2016 Exchange Rates- OUCH

[Mulligan]

Quote:

Originally Posted by meierlde Actually all the other regulation in the ACA will stay just no subsidy. The case is a narrow one. Now after this what may happen is another question. (Also High deductable cat plans will still be outlawed pending any changes in the law)

Exactly and I wonder if many people are even aware. ACA has cost me dearly but SC could really stick it to me if they rule against exchange subsidies. Many forward thinking states could just simply set up an exchange, but my state wont even consider it in its present constitution. It focus's its attention on more important things such as writing legislation making Sharia law illegal in our state. You know, the important stuff!


Sent from my iPad using Tapatalk

[ERhoosier]

Quote:

Originally Posted by Free_at_49 Healthcare cost is already too high, and quality is very low by international standards. Especially when you compare with countries that have universal care that covers everything. You can download the data directly (PDF) from the World Health Organization.

While I fully agree that US HC costs are far too high and do not consistently produce better outcomes than some other developed nations, quality in US is certainly not "very low". The wiki (1st) link you cite is of a 15 yrs old and highly suspect WHO ranking system. Can it be seriously argued that US HC system delivers inferior care to that of Greece, Cyprus, Dominica, etc. Or that UK HC system is also inferior to Greece

IMHO- A more relevant comparo is to current care given by some of the better facilities in Mexico. Some US insurers are already starting to cover care delivered there.
http://www.usatoday.com/story/news/n...acare/8517917/
I believe that as US HC costs continue to rise, this 'medical tourism' will grow as well. I have no problem with this so long as quality of actual care delivery (measured independently & objectively) meets reasonable standards and folks realize the possible pitfalls of seeking care outside their own nation.

[Free_at_49]

Quote:

Originally Posted by ERhoosier While I fully agree that US HC costs are far too high and do not consistently produce better outcomes than some other developed nations, quality in US is certainly not "very low". The wiki (1st) link you cite is of a 15 yrs old and highly suspect WHO ranking system. Can it be seriously argued that US HC system delivers inferior care to that of Greece, Cyprus, Dominica, etc. Or that UK HC system is also inferior to Greece IMHO- A more relevant comparo is to current care given by some of the better facilities in Mexico. Some US insurers are already starting to cover care delivered there. Health care, and patients, go south — to Mexico I believe that as US HC costs continue to rise, this 'medical tourism' will grow as well. I have no problem with this so long as quality of actual care delivery (measured independently & objectively) meets reasonable standards and folks realize the possible pitfalls of seeking care outside their own nation.

I think you can google and fetch reports for any year.

[ziggy29]

Mine was up over 25% last year, wouldn't be surprised to see the same next year. BCBSTX has been the only "player" in my part of the state, which sucks in terms of lack of competitive pressures on rate increases. But as I am no longer going to be on my Exchange plan as of 6/30, it's a moot point for me. At least for now.

[AllDone]

Charles Gaba (who follows the rate increase very closely) is estimating an overall average increase of 5.4% next year although there are clearly some insurers who are asking for much more:

Obamacare 2016 premiums: Insurers ask for big rate hikes

[MichaelB]

Percentage increases without any reference or framework to give them relevance are exciting to the media (and us) but of little benefit.

We know the average cost of healthcare in the US in 2014 from this source 2014 Employer Health Benefits Survey | The Henry J. Kaiser Family Foundation Last year (2014) large group policies for high deductible plans averaged $5.3K per individual and $15.4K for families. Increase that by 5% for 2015 and 2016 and this sets the baseline. Add the age differential and one can see how far from the average one is currently paying. Prices will trend toward this mean ($486 per month before age) in most major metropolitan areas for "average" policies. I would guess that the closer one's current premium is to this number the lower the expected increase for 2016.

[AllDone]

There's another, non-political analysis out this morning that looks pretty good in historical terms:

Avalere Health : Lowest-Cost Exchange Premiums Remain Competitive in 2016; Consumers may be able to keep increases small by selecting a low-cost silver option

[eta2020]

Quote:

Originally Posted by ERhoosier While I fully agree that US HC costs are far too high and do not consistently produce better outcomes than some other developed nations, quality in US is certainly not "very low". The wiki (1st) link you cite is of a 15 yrs old and highly suspect WHO ranking system. Can it be seriously argued that US HC system delivers inferior care to that of Greece, Cyprus, Dominica, etc. Or that UK HC system is also inferior to Greece IMHO- A more relevant comparo is to current care given by some of the better facilities in Mexico. Some US insurers are already starting to cover care delivered there. Health care, and patients, go south — to Mexico I believe that as US HC costs continue to rise, this 'medical tourism' will grow as well. I have no problem with this so long as quality of actual care delivery (measured independently & objectively) meets reasonable standards and folks realize the possible pitfalls of seeking care outside their own nation.

US healthcare is good compared to lets say Brazil or Hungary but not compared to Advanced Economies. (France, Italy, Germany....)

But if you have huge sums of money it is probably best in the world. No surprise wealthy people from all around the world come to US for treatment.

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally - The Commonwealth Fund

[MichaelB]

The Commomwealth Fund is an excellent source of analysis of health care issues, but this international comparison is weak IMO.

- It is a ranking, not a scoring. The difference between one "place" and another is relevant but not included. Last does not mean bad.

- It includes access to healthcare more than once, over-weighting that aspect on it's scale.

- It includes lifestyle, which affects health but really is not a core part of the healthcare system.

In all, the scale tends to more heavily weight some aspects that we know are weakest in the US. In fact, in the core health measures, what they call "quality care", the US scores are in the middle. This becomes relevant because the ACA has focused heavily on access to care, and major inroads here should result in a substantial improvement in the US ranking. We shall see if TCF reflects this in their next update.

[eta2020]

Quote:

Originally Posted by MichaelB In all, the scale tends to more heavily weight some aspects that we know are weakest in the US. In fact, in the core health measures, what they call "quality care", the US scores are in the middle. This becomes relevant because the ACA has focused heavily on access to care, and major inroads here should result in a substantial improvement in the US ranking. We shall see if TCF reflects this in their next update.

We are moving in a right direction.

In support of free_at_49 notice how we score on almost identical place in longevity as in tables for Health Care. So do many other countries (but certainly not all).

https://en.wikipedia.org/wiki/World_...ystems_in_2000
https://en.wikipedia.org/wiki/List_o...ife_expectancy

It is very interesting is't it?

This is my last post on this "Hot Topic"

[marko]

Quote:

Originally Posted by Fermion I will just point out that if they get rid of the subsidies, the requirement to cover pregnancy for a 60 year old man will also go away. Premiums should go down then.

I don't see how there is ANY cost of covering a 60 y.o. man for pregnancy. So I don't see how that would affect the premiums.

Covering a 60 y.o. man against heart attack, sure, as there is an obvious cost and likelyhood.

[HFWR]

I, for one, am happy that pregnancy is rare in 60 yo men...

[samclem]

A minor suggested change, shown below:

Quote:

Originally Posted by MichaelB We know the average cost of healthcare private health insurance in the US in 2014 from this source 2014 Employer Health Benefits Survey | The Henry J. Kaiser Family Foundation

Total healthcare costs are higher than the costs of health insurance premiums (due to co-pays and other OOP costs).

Further, the cost of private insurance may differ considerably from the cost of public health care (which is not directly related to the issue under discussion, but just bears mentioning)

[Ian S]

Quote:

Originally Posted by meierlde Actually all the other regulation in the ACA will stay just no subsidy. The case is a narrow one. Now after this what may happen is another question. (Also High deductable cat plans will still be outlawed pending any changes in the law)

It may indeed be a narrow decision but the consequences are apt to be huge for everyone in the individual insurance market even those not getting subsidies. Many getting subsidies and who are healthy will opt to go uninsured and because the non-subsidized rates are so high, those opting out will likely be exempt from the tax penalty. Meanwhile, the sicker folks will hang onto their insurance and without the healthier folks, rates will increase, more folks will drop out, and the cycle will continue possibly becoming what's called a "death spiral." Insurers will pull out of those states most affected. More uninsured will show up in ER's and the hospitals will have to treat them. But the ACA reduced payments to hospitals under the reasonable assumption that there'd be far fewer uninsured going to ERs with the ACA in place. The reduced payments remain reduced even with the increase in costs for hospitals treating the uninsured. The worst hit hospitals may wind up closing. It's apt to be a disaster for many more than those getting subsidies in the affected states.

So glad I'll be going on Medicare next year. Unfortunately, I'm not sure even Medicare will escape fallout from any unraveling of the ACA.

[MichaelB]

Quote:

Originally Posted by samclem A minor suggested change, shown below: Total healthcare costs are higher than the costs of health insurance premiums (due to co-pays and other OOP costs). Further, the cost of private insurance may differ considerably from the cost of public health care (which is not directly related to the issue under discussion, but just bears mentioning)

Valid point, your suggested change makes my post clearer. Thanks..

[samclem]

IF the Supreme Court agrees with King about the "four little words," and the subsidies are barred for federal exchanges, I think there's little doubt that many states will quickly work with the federal government to put their state logos on the federal website and do whatever cosmetic steps need to be done to satisfy the letter of the law--making the exchanges "theirs". Their residents will receive subsidies when they go to the exchanges.

Some states will not go along with this. Those presently insured through their employers would remain largely unaffected (except the employer mandate would go away, but most people who get insurance through their employers post ACA already got it that way pre-ACA), all insured through Medicare and Medicaid would remain unaffected. I'd imagine in these states a new market in "non-ACA compliant" high deductible policies would make it possible for many people now on the exchanges to remain insured at reasonable costs. But there will be a lot of people falling through the cracks (esp the sick). This will increase the costs and probably build pressure for those states to establish ACA exchanges or for establishment of an alternate framework from Washington that allows the federal money (paid in part by the residents of those states) to flow to those states and provide benefits. And that "alternate framework" might provide a vehicle for many state laboratories on ways to deliver high-quality care at lower costs. I doubt that anyone thinks the "old way" or ACA is optimum, so we agree there's room for improvement. We can bet Oregon will take a different road than Texas, and maybe we'll figure some things out that benefit everyone.

But we'll know soon if all this thought is wasted effort. Regardless of the result, I don't think there is cause for panic.

[InTheSticks]

Quote:

Originally Posted by Ian S Many getting subsidies and who are healthy will opt to go uninsured and because the non-subsidized rates are so high, those opting out will likely be exempt from the tax penalty.

I realize this is anecdotal, but here is an example of ACA not working. A friend of mine was complaining that his HI premium was going to increase from $400/month to $800/month in 2014. So he dropped his HI. He also mentioned that he had to pay a $900 penalty for 2014. With a 1% of income penalty, I estimate his MAGI at 90k. I have told him that the penalty will go up for the 2015 tax year. He was already aware of this. As background, He and his wife are self employed. They are both in their mid 50s. They are both pretty healthy and don't smoke.

He's in a bad spot income wise, too much for subsidies and too little for the premium to still be a significant part of his income.

I don't know what to tell my friend. I wish he and his wife would get HI. But, I can't be pushy about it. I just hope they don't get sick or injured.

Thanks for listening.

[utrecht]

Quote:

Originally Posted by Ian S . Many getting subsidies and who are healthy will opt to go uninsured and because the non-subsidized rates are so high, those opting out will likely be exempt from the tax penalty.

What makes you think those opting out will be exempt from a penalty? I doubt the law says you can opt out penalty free if your rates are too high.

[samclem]

Quote:

Originally Posted by utrecht I doubt the law says you can opt out penalty free if your rates are too high.

It kinda says that. From a CRS paper:

Quote:

Certain other individuals (and their dependents) may be exempt from the penalty, including any individual whom the Secretary of HHS determines to have suffered a hardship with respect to the capability to obtain coverage under a qualified health plan. In addition, individuals (and their dependents) whose household income is less than the filing threshold for federal income taxes for the applicable tax year will not be subject to a penalty, as well as those whose required contribution for self-only coverage for a calendar year exceeds 8% of household income.11 After 2014, the 8% will be adjusted to reflect the excess rate of premium growth above the rate of income growth for the period.12

And I vaguely recall there was another rationale that would eliminate penalties if the subsidies went away, but I can't point you to it.

[marko]

Quote:

Originally Posted by utrecht What makes you think those opting out will be exempt from a penalty? I doubt the law says you can opt out penalty free if your rates are too high.

I think the point was that the law would no longer be in effect.