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Almost sounds to good to be true.

The subsidies to insurance companies and tax credits to individuals is the "Affordable" part of the name ACA.

Forcing people to have it was one of the most important provisions because it forces young healthy people to buy into it so their premiums can be used towards older and/or sicker people.

Take those two components out and you killed the while thing.

Under ACA health insurance companies basically became the same as electric utilities.

In exchange for a huge increase in volume of insurance premiums, the insurance companies agreed to a profit cap (in some states) but also a guaranteed profit. They now make their money more off volume that managing the cost of healthcare. If healthcare costs double due to greater access and the elimination of yearly caps and pre-existing conditions, they insurance companies double their premiums and still get their guaranteed profit.

Electric utilities have a monopoly over a service area and their rates are controlled by a Public Utilities Commission in each state to give them a guaranteed profit.

What are the medical expenses currently being paid by society for charitable write-offs, Medicaid and Medicare for those who are uninsured and seek primary and non-emergency care from hospital ERs because they cannot afford insurance?

The ACA still doesn't hit on the growing costs of healthcare. The subsidies only give the appearance that health insurance is more affordable. After all it is the taxpayers that fund the government and ultimately these subsidies. Costs will continue to go up because the patient (healthcare consumer) will continue to over utilize insurance which distorts the cost. Basic healthcare services and regular screenings and procedures shouldn't be something we use insurance to cover. These are things that should be paid out of pocket. The reason people can't afford to pay for it out of pocket today is because of those that have insurance and use insurance to pay for their services. Doctors don't have to list prices and compete with other offices because consumers don't care. They just walk in with their $20 copay and price isn't a concern. I understand most people couldn't afford cancer treatments and other catastrophic care. This is what insurance should be for. Premiums would be lower because claims would be paid to a much smaller number of people. Not everyone is going to have cancer or a preexisting condition requiring constant medical attention.

Who cares about controlling the cost of healthcare. The insurance companies now get their 15% profit on the volume of throughput.

They used to have a vested interest in controlling costs but we didn't like that they did things like max caps, pre-existing conditions denial, and higher rates for women than men to pay for pregnancy.

Yea they will just charge higher premiums to take care of the pass through and consumers will not choose the cheaper competitor.

Remember when folks thought competition actually worked?

The industry is moving (and has been for a long time) from pay for production to pay for performance.

Does that prove they no longer care about costs and are jacking premiums up or the opposite?

LOL - is that so?

Premium cost is varried geographically. I've not seen anything solid one way or another. Especially anything actuarily sound taking into consideration all variable.

I am well aware of the cost to premium ratio but to think they in no way will attempt to lower costs as a result is a stretch at best. It is still in their best interest to lower costs.

We used to base provider referal pools on projected costs (for profit HMO) and often had to readjust when costs came in lower than projected (thus cutting checks to off set the difference). Haveing a lower than expected cost over any time period was still a good thing. We still got ours and the cheaper our product the better.

On the other side (working for a health system) we negotiated percent of premium contracts with insurance companies in which we got X% of the total premium collected (I'm over simplifying a bit). I didn't see an effort to increase or lack of effort to decrease cost there.

Let's hope not. Although it is ironic to think it is the democrats that want this to fail while it is the republicans attempting to defund or delay it. To delay it would be a death nell and they know it (thus why they are trying to do so).

I don't like it either, but I sort of think the dems really want it to work. It may not, but it is a weird argument all the way around.

Unfortunately any given providers revenue stream is still often 60% or more from Medicare and Medicaid. Those programs still drive the boat in many ways.

TW most normal D's do.


It will fail no matter who gets their way.

^ closer to my opinion other than they got a money grab and more customers

When I worked for the for profit HMO we paid most of our providers (not hospitals etc) an average of 1.4 RBRVS. 1 times RVRBS was Medicare payment. RVRBS is calculated using time, resources, local costs etc..... I am way over simplifying but spent a lot of time calculating RVRBS in the private and public sector if anyone really wants to dealve that deep into it.

As an aside My HMO had a 25% admin rate ie for every buck we collected in premium we spent 75 cents on medical expenses. When we went percent of premium we forced them down to 15%


In our area, every area is different, we paid our docs less than most. I moved to the provider side and this is what I found.

Most payors paid us 1.6ish RVRBS. Our charges were around 1.8RVRBS. We were actually paid at a fairly high rate compared to the rest of the country relative to RVRBS which varies geographically itself.

The only people ever paying us at billed charges were the private pay folks. Medicare paid 1, Medicaid paid less than 1 (don't remember maybe .75), aggressive HMOs paid 1.3-1.4, indemnity paid 1.6ish etc.

Part of my job was to negotiate these contracts using our utilization and costs. The problem was costs were in no way related to charges.... thus we had no data on cost we could use to validate our charges and our charges were not relative or rellavant to anything. Not uncommon.

There is no way for a physician or large group of physicians to manipulate RVRBS in any substantial form. Their associations argue back and forth on with some success but there is a larger (aggregate) component that comes into play meaning to increase in one place means a decrease is necessary in another.

http://www.youtube.com/watch?v=Nzzkb8JtgTk

He is s deek and it was a bad answer. It is also disengenuous gamesmenship by they other side. they are all deeks.

Has anyone ever compared admin costs between the two?

Here is a disengenous answer of my own. The govt will always tell you Medicare admin cost is 2ish% while private insurance is being maxed at 15% in the exchanges. Its apples to oranges though and everyone should know that.

Insurance Manager: ‘We Have Yet To Have Someone Successfully Register On The Marketplace’


Overloaded websites and jammed phone lines frustrated consumers for a second day as they tried to sign up for health insurance under the nation’s historic health care overhaul.

That was putting pressure on the federal government and the states that are running their own insurance exchanges to fix the problems amid strong demand for the private insurance plans.

“I think I’m through with Hawaii Health Connector,” said Richard Gamberg, 61, of Honolulu, after tweeting messages to officials and complaining to state lawmakers on Wednesday. “They’ve got ads in the newspaper, they’ve got ads on the TV — it just flabbergasts me.”

He was among the would-be customers in Hawaii who were still unable to buy insurance policies online Wednesday, forcing them to turn directly to insurance companies to examine their options. In Oregon, officials said a faulty online calculator would not be fixed until late October.

The delays that continued Wednesday offered one good sign for President Barack Obama and supporters of his signature domestic policy achievement, demonstrating what appeared to be exceptionally high interest in the new system. But the problems also could dampen enthusiasm for the law as Republicans use it as a rallying cry to keep most of the federal government closed.

“It’s day two of health care reform, and we have yet to have someone successfully register on the marketplace,” said Matt Hadzick, manager of a Highmark retail insurance store in Allentown, Pa., where people could go to register for the online insurance marketplace. “The registration process is very slow, and at one point it just shuts down.”

The sweeping changes under the Affordable Care Act include federal subsidies to make insurance more affordable for low-income consumers and preventing health insurance companies from denying coverage to people with pre-existing conditions. That will open the door for coverage to many people who have been locked out of the insurance market.

In California, home to 15 percent of the nation’s uninsured, officials took down the enrollment portion of the Covered California website for emergency upgrades. It was restored at mid-morning Wednesday, and 7,770 people had started applications by then, spokesman Roy Kennedy said.

California is one of a handful of mostly Democratic states that opted to set up their own exchanges rather than let the federal government do it for them. In the 36 states being operated by the federal Department of Health and Human Services, consumer patience was being tested.

Agency spokeswoman Joanne Peters said many Americans successfully enrolled on the first day, but she declined to put a number on it. She said the delays were due to “overwhelming interest” and high volume.

The delays come three months after the congressional Government Accountability Office said a smooth and timely rollout could not be guaranteed because the online system was not fully completed or tested.

The bumpy debut has the hallmarks of a technology project that may have rushed to meet the Oct. 1 deadline, said Bill Curtis, chief scientist at CAST, a software quality analysis firm, and director of the Consortium for IT Software Quality, which develops standards.

“It almost reminded me of going online and trying to buy Springsteen tickets,” said Sharon Schorr of suburban Cleveland, a self-employed accountant who finally gave up after eight hours of trying to use the exchange’s website.

With websites crashing, those who have been trained to explain the benefits under the federal law were trying to reach out to those who could be helped by the exchanges, handing out information at public transit hubs and holding town hall meetings in smaller communities.

Without online access, however, they could not actually guide people through the enrollment process.

“I’ve been unable to get in, and if I could have that would be great,” said Donene Feist, an outreach worker who also is executive director of Family Voices of North Dakota, a nonprofit advocacy group. “For those who got in, they said it was easy to follow.”

The Obama administration hopes to sign up 7 million people in the first year, and eventually cover at least half of the nearly 50 million uninsured Americans through government-subsidized plans and a Medicaid expansion.

Many states expect people to sign up closer to the Dec. 15 deadline to enroll for coverage starting Jan. 1. Customers have until the end of March to sign up to avoid tax penalties.


http://washington.cbslocal.com/2013/10/03/insurance-manager-we-have-yet-to-have-someone-successfully-register-on-the-marketplace/



Then there's the very slim portion of America that Obamacare was carved out for to begin with...makes you really wonder when...yes when...they FINALLY admit this is a disaster.

They've had 3 full years to get this right.

Obamacare...say it with pride. It's his baby. It's his hallmark.

noise......

I want transparency in consumer costs and ability to make cost comparisons between providers (care and insurers).

The rest is all noise.


I do not accept the assertion that controlling one (or more) variables is irrelavent because things will even out somewhere along the way. Those that benefit from the fact that the system is incomprehensible have absolute zero incentive in clarifying any of it. I am not thrilled about the government stepping in to fix things, but we are a long way from any sort of consumer advocacy force being able to handle it. I'm tired of being bent over by the health care and insurance industries. I guess I'm just rather used to taking it in the butt from the goverment.

did you kill any chickens while you were there..??

The federal government has never improved efficiency by getting involved.

The fact that our current healthcare insurers are inefficient to begin with should only make you more afraid of the end result.

sounds like we need an Obamacare czar or two...