries. That's enough.
5
Our health system is convoluted complicated and disgusting. Even with an expert it's hard to figure out who to go to and what we are entitled to. The only way this can be solved and made simple is a single payer tax based system similar to other civilized countries. Anything short of that is more confusion, headaches and more sick people.
19
No further argument supporting the expansion of medicaid is necessary. It such expansion were proven to create a veritable heaven of health across America, the GOP would still dedicate itself to its destruction. The political idea here is to stymie Obama rather that to improve national wellness.
Donald Trump and his Republican Party are not to be swayed by mere evidence. We can expect nothing better from a Party whose national leader claims that climate change is an evil Chinese plot to de-industrialize America.
www.endthemadnessnow.org
Donald Trump and his Republican Party are not to be swayed by mere evidence. We can expect nothing better from a Party whose national leader claims that climate change is an evil Chinese plot to de-industrialize America.
www.endthemadnessnow.org
18
The Party of "No" cant stand results/facts like this...
7
The Party of NO depends upon an expanding underclass.
6
Chesbay wrote, "The Party of NO depends upon an expanding underclass."
And that is one reason why Maine's Governor LePage, a troglodyte Republican, made sure ill Mainers will suffer along without Medicare.
His supporters love to assert that Democrats depend on the underclass to vote for them in elections. Well, why are we liberals? Republicans' pro-1% policies keep deepening the underclass, and the intelligent folks among the 99% vote for Democrats to help us survive!
And that is one reason why Maine's Governor LePage, a troglodyte Republican, made sure ill Mainers will suffer along without Medicare.
His supporters love to assert that Democrats depend on the underclass to vote for them in elections. Well, why are we liberals? Republicans' pro-1% policies keep deepening the underclass, and the intelligent folks among the 99% vote for Democrats to help us survive!
2
Ga republicans refuse to expand Medicaid , & that blocks out many working poor from being able to purchase ins. & receive subsidies.
The loop hole left in the law, could be fixed, except Federal republicans refuse to do so.
All the while, people suffer & die.
The loop hole left in the law, could be fixed, except Federal republicans refuse to do so.
All the while, people suffer & die.
11
Another huge entitlement taxpayer's will foot the bill for.
8
Those low end workers are taxpayers, too.
4
Janis, When those with no healthcare insurance need medical help, where do they go? To the hospital emergency room where they are treated for free. Guess who pays for that?? You do!! Meanwhile, the 1% use their money to prop up the GOP and make sure they don't pay for anything outside of their next yacht.
4
So only employed people are entitled to health care, Janis? Aside from the moral bankruptcy of your position, a poor person with diabetes is going to get health care one way or another. That person could have 4 visits to a primary physician financed by medicaid for about 200 dollars per visit and a relatively inexpensive drug expense or they could remain untreated and they'll use the emergency room at about 3,000 dollars for 2 or 3 visits per year. And you and I are currently picking up that tab, Janis. And eventually they'll have that foot amputated which will cost tens and thousands of dollars. So your position is not only morally bankrupt, it is financially foolish also. People who actually think about these issues with more than the callous disregard you appear to have for the poor and sick actually understand that compassion is the right way to go.
5
I just realized something. HHS must really be concerned that what happened in Pinal County, Arizona where the exchange marketplace collapsed will spread- it's a real death spiral as every insurer at this point has pulled out and there is no way for to get a subsidy. Everyone must buy off exchange and pay full price.
Arizona expanded Medicaid. The Obama Administration and HHS have realized that in non-Medicaid expansion states where as many as 40% of exchange enrollees would be Medicaid eligible, the Pinal County insurance exchange collapse would be a disaster. Low income and poor people would not be eligible for subsidies and would have to pay full price to gain insurance - they couldn't afford it. Middle income and upper income people can't so how could they?
Arizona expanded Medicaid. The Obama Administration and HHS have realized that in non-Medicaid expansion states where as many as 40% of exchange enrollees would be Medicaid eligible, the Pinal County insurance exchange collapse would be a disaster. Low income and poor people would not be eligible for subsidies and would have to pay full price to gain insurance - they couldn't afford it. Middle income and upper income people can't so how could they?
1
The first step to truly solving the entire mess of health insurance in America is to extend to ALL Americans the right to buy health insurance using pre-tax-dollars. This will eventuallly MERGE the EMPLOYED adn UNEMPLOYED risk pools. Only after ALL Americans can claim a full 100% tax deduction for their health insurance premiums on their federal income tax returns will the system finally begin to heal. The corrupting "unequal income tax treatment of health insurance payments" has fragmented America's health insurance risk pools, with Wall street cornering the most profitable, healthiest, EMPLOYED risk pool while the government, families, and medical providers literally "bag-holders" stuck with the UNEMPLOYED risk pool.
4
It would probably be much better to cut costs, if that could be done.
2
As long as insurance companies involved in healthcare are more involved in primarily increasing profits for their stockholders than insuring patients, we'll have problems providing adequate care to those who need it.
I give you Senator Dr. Bill Frist as an example. Yes, they need profits to cover healthcare needs but not obscene profits.
Notice how all insurance companies often have the tallest buildings in prime real estate in major cities.
I give you Senator Dr. Bill Frist as an example. Yes, they need profits to cover healthcare needs but not obscene profits.
Notice how all insurance companies often have the tallest buildings in prime real estate in major cities.
16
You do realize that more than 1/2 of all Americans with health insurance are covered by a charity, not-for-profit, or employer-based plan where the employer carries all the risk.
ONly about 35% of us have insurance with a for-profit plan where that plan is carrying the risk for medical care, and could subsequently "deny" treatment or act on behalf of shareholders in an overt way.
But it feels good to say it, right? yeah, I get that.
WR
ONly about 35% of us have insurance with a for-profit plan where that plan is carrying the risk for medical care, and could subsequently "deny" treatment or act on behalf of shareholders in an overt way.
But it feels good to say it, right? yeah, I get that.
WR
Nothing changes the underlying issue. Healthy people must pay more so that those who are "sicker" can have the fundamental human right of healthcare. The real debate must turn to our political will to eliminate the for profit motive in the delivery system. A single payer system must be the backbone of catastrophic care. The rest of the industrial world already delivers broad better outcomes at far lower costs. That should be instructive.
22
I would concede your point as long as you are aware of the premise and restrictions of a single payer system like the Europeans' or Canadians'. Not everyone gets all the newest technologies or treatments. Not everyone will get total joint replacements or renal dialysis, etc. It is only fundamental that there are limitations, otherwise, their healthcare costs would far exceed even ours. Afterall, isn't that what the United States is concerned about? Cost? If we Americans are willing to accept those terms and limitations, I'm all for it.
1
The premise and restrictions you make mention of in Single Payer systems in Europe or Canada (what about Hong Kong, Singapore, Australia, New Zealand and many more you fail to mention) and if actually true, would apply even more and to a greater extent for America which already starts the tally with 20% of its people as they are uninsured.
You also need to then work out the number of Americans who won't be able to afford the co payments for these procedures and then those who will go Bankrupt from the overall costs resulting. You will find that America has as many or worse terms or limiting factors than any in the systems you mention.
Finally...on almost all measures, the single payer systems that have Universal Coverage, at half the cost of America's system per capita, also all record better outcomes than seen in America on virtually every measure and every disease and ailment telling all that regardless of fancy tech or latest treatments, the American way is one of the worse systems used based on almost every criteria by which this Category is seen to provides its respective nations.
You also need to then work out the number of Americans who won't be able to afford the co payments for these procedures and then those who will go Bankrupt from the overall costs resulting. You will find that America has as many or worse terms or limiting factors than any in the systems you mention.
Finally...on almost all measures, the single payer systems that have Universal Coverage, at half the cost of America's system per capita, also all record better outcomes than seen in America on virtually every measure and every disease and ailment telling all that regardless of fancy tech or latest treatments, the American way is one of the worse systems used based on almost every criteria by which this Category is seen to provides its respective nations.
8
"Not everyone gets all the newest technologies or treatments. Not everyone will get total joint replacements or renal dialysis, etc." ??
I have news for you. They don't now...
I have news for you. They don't now...
2
As Albert Einstein suggested, simplify, simplify...
Medical care for all (at point of need) with all paying a fair share toward Medicare. Even the super rich will have access, as they do presently at age 65.
Medical care for all (at point of need) with all paying a fair share toward Medicare. Even the super rich will have access, as they do presently at age 65.
13
In the waning days of the Obama Administration, as the President's signature domestic policy - the ACA - shows signs of failing, I'm fascinated by HHS's attempt to spin a positive picture of this misguided approach to expanding healthcare to all Americans and making it affordable. I'd love to see the actual data and the counties chosen rather than just the spin. Note Ms. Sanger Katz's caveat about demographics.
I also wonder if the people facing 60% insurance premium increases who are not eligible for subsidies would really be that impressed by data showing a 7% potential drop in their premium costs from expanded coverage for the poor. After all, they may be facing a future with no health insurance at all. Or, presumably, they can pay the steep premiums for the new individual market - a pricey version of Medicaid with big deductibles. HHS closed off the short term insurance option that may have provided some peace of mind and financial security.
It's time to recognize that the ACA's approach has failed. We need a Medicare type option so that middle income people- and upper income as well - in the individual market can have quality coverage at reasonable cost.
Too often we forget that at least 9 million people are in the individual market and receive no subsidies. This year we need to focus on them as well as on the low income Americans we have expanded coverage to.
I also wonder if the people facing 60% insurance premium increases who are not eligible for subsidies would really be that impressed by data showing a 7% potential drop in their premium costs from expanded coverage for the poor. After all, they may be facing a future with no health insurance at all. Or, presumably, they can pay the steep premiums for the new individual market - a pricey version of Medicaid with big deductibles. HHS closed off the short term insurance option that may have provided some peace of mind and financial security.
It's time to recognize that the ACA's approach has failed. We need a Medicare type option so that middle income people- and upper income as well - in the individual market can have quality coverage at reasonable cost.
Too often we forget that at least 9 million people are in the individual market and receive no subsidies. This year we need to focus on them as well as on the low income Americans we have expanded coverage to.
24
And how many of these 9 million vote for republicans? Yet, they're still gonna complain about how unfair it is that they vote against their self interest.
…All this talk about "markets" for health insurance and for health providers when neither exist in many metro areas. Our payer and delivery system is dominated by cartels. or "oligopolies" in Economics 101 terms.
The article also misses an important point. Medicaid expansion is not "free". It is paid for in early years by Federal taxpayers (actually by Federal debt, passed on to future taxpayers). The real economic question is what is the incremental taxpayer cost for Medicaid expansion in an area versus any observed reduction in costs for the privately insured. (Note: This point reflects economics only, not the societal value of coverage for more people).
If we had efficient, true health provider "markets" wouldn't we expect costs AND prices for privately insured patients to be reduced, when a large percentage of formerly "bad debt" clients now become subsidized by taxpayers rather than privately insured patients? (Medicare and Medicaid do not negotiate prices--- they set provider prices at a level such that only the most efficient providers can cover costs)…. What incentives do health provider cartels have to become "efficient" --or care about costs or prices-- when you they can become monopolistic cartels, demanding exorbitant prices from insurers, and then blame insurers for the resultant, huge prices (both of private health services and resultant, insurer premium levels)….. Welcome to the realities of health care prices and premiums levels.
The article also misses an important point. Medicaid expansion is not "free". It is paid for in early years by Federal taxpayers (actually by Federal debt, passed on to future taxpayers). The real economic question is what is the incremental taxpayer cost for Medicaid expansion in an area versus any observed reduction in costs for the privately insured. (Note: This point reflects economics only, not the societal value of coverage for more people).
If we had efficient, true health provider "markets" wouldn't we expect costs AND prices for privately insured patients to be reduced, when a large percentage of formerly "bad debt" clients now become subsidized by taxpayers rather than privately insured patients? (Medicare and Medicaid do not negotiate prices--- they set provider prices at a level such that only the most efficient providers can cover costs)…. What incentives do health provider cartels have to become "efficient" --or care about costs or prices-- when you they can become monopolistic cartels, demanding exorbitant prices from insurers, and then blame insurers for the resultant, huge prices (both of private health services and resultant, insurer premium levels)….. Welcome to the realities of health care prices and premiums levels.
6
The basic issue with American healthcare goes deeper than Medicaid or ACA. The reality is that the entire industry is a collection of monopolies, duopolies and cartels. This drives the prices upward. All of the other problems derive from the fact that healthcare is an inelastic market compounded by the both the inefficacy and costs of these concentrations in the industry. Whatever cost savings that occur from scale are completely lost (and more) to the consumer.
Ultimately, America's failure to accept the reality that healthcare is not a functionABLE market is at the core of all the retirement, employment, political and financial problems.
Ultimately, America's failure to accept the reality that healthcare is not a functionABLE market is at the core of all the retirement, employment, political and financial problems.
34
What about taking the states that refused to expand Medicaid and turning them into a single market for ACA Exchange policies? Insurors would have to cover the entire market, or not take part in it. The market would be far larger than any state market, thus making it more profitable. Would not this make it more likely that the newly-expanded market would be more competitive?
5
Good idea. But the congressional reps from those states would block it. Remember, their goal is to make their constituents as unhealthy as possible.
They tried that with the MSPP policies in PPACA. They are almost all shut down, a victim of no carriers wanting to touch them. But for about a year, plenty of people got some really stellar insurance coverage. But carriers lost a fortune doing it.
WR
WR
Current Heathcare remains the largest subsidy by far to American private industry by the Government. As the subsidies get larger in RomnyCare (now called ObamaCare) the total costs of American healthcare get more and more expensive. The Healthcare reform of US healthcare begun 30 years ago has doubled the cost of American Healthcare as a percentage of GNP.
The rest of the advanced democratic economies from Australia, to Europe, England and Japan have a simpler and cheaper solution. Give every legal citizen or Resident of the country the healthcare that the country can afford and for those who want more let thm pay for it by themselves without government help. The result of the this "fpreogn" system is better outcomes in all measures of heathcare than the USA, and a much lower cost to the government. This type of health system also acts as a subsidy for many of our foreign business competitors. Americans refuse to accept it because they have the false belief that the rich will get better care; but that is not what the statistics show.
The rest of the advanced democratic economies from Australia, to Europe, England and Japan have a simpler and cheaper solution. Give every legal citizen or Resident of the country the healthcare that the country can afford and for those who want more let thm pay for it by themselves without government help. The result of the this "fpreogn" system is better outcomes in all measures of heathcare than the USA, and a much lower cost to the government. This type of health system also acts as a subsidy for many of our foreign business competitors. Americans refuse to accept it because they have the false belief that the rich will get better care; but that is not what the statistics show.
13
Why the Government chose to re-invent the wheel with the expensive and confusing and convoluted ACA is typical .
Rather than a simple expansion of Medicaid with incentives for carriers , tax offsets for employees and employers premiums , and addressing the even more important need to encourage people set aside funds for Long Term Care while affordable and available politicians allow compromises for special interests to cause them to " go into the kitchen to make a cake and take out of the oven something inedible " .
They do it all of the time .
Rather than a simple expansion of Medicaid with incentives for carriers , tax offsets for employees and employers premiums , and addressing the even more important need to encourage people set aside funds for Long Term Care while affordable and available politicians allow compromises for special interests to cause them to " go into the kitchen to make a cake and take out of the oven something inedible " .
They do it all of the time .
5
Very well said. +1
A simple 20 page Bill expanding Medicaid to 150% of FPL would have accomplished so much more than PPACA and incited no challenges, no political opposition, no warfare that we've endured for the last 6 years.
The whole thing is paid for with borrowed money anyway ($650B in borrowing for 2017 projected?) so why not just take care of the poor and leave the Individual markets alone. Just because NY's was a mess, why punish the rest of us?
WR
A simple 20 page Bill expanding Medicaid to 150% of FPL would have accomplished so much more than PPACA and incited no challenges, no political opposition, no warfare that we've endured for the last 6 years.
The whole thing is paid for with borrowed money anyway ($650B in borrowing for 2017 projected?) so why not just take care of the poor and leave the Individual markets alone. Just because NY's was a mess, why punish the rest of us?
WR
Maybe we should tell the whole story
One of the untold consequences of expanding Medicaid (at least in New York City) to cover uninsured people, has been that a lot of dual eligible people (medicare and medicaid) are no longer eligible for medicaid because the "financial parameters" have changed> It started in 2015. So, in order to give to some, we take away from others. The people we are taking away medicaid from, are old, disabled, and poor.
I am a firm believer in universal medical coverage and single payer, I practice in an underprivileged area, but the lack of transparency (and honesty) both by lawmakers and media is appalling.
One of the untold consequences of expanding Medicaid (at least in New York City) to cover uninsured people, has been that a lot of dual eligible people (medicare and medicaid) are no longer eligible for medicaid because the "financial parameters" have changed> It started in 2015. So, in order to give to some, we take away from others. The people we are taking away medicaid from, are old, disabled, and poor.
I am a firm believer in universal medical coverage and single payer, I practice in an underprivileged area, but the lack of transparency (and honesty) both by lawmakers and media is appalling.
35
This is not the only way Medicaid is hurting New York. The state has to pony up hundreds of billions of dollars for its share of the cost. A lot of this money is raised through local property tax. This is one of these reasons why rents are so high, even in remote rural areas.
9
Health care, note the care part, is more than having insurance and paying premiums although you wouldn't know it to look at our wealth care system. Health care means being able to see the doctor when you need to see her. It means being able to see the specialist when you need to and the one that is expert in your condition which may not be the one on your narrow network insurance plan. The "coverage" provided by most insurance nowadays is so meager that, unless we are independently wealthy, we cannot afford the care we need without worrying about going bankrupt.
Furthermore, too many of us have to worry about being unable to complete a course of treatment with the doctor we started it with. It's pure hypocrisy to tell us that having a relationship with the doctor is important while dropping them from the network. A real health care system would work for the patients. Ours doesn't and it won't until we get a system where being affordable means that the care is affordable, not just the premium. It also means that the medications are affordable, the hospitals are affordable, and that the care is of good quality.
Needing medical care for a serious condition or any condition shouldn't send a patient to the poorhouse. It shouldn't mean that we have to hire a patient advocate and pay more to get our claims properly sorted and paid. For the last 30 years our wealth care system has been based upon milking the patient for as much money as possible. What about our health?
Furthermore, too many of us have to worry about being unable to complete a course of treatment with the doctor we started it with. It's pure hypocrisy to tell us that having a relationship with the doctor is important while dropping them from the network. A real health care system would work for the patients. Ours doesn't and it won't until we get a system where being affordable means that the care is affordable, not just the premium. It also means that the medications are affordable, the hospitals are affordable, and that the care is of good quality.
Needing medical care for a serious condition or any condition shouldn't send a patient to the poorhouse. It shouldn't mean that we have to hire a patient advocate and pay more to get our claims properly sorted and paid. For the last 30 years our wealth care system has been based upon milking the patient for as much money as possible. What about our health?
42
How about a system that ENCOURAGES people to change carriers or programs every 12 months like www.healthcare.gov does? The system changes the value equations of policies every 12 months, incites chaos into the marketplace with fluid and ever changing federal interpretations of the rules, drives the insured to shop for the cheapest plan possible every 12 months, and then feigns surprise that costs are skyrocketing and people can't find a doctor?
What a joke.
WR
What a joke.
WR
1
It is insulting to people like me on Obamacare who are paying the full premium to simply talk about insurance cost only mentioning the premiums. The premiums only get you a card in the mail from the insurance company What is more important is the overall cost of the plan when you actually use it. This includes the premiums, deductibles, coinsurance and copays. Simply lowering premiums does not help people who are actually paying for the insurance.
36
To Steven,
Premiums are easy to compare because they are fixed, single numbers. Out-of-pocket (OOP) exposures (e.g., deductible, co-insurance, co-pays, etc.) are variable amounts that are not easy to compare - without knowing how much each individual paid out for a year. That is why the comparison was of premiums.
As you noted, the total cost of care = premium + OOP. Insurers almost always design plans to collect more in premiums than OOPs because premiums are guaranteed revenue all of which is collected by the insurer. That is certainly true of Obamacare. Insurers offering Qualified Health Plans on the exchanges are required to make OOPs equal the following portions of plan costs or refund excesses to enrollees: Bronze = 40% OOP; Silver = 30% OOP; Gold = 20% OOP and Platinum = 10% OOP. Those are the maximum OOP percentages allowed.
Now back to the study. Premiums on the federally operated ACA exchanges were 7% lower. And OOPs can be no more than a fixed percentage of total cost, so they would each be reduced by 7% as well.
BTW: If you are self-employed or paying your health care costs with your own funds, you are eligible to deduct either all or anything over 10% of your income. If you take these deductions, you are getting subsidized health care coverage.
And, you are benefiting from discounts likely to be 30%+ of physician costs and 55%+ of hospital costs. The uninsured truly pay full charges
Premiums are easy to compare because they are fixed, single numbers. Out-of-pocket (OOP) exposures (e.g., deductible, co-insurance, co-pays, etc.) are variable amounts that are not easy to compare - without knowing how much each individual paid out for a year. That is why the comparison was of premiums.
As you noted, the total cost of care = premium + OOP. Insurers almost always design plans to collect more in premiums than OOPs because premiums are guaranteed revenue all of which is collected by the insurer. That is certainly true of Obamacare. Insurers offering Qualified Health Plans on the exchanges are required to make OOPs equal the following portions of plan costs or refund excesses to enrollees: Bronze = 40% OOP; Silver = 30% OOP; Gold = 20% OOP and Platinum = 10% OOP. Those are the maximum OOP percentages allowed.
Now back to the study. Premiums on the federally operated ACA exchanges were 7% lower. And OOPs can be no more than a fixed percentage of total cost, so they would each be reduced by 7% as well.
BTW: If you are self-employed or paying your health care costs with your own funds, you are eligible to deduct either all or anything over 10% of your income. If you take these deductions, you are getting subsidized health care coverage.
And, you are benefiting from discounts likely to be 30%+ of physician costs and 55%+ of hospital costs. The uninsured truly pay full charges
14
While this is all true but it does not address the actual cost problem. It just moves the money around. Basically, all of it (the tax deductions, ACA, premium caps, etc.) are just Band-Aids. The point is that someone will pay more and that someone could be you sometime later if your circumstances changes.
The American healthcare needs major surgery and has needed it for 20+ years. Its failure to address the core problem in a more holistic fashion back in the 1990s when it was a more manageable problem is exactly the reason why we are here now.
The American healthcare needs major surgery and has needed it for 20+ years. Its failure to address the core problem in a more holistic fashion back in the 1990s when it was a more manageable problem is exactly the reason why we are here now.
9
Anyone who gets health insurance via an employer gets subsidized health insurance, because it's income not taxed. Costs the government $250 billion a year.
4
The governors and/or state legislators that have refused to expand Medicaid are already hurting the entire populations by foregoing hundreds of millions of dollars in tax money.
If an injection of cash won't cure them, only a heart transplant and grafting a soul may save them from the fires below.
If an injection of cash won't cure them, only a heart transplant and grafting a soul may save them from the fires below.
23
Maybe they are hurting entire populations or not.
But where do you think the 'tax" money comes from? Just rains in from the heavens above??
Many rejected the unfunded mandate as they saw the funding only lasting a few years, then the states' take over.
If the states' want it, they will get it via voting. If they don't, they won't. By states, I mean the population.
But where do you think the 'tax" money comes from? Just rains in from the heavens above??
Many rejected the unfunded mandate as they saw the funding only lasting a few years, then the states' take over.
If the states' want it, they will get it via voting. If they don't, they won't. By states, I mean the population.
5
care at one facility, no less one that may be in proximity to where they live.
I'm all for this expansion but not when access and care are so problematic
for patients at a most vulnerable time.