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Old 05-23-2012, 06:09 AM   #41
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I would think all of the state high-risk pools would be moving over to normal insurance coverage. Plus a bunch of "self-insured" people who perhaps have pre-existing conditions that precluded private insurance and didn't want to pay the high-risk pool prices.
Unfortunately, I suspect it will be more the other way. I suspect that the "regular" insurance without limitations for pre-existing conditions will be priced closer to the high-risk pool prices. It may not be as bad for the 20 somethings but I expect it to be true for the 50+.
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Old 05-23-2012, 08:34 AM   #42
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A few posters in this thread have said that PPACA won't increase affordability or reduce uncertainty around costs for healthcare. However, I don't really understand this position since it includes caps at about 10% of income (tables go up to 400% of FPL). In addition there is the limit that different age tranches can't cost more than x3 and that medical loss ratio can't exceed 80%.

Are folks who are saying that there will still be large cost uncertainty expecting income well beyond 400% in ER? or do they see the capped cost as too high? What am I missing?
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Old 05-23-2012, 09:02 AM   #43
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I didn't read every post, but Obamacare will make me more worried about the future and less likely to spend freely on discretionary items.

We are getting into a situation where massive tax increases and/or entitlement means-testing will be necessary. Either one will cost me a lot of money.
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Old 05-23-2012, 09:05 AM   #44
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Originally Posted by photoguy View Post
A few posters in this thread have said that PPACA won't increase affordability or reduce uncertainty around costs for healthcare. However, I don't really understand this position since it includes caps at about 10% of income (tables go up to 400% of FPL). In addition there is the limit that different age tranches can't cost more than x3 and that medical loss ratio can't exceed 80%.

Are folks who are saying that there will still be large cost uncertainty expecting income well beyond 400% in ER? or do they see the capped cost as too high? What am I missing?
Everything I read suggests that cost uncertainty will indeed be reduced by several PPACA mechanisms. But total cost (already much higher than any other developed country period) will be as high or more likely higher. Reducing the uninsured - folks who can't get insurance due to pre-existing conditions or other reasons and folks who can't afford insurance - would only add cost all else being equal. But there's a lot I don't know/understand still...
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Old 05-23-2012, 10:54 AM   #45
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So in Mass this is a great program for those of low income, where the taxpayers (commonwealth care) pick up your premium.

If you're a couple and make $75K, you have to come up with $12K a year of added insurance expense...(or move 15 miles north to NH).

More interestingly, the couple break for "comm care" is $65K but the state won't let you deduct the $12K that would bring a $75K family under the wire.

Also, Mass won't let you deduct the $12K from your State income tax.
The MA reforms have removed the worry about getting insurance, but the way you pay for insurance and the overall costs need to improve. I would like to see a progressive phase out of eligibility for Commonwealth Care and subsidies rather that a strict $35k income limit and obviously costs need to be controlled. The current market forces have failed to do that so maybe the new MA cost legislation will help.

As a 50 year old guy thinking of ER guaranteed access to reasonably priced insurance means one less thing to worry about which is why I'll stay MA resident as long as I'm in the USA.
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Old 05-23-2012, 12:41 PM   #46
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Originally Posted by photoguy View Post
A few posters in this thread have said that PPACA won't increase affordability or reduce uncertainty around costs for healthcare. However, I don't really understand this position since it includes caps at about 10% of income (tables go up to 400% of FPL). In addition there is the limit that different age tranches can't cost more than x3 and that medical loss ratio can't exceed 80%.

Are folks who are saying that there will still be large cost uncertainty expecting income well beyond 400% in ER? or do they see the capped cost as too high? What am I missing?
People recognize that:
--The PPCA does almost nothing to limit the growth of spending on medical care (expressed as a percent of GDP, if you choose). As you point out, it does attempt to limit the cost of insurance for some folks. See the problem? The money for care will have to come from somewhere. Many people with the resources to retire believe they'll be seen as a handy source of these funds. So, from a big-picture perspective the PPCA doesn't decrease my level of uncertainty.
-- Regarding the cost and availability of care for myself and my family--that's another problem. I think it might take a lot more time to see a doctor than it used to. And as waiting lists increase, the market for cash-only services will probably become more robust (a good thing, in my view, but something for which we didn't budget).

In about a month the SCOTUS will have ruled and the next phase of the transformation can begin.
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Old 05-23-2012, 01:59 PM   #47
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I didn't read every post, but Obamacare will make me more worried about the future and less likely to spend freely on discretionary items.

We are getting into a situation where massive tax increases and/or entitlement means-testing will be necessary. Either one will cost me a lot of money.
+1 Compounding the problem is virtually no politician wants to tackle the isue, for fear of losing their re-election bids. So, the problem keeps growing like a cancer..........
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Old 05-23-2012, 11:21 PM   #48
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Obamacare Is a gonner........ movin on........
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Old 05-24-2012, 07:13 AM   #49
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Obamacare Is a gonner........ movin on........
Not that I would mourn a total wipe out by SCOTUS, there are many elements that will be highly favored by a large number of Americans. Congress will be forced to address health care.

Now if SCOTUS upholds the healthcare law, congress will be focused more on ripping out what is perceived as unworkable or unacceptable. Making workable changes will be difficult but without doing something our uncertainty will continue into the indefinite future.

It would probably be better for the process if SCOTUS does let a new congress start over. The current law was done as a total "cram down". The last minute passage in the Senate using their only means of passage (without amendment) prevented making many fixes.

Floggings will continue until morale improves!
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Old 05-24-2012, 07:37 AM   #50
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It would probably be better for the process if SCOTUS does let a new congress start over. The current law was done as a total "cram down". The last minute passage in the Senate using their only means of passage (without amendment) prevented making many fixes.
I strongly disagree that we would be better off starting over. If the whole bit is thrown out we will probably wait another 15-20 years to get meaningful reform just as we did after the 1993 debacle. Nothing about the makeup of the current or likely future congresses indicates that compromise will be reached without drastic external pressure. We had a poll in which 75% of us concluded that it would be better to revise the PPACA than to start over. If the PPACA is as bad as many think the pressure will be intense to fix it -- but only if it survives. If SCOTUS throws out the mandate while leaving the rest intact, we could also see meaningful reform since the cost implications of no prior conditions coupled with no mandate would create intense pressure to compromise. Who knows, we might actually see something useful in the lame duck this year -- debt and health care. Wouldn't that be a change?
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Old 05-24-2012, 09:44 AM   #51
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Midpack/Samclem -- thanks for your response. I do understand that if coverage is being expanded to a greater percentage of Americans there is significant possibility of overall additional costs which may have to be paid by expanded taxes. Still as an individual/couple with modest assets I think I will benefit significantly from PPACA.

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People recognize that:
--The PPCA does almost nothing to limit the growth of spending on medical care (expressed as a percent of GDP, if you choose).
Do you not consider the creation of Accountable Care Organizations (ACOs) part of attempt to limit medical spending? or tying of reimbursement to medicare star ratings? Or do you see this as too little?

Stephen
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Old 05-24-2012, 10:17 AM   #52
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Do you not consider the creation of Accountable Care Organizations (ACOs) part of attempt to limit medical spending? or tying of reimbursement to medicare star ratings? Or do you see this as too little?
No one has seen an ACO yet, it's just a concept put into the legislation. Normally one would recommend pilot studies, maybe a single-state test, etc. Instead, we'll get to see it on a national basis. Maybe it'll work.
I'm more optimistic about the health care exchanges in general, especially if there's some mechanism by which health care consumers benefit when their overall healthcare expenses are low. It can't be so much that folks put off needed care, but I want Mr Smith to at least ask the Doc why he needs an MRI for his sprained ankle.
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Old 05-24-2012, 11:16 AM   #53
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I'm more optimistic about the health care exchanges in general, especially if there's some mechanism by which health care consumers benefit when their overall healthcare expenses are low. It can't be so much that folks put off needed care, but I want Mr Smith to at least ask the Doc why he needs an MRI for his sprained ankle.
I'm hoping that is the case, and higher deductibles should lead people to question a little more rigorously when tests are prescribed. Still, I remember the last time I tried that on behalf of DW - the doctor's office said they had no idea of the cost, the hospital agreed only to give me the list price of the test, and the insurance company said the 'agree" price was not my concern and that I should plan to pay the deductible amount. Multiple calls and efforts to escalate (ineffective) only resulted in hard feelings and a scolding (by them to me) by the insurance co reps that I was wasting their time.
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Old 06-15-2012, 06:24 AM   #54
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The decision from SCOTUS should be known any day now. I am getting anxious.
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Old 06-15-2012, 10:22 AM   #55
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The decision from SCOTUS should be known any day now. I am getting anxious.
I admit that I am too as I have followed it with interest. Though I don't really know of the ramifications either way for me, since I purposely got an individual HI plan prior to its initial implementation to avoid the mandates and costs.
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Old 06-15-2012, 10:34 AM   #56
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The amazing part, to me, is that we've heard no "leaks" regarding the deliberations and back-and-forth of the Justices. There are lots of clerks involved in the research needed to write the opinions that will accompany this decision, and I haven't read anything resembling a hint of the outcome. Surely some folks are getting rubbed the wrong way, and that normally (in politics, business, etc) results in disgruntled folks talking to their pals. Apparently this effective secret-keeping is the norm--the SCOTUS has a good record for keeping their work under wraps until the designated official unveiling.
A little advance notice of the ruling could make somebody a LOT of money via the options market.
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Old 06-15-2012, 11:07 AM   #57
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Medicare in six months; DW five months after that (sorry, don't care about U; we have our own life to live).
If Obamacare passes, and people learn to live with it -- my guess is that after a couple of years of operation, anyone trying to repeal it would be lynched, cf. those wonderful pictures of people holding placards saying "Keep Government out of Medicare" -- then presumably at some point the US Government will wake up to the fact that it has its finger in the healthcare pie in multiple ways, and perhaps some merging will take place.

The most shocking thing for me is that the US Government already spends about as much on health care as European governments (what with military, federal employees, Medicare etc) and yet doesn't leverage that to get better value. When the French Health Minister calls Pfizer or Roche to tell them how much he's prepared to pay for tablet X, they listen.
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Old 06-15-2012, 11:48 AM   #58
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The OP was about the 'risk' aspect. I suspect that most employers have already figured out what they'll do.

If it remains as is, many have told me that they'll drop their current coverage and 'allow (send) the employees out to get their own' i.e. discontinue the benefit.

The 'risk' seems to be not so much over Obamacare but in the lack of clarity in general business regulations.

Again, most employers I know are holding off from hiring because they don't know what that employee will cost them, what their corporate taxes will be and what the cost of added (and yet to be defined) regulations are.
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Old 06-15-2012, 12:39 PM   #59
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.......... When the French Health Minister calls Pfizer or Roche to tell them how much he's prepared to pay for tablet X, they listen.

When Pfizer or Roche call up our politicians to tell them how much they will contribute to their endless campaigns, they listen.
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Old 06-15-2012, 01:09 PM   #60
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I'm hoping that is the case, and higher deductibles should lead people to question a little more rigorously when tests are prescribed. Still, I remember the last time I tried that on behalf of DW - the doctor's office said they had no idea of the cost, the hospital agreed only to give me the list price of the test, and the insurance company said the 'agree" price was not my concern and that I should plan to pay the deductible amount. Multiple calls and efforts to escalate (ineffective) only resulted in hard feelings and a scolding (by them to me) by the insurance co reps that I was wasting their time.
Yes, there definitely needs to be price transparency. Price shopping is impossible even when you explain that you're self pay.

Another way to decrease health care costs is graduating more physicians. The US has too few doctors, especially GPs, when compared to western European countries. Too few doctors means longer waits and higher costs.

Also, non-emergency may well decrease when there are better options for the current un- or barely insured.*

"The Effect of Insurance on Emergency Room Visits: An Analysis of the 2006 Massachusetts Health Reform"

New Jersey Demonstration Reduces Non-Emergency ER Visits By 22% | Capacity Management


*8-27% of ER visits are non-emergencies. We already pay for these visits even though they're not a line item on the 1040.
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