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Old 09-11-2013, 08:17 PM   #261
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There are some positive and negative quotes in this article, but the federal hub looks like it will be ready for business in 3 weeks.

Obamacare’s data hub insurance network is completed, White House officials say - The Washington Post

This sounds encouraging. I live in a state which will not be setting up its own exchange, so I have been waiting to hear some good news about the federal exchange system.
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Old 09-11-2013, 09:14 PM   #262
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There are some positive and negative quotes in this article, but the federal hub looks like it will be ready for business in 3 weeks.

Obamacare’s data hub insurance network is completed, White House officials say - The Washington Post
Time will tell how well the system works and how vulnerable it is to hacking. Personally I'm very glad I do not have to sign up during 1st yr roll-out of ANY gov't program, especially one this complex.
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Old 09-11-2013, 10:03 PM   #263
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Time will tell how well the system works and how vulnerable it is to hacking. Personally I'm very glad I do not have to sign up during 1st yr roll-out of ANY gov't program, especially one this complex.
You will also be able to purchase off exchange through insurance providers website or ehealthinsurance instead of the exchange provided you are not needing to access a subsidy. At my present understanding, I imagine I will be purchasing off exchange. Not for security reasons, but for increased options that will not be on the exchange. Especially if there is not an HSA available on exchange through my state.
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Old 09-13-2013, 06:10 PM   #264
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Iowa is one of the states where the feds will run the exchange.

Their state officials are ready to release rate information, perhaps without waiting for the opening of the exchange on the 1st.

Sure wish my state would.

http://www.desmoinesregister.com/art...nclick_check=1

Health Insurance Marketplace Participating Insurers Confirm Their Commitments | Iowa Insurance Division

Quote:
A recent national publication comparing seventeen states who have published rates so far uses the second lowest “Silver” plan, which meets a medium set of standards to be met for coverage offered in the marketplace, as a comparative standard. While prices vary across Iowa’s seven geographic pricing regions, central Iowa’s second-lowest monthly premium for the silver level plan rate for a 40-year-old non-smoker is $219.69. Only two of the states in that national report listed lower rates on this measure than Iowa’s.
Iowa will be one of relatively few states that have explicitly announced a tobacco use surcharge.

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Factors of age, location and smoker status will result in differences in rates for Iowans. For instance, the 40-year-old smoker’s monthly rate for the silver plan would be $329.32 instead of $219.69.
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Old 09-13-2013, 06:38 PM   #265
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Wow, that's $1200 more a year on top of what the cigarettes cost.

Expensive habit.
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Old 09-13-2013, 06:51 PM   #266
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Wow, that's $1200 more a year on top of what the cigarettes cost.

Expensive habit.
And it's 100% on the insured. Any subsidy calculation is made on the base amount.
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Old 09-13-2013, 08:15 PM   #267
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Wow, that's $1200 more a year on top of what the cigarettes cost.

Expensive habit.
That would be tough to prove unless the government tested monthly, used expensive hair sampling or used random testing. And then if one was caught, what would be the worst that could happen?
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Old 09-13-2013, 08:35 PM   #268
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Well has Orwell ever been wrong:-)?

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Old 09-14-2013, 05:09 AM   #269
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I suspect any significant amount of lying about smoking would be used as rationalization for restructuring health insurance applications to contain a smoke-free discount instead of a smoking surcharge, thereby requiring all of us to subject ourselves to some medical test to prove we're not a smoker, if we want to get the discount, meaning the discount would would be eaten up, at least in part, by the fee for the medical test and the cost of our time to do it every year or two or three. Then there would be the black market for the testing, so the group would pay the added freight of a non-smoking discount given to a smoker, with an unscrupulous lab benefiting on the side.

None of this is really unusual - it's basically the way other things work. There's a discount for folks who drive short distances to work, but people lie. The insurance pool the liar is in pays the added freight for the higher risk. Auto insurance also generally requires cars are in safe operating condition, but in the past there were unscrupulous mechanics in states where the inspections are done by private mechanics who took money to pass a car that failed the tests. It actually ends up with various new costs, associated with the individuals who would engage in such unscrupulous practices, being laid on everyone. Our state's inspection system now has inspectors who inspect the inspectors. The testing machines are certified and sealed, and test results are strictly electronic and encoded, so that they cannot be fudged, adding a bit more cost for everyone.

So like all honor systems, there's probably going to be a cost to everyone associated with those who won't engage the system with honor.
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Old 09-14-2013, 07:14 AM   #270
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they are saying a smoker surcharge but what it really means is anyone who uses tobacco. If you have nicotine from snuff, nicotine gum, electronic cigarettes or any other nicotine producing product how could they tell the difference? so if you use products that produce nicotine, you are labeled tobacco and have to pay the surcharge. If you tell them you do not use tobacco and in the course of blood tests yearly, they detect nicotine, how will they know what product produced it and what would be the penalty?
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Old 09-14-2013, 09:02 AM   #271
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My spouse is subject to the employer health insurance smoker surcharge due to Nicorette use. The foundation of the surcharge is not only the effects of carcinogens (like tar), but also nicotine, which although it is not classified as a carcinogen, it has been noted to directly cause cancer through a number of different mechanisms, and has several indirect impacts, such as promoting tumor growth. There are also concerns about nicotine causing birth defects. But most directly, there is a concern about how nicotine increases blood pressure and heart rate in humans, contributing to a set of problems unrelated to cancer.
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Old 09-14-2013, 09:08 AM   #272
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You all make good points on the declaration and verification of tobacco use.

I suspect the surcharge scheme is further flawed when there is an arbitrary 50% surcharge.

I think it's important to draw a distinction between smokers' long-term health outlook versus short term. If a smoker is shopping for life insurance, a premium bump is very logical. Once a policy is written, the risk reward relationship is set for as long as the insured keeps paying his premiums. Smoking increases the likelihood of a fatal disease taking one's life sooner than the others in your age cohort. This is an observable fact at the time the policy is written, and can be calculated "fairly" on an actuarial basis.

Health insurance has different math. Is it a verifiable fact that annual (or even lifetime) health care expenses are exactly 50% greater for tobacco users at all ages? I doubt it.

Add in politics, the verification issues, the exclusion of subsidy on the surcharge and the fact that tobacco use is the only lifestyle or health condition that does not fall under the PPACA's pre-existing condition rules, and it's pretty clear that the tobacco use penalties are just that, penalties.

Fair? Maybe, maybe not. My point is that the whole tobacco surcharge issue is mathematically suspect, and as such will be the subject of continuing debate as the PPACA system evolves.
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Old 09-14-2013, 09:08 AM   #273
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they are saying a smoker surcharge but what it really means is anyone who uses tobacco. If you have nicotine from snuff, nicotine gum, electronic cigarettes or any other nicotine producing product how could they tell the difference? so if you use products that produce nicotine, you are labeled tobacco and have to pay the surcharge. If you tell them you do not use tobacco and in the course of blood tests yearly, they detect nicotine, how will they know what product produced it and what would be the penalty?
I try to find the logic in this but can't. Being punished for using nicotine gum or mints and being treated like a smoker is wrong. My doctor has said they are fine and you can be on them indefinitely provided you have no serious heart problem. FDA even said they are safe to use indefinitely. Yet Two Ton Tessy (or Ted) gets a free pass for gorging themselves into serious if not numerous health issues and gets a free pass.
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Old 09-14-2013, 01:48 PM   #274
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So if someone in Colorado 'smokes' something legal in that state, that doesn't contain nicotine. They are a 'nonsmoker'. But chew on a piece of gum and your now a smoker. Yea I get that.

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Old 09-14-2013, 02:25 PM   #275
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Right or wrong it is nothing specific to ACA. All insurance having tobacco usage surcharges but they don't test for smoking other substances. ACA was somewhat patterned after existing group health plans which typically include a tobacco usage question. In group plans they would probably deny claims for things found to be tobacco related. In the individual market they would cancel your policy. But why would you be using nicotine gum unless you were a smoker.

Government declared war on tobacco almost 40 years ago, obesity is just now getting attention so it may get a hit in the future.

Maybe it would be better to put a health tax on the actual tobacco product at point of sale rather than penalties on the insurance premium.
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Old 09-14-2013, 07:25 PM   #276
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Thanks for a very reasonable explanation.
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Old 09-14-2013, 08:05 PM   #277
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Right or wrong it is nothing specific to ACA. All insurance having tobacco usage surcharges but they don't test for smoking other substances. ACA was somewhat patterned after existing group health plans which typically include a tobacco usage question. In group plans they would probably deny claims for things found to be tobacco related. In the individual market they would cancel your policy. But why would you be using nicotine gum unless you were a smoker.

Government declared war on tobacco almost 40 years ago, obesity is just now getting attention so it may get a hit in the future.

Maybe it would be better to put a health tax on the actual tobacco product at point of sale rather than penalties on the insurance premium.
That has already been done, the Tobacco settlement effectively imposed a tax on Tobacco. This is the source of funding states used to issue some bonds. Its also why the price is so much higher than it was relative to inflation.

Note that the Texas High Risk pool used to have 2 sets of rates one for smokers and one for non smokers. Which is an example of what was cited above.
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Old 09-15-2013, 07:30 AM   #278
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Note that the Texas High Risk pool used to have 2 sets of rates one for smokers and one for non smokers. Which is an example of what was cited above
most states have a health insurance surcharge for smokers or people using nicotine. but under ppaca a lot of the states do not have the surcharge.


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But why would you be using nicotine gum unless you were a smoker.
this is the same as asking why would anyone use energy drinks or drink espresso. they want the energy push.
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Old 09-15-2013, 08:16 AM   #279
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So simple to solve and not really worth the extensive discussion.

1) Give it up
2) Do not give it up, smell bad, pay more, live a shorter life.

IMHO This should apply to Medicare also. Smokers should pay more as they are a far greater burden on the system. Seems straight forward to me.
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Old 09-15-2013, 08:28 AM   #280
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IMHO This should apply to Medicare also. Smokers should pay more as they are a far greater burden on the system. Seems straight forward to me.
Well, I don't want this to stray too far into ideology of things -- this isn't the place for it -- but I would say that if we're going to go down this road, we have to realize that "healthy" lifestyles put a greater burden on Social Security and public pensions because they are living several years longer on average, thus collecting more benefits. So shouldn't they receive lower benefits to compensate for it?

Then, one can also say, "why single out smoking? Why not target alcohol, junk foods, supersized portions, et cetera?" Pretty soon we'd have a bureaucracy calculating the "public cost" of everything we do and don't do.

We need to be really careful about opening Pandora's Box, as applying principles (like "their lifestyles are costing me money!") consistently can create a *lot* of unintended consequences. This is why, for now, we should just keep it simple and perhaps "health care surcharges" for using unhealthy products might be better levied on the products themselves (at some point in the future). But for now, we deal with what we actually have, and how we prepare for it.
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