ACA Federal Marketplace updates

[samclem]

Luckily the entities which drafted this legislation and those charged with implementing it had 100% access to everything they needed to determine the complexity of the task ahead. All the private, state, and (especially) federal IT systems involved in health care insurance, payment, and delivery were known in advance. I am sure the administration will not gripe about states making late decisions about implementing various portions of the law when HHS itself has moved deadlines back to permit this very thing.

Opponents of the legislation raised many of the same issues concerning complexity and the inherent difficulties that are now being raised by those who favor the ACA. In that sense, I suppose we can say that the ACA has helped to build a bipartisan concensus, which is a good thing, right? Now, let's trust those who fought for the job of establishing this new system. The legislation has not enjoyed majority support, so those implementing it have a golden opportunity to change some minds.

 

[Gatordoc50]

Why are you switching from talking about the exchanges themselves to talking about point of service? We were talking about the exchanges.

But the states did... I'm pretty sure that's what I mentioned earlier, that started this portion of the thread.

Sorry, didn't mean to hijack the thread. It doesn't really matter if we are a few months late. What matters is that we are going to get universal care at higher quality and with less cost.

 

[Mulligan]

Good points. One other major task may be the need to interface with other legacy systems that sponsor or are involved in health care for the needy, such as CHIPS and Medicaid. That must be a nightmare.

I was reading an article from USVI, and setting these things up are expensive, way beyond what I could conceive. Article said each state exchange alone will cost between
30-50 million dollars. On a side note, if you are hell bent on avoiding Obamacare and still want to live in the US, you can move to a US territory including USVI and avoid it. I am sure they have top notch medical facilities. St. John doesn't even have a hospital.

States can opt to use an exchange set up by the federal government, but territories like the U.S. Virgin Islands do not have that option, she said. Building an exchange from scratch is typically costing states between $30 and $50 million, Phillips-Dorsett said. "That cost is why several states have opted to have the federally run exchange."

 

[samclem]

"That cost is why several states have opted to have the federally run exchange."

Yes, and some states reported they couldn't get answers from the federal government that would allow them to establish a compliant exchange. Some state leaders remarked that the lack of flexibility allowed under the law resulted in little perceived benefit to setting up a state exchange--if the federal government will be making the important decisions and determinations anyway, some governors saw no advantage to spending their state resources in this area.
The reluctant states can hop in later, after the federal government offers more clarity on how these exchanges will be run, and after some of the lead states have made their mistakes. And if things end up changing >a lot<, the states that waited could look pretty smart. It would be especially interesting if some of the contiguous smaller (population) states set up pooled exchanges--voluntarily harmonizing their insurance laws and regulations so more companies will participate in these markets. That's something the federal government can't do for them, and which might make a big difference in costs and quality of service.

 

[bUU]

Luckily the entities which drafted this legislation and those charged with implementing it had 100% access to everything they needed to determine the complexity of the task ahead.

And still the states that didn't like the law dragged their feet, and did whatever they could, really, to try to make what they were legally-obligated to do into a failure.

Isn't politics grand?

Opponents of the legislation raised many of the same issues concerning complexity and the inherent difficulties that are now being raised by those who favor the ACA.

So you're saying that they had a vested interest in dragging their feet and otherwise interfering with the success of the program through political sabotage, so that their earlier claims, which they presented because their politics didn't want the goals of ACA to see the light of day, wouldn't be proven wrong. So you're saying that this was all just a matter of critics of ACA trying to save face?

Sam: Seriously: This isn't the right forum for such political debate, even if hidden in sarcasm. If you have something constructive to say about ACA, then please share. Otherwise, let's stop with the criticizing and so we can stop with the defending.

Deal?

 

[pb4uski]

If the PPACA is a national law, why have 50 monkeys each building similar houses at $30-50 million a pop. Why not have the big gorilla build a 50 unit apartment building that the 50 monkeys can use?

I can see that each monkey may decorate their apartment differently to meet their unique needs, but the basic apartment would be the same for each.

Sort of like how a commercial software vendor designs and maintains software that it sells to companies and each company can modify it as they need to but are responsible for the mods when new releases are made.

 

[travelover]

If the PPACA is a national law, why have 50 monkeys each building similar houses at $30-50 million a pop. Why not have the big gorilla build a 50 unit apartment building that the 50 monkeys can use?

I can see that each monkey may decorate their apartment differently to meet their unique needs, but the basic apartment would be the same for each.

Sort of like how a commercial software vendor designs and maintains software that it sells to companies and each company can modify it as they need to but are responsible for the mods when new releases are made.

Because the opponents of the ACA painted it as "big government taking over your healthcare decisions". Allowing everyone to build their own monkey house was a sop to these concerns. All part of the sausage making process.

 

[ERhoosier]

The smell of bacon increases as the political comments move farther OT.
I still think a thread like this could be good for sharing reliable info on actual updates re ACA Fed Marketplace system. IMHO- at this point speculation regarding why more progress has/has not been made is not useful to those who will may need to get their HI via this system (warts and all) in just a few short months. I expect (& hope for!) increasing volume of info to become available as Oct 1 approaches.

 

[Gatordoc50]

http://www.miamiherald.com/2013/06/14/3451683/one-month-later-florida


An update on Florida. Florida is one of the states that has opted not to form a state exchange but rather use the federal exchange. Florida is in the process of overhauling it's Medicaid but not expanding it to the point of covering everyone who doesn't qualify for the exchange.

 

[Gatordoc50]

http://www.miamiherald.com/2013/06/14/3451683/one-month-later-florida

An update on Florida. Florida is one of the states that has opted not to form a state exchange but rather use the federal exchange. Florida is in the process of overhauling it's Medicaid but not expanding it to the point of covering everyone who doesn't qualify for the exchange.

The article didn't come up! Dang!

 

[ERhoosier]

The article didn't come up! Dang!

Is this the article?

TALLAHASSEE: One month later, Florida lawmakers no closer to Medicaid deal - Florida - MiamiHerald.com

 

[Silver]

Thank you Gator and Hoosier. I appreciate the update.

 

[rbmrtn]

I looked at https://www.healthcare.gov/ today, looks like the site has been relaunched with a new interface.

 

[Gatordoc50]

Is this the article?

TALLAHASSEE: One month later, Florida lawmakers no closer to Medicaid deal - Florida - MiamiHerald.com

Yes, thank you,

 

[ERhoosier]

I looked at https://www.healthcare.gov/ today, looks like the site has been relaunched with a new interface.

Big improvement over old site. But sad to see this "update" is still seriously out of date.
-Glossary still does not include specific dollar figures (individual/family) for 2014 out-of-pocket maximum costs, which have been known for some time now.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit

-Site still lists SHOP as opening enrollment Oct 1, 2013.
https://www.healthcare.gov/small-businesses
While some states have their own SHOP (or equivalent), months ago HHS delayed federal program until 2015.
HHS Delays Basic Health Plan Option Until 2015 – Capsules - The KHN Blog

- IMHO- More than semantics. Site still terms the penalty for having no qualified HI in 2014 a "fee". SCOTUS clearly ruled this levy is a "tax", and there are important differences between a gov't "fee" vs a "tax".
https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014

 

[cabermj]

This is a pretty interesting article that outlines the challenges involved in setting up the exchanges and provides some insight on current progress.

States brace for web barrage when health reform goes live - NBC News.com

 

[kmt1972]

See

UnitedHealth to exit individual insurance market in California - latimes.com

"The nation's largest health insurer, UnitedHealth Group Inc., is leaving California's individual health insurance market, the second major company to exit in advance of major changes under the Affordable Care Act."

"I don't think this is a good result for consumers," said California Insurance Commissioner Dave Jones. "It means less choice, less competition and even more consolidation of the individual market with three big carriers."




I wonder how many insurers will participate in the NY State exchange. I assume it should at least one which is Blue Cross-Blue Shield.

Blue Cross-Blue Shield Bets Big On Obamacare Exchanges - Kaiser Health News

“The Blues will definitely participate,” said Ana Gupte, an insurance stock analyst for Dowling & Partners. “If there is an exchange I’m sure there will be the Blues.”


Of course looking at the NY State website on health insurance exchanges

http://www.healthbenefitexchange.ny.gov/

It has no real info on how it will work or which insurers will participate. And we are only about 3 months from when this exchange will open.

 

[Htown Harry]

I wonder how many insurers will participate in the NY State exchange.

New York has some unique considerations, as described in this article:

Obamacare could lower premiums in New York, new study finds

In answer to your question, ehealthinsurance.com currently lists 5 companies offering individual health insurance policies. The number offered on the exchange will be more, less or the same.

Individual and Family Health Insurance Companies in New York

• Easy Choice Health Plan of New York
• EmblemHealth
• Empire
  
• MVP
• Oxford NY

 

[MichaelB]

In answer to your question, ehealthinsurance.com currently lists 5 companies offering individual health insurance policies. The number offered on the exchange will be more, less or the same.

How can you be sure?

New exchange policies in NY will definitely be a major improvement over the current guaranteed issue policies available to individuals. I used those policies for many years. They are expensive, have poor coverage and low limits and are only useful to individuals that have no other choice.

 

[Mulligan]

See

UnitedHealth to exit individual insurance market in California - latimes.com

"The nation's largest health insurer, UnitedHealth Group Inc., is leaving California's individual health insurance market, the second major company to exit in advance of major changes under the Affordable Care Act."

"I don't think this is a good result for consumers," said California Insurance Commissioner Dave Jones. "It means less choice, less competition and even more consolidation of the individual market with three big carriers."

I wonder how many insurers will participate in the NY State exchange. I assume it should at least one which is Blue Cross-Blue Shield.

Blue Cross-Blue Shield Bets Big On Obamacare Exchanges - Kaiser Health News

“The Blues will definitely participate,” said Ana Gupte, an insurance stock analyst for Dowling & Partners. “If there is an exchange I’m sure there will be the Blues.”

Of course looking at the NY State website on health insurance exchanges

http://www.healthbenefitexchange.ny.gov/

It has no real info on how it will work or which insurers will participate. And we are only about 3 months from when this exchange will open.

I am curious about the amount of competitors in my state, but the silence has been deafening so far on this. Blue Cross is much cheaper currently than anyone else is in the individual market in my state. I am curious if the competition will get better on the exchanges. "Blue" just sent me a letter jacking up my insurance $11 this week effective August 1, so they are not missing out on a chance to make a few more bucks before Jan. 1.

 

[MichaelB]

I am curious about the amount of competitors in my state, but the silence has been deafening so far on this. Blue Cross is much cheaper currently than anyone else is in the individual market in my state. I am curious if the competition will get better on the exchanges. "Blue" just sent me a letter jacking up my insurance $11 this week effective August 1, so they are not missing out on a chance to make a few more bucks before Jan. 1.

Is that an annual renewal rate, and does that mean your new policy rate is guaranteed through 7/2014 ?

 

[Mulligan]

Is that an annual renewal rate, and does that mean your new policy rate is guaranteed through 7/2014 ?

Michael, their form letters seem to create more questions than answers on everything. They rounded up the usual lengthy list of suspects for reasons of the rate increase, but also said only some of them may apply to each individual. My increases have always occurred at this year and is effective starting August 1. It did not mention anything about it being guaranteed through next July. In fact a previous letter a month ago mentioned " new and exciting plans" starting January 1. I took this as a cryptic statement that the current plans will all be scrapped and we will be forced into these January 1.
But yet on this current letter it also mentioned if you are unhappy with the rate increase, you can undergo underwriting for different higher deductible to save on premium costs. But it specifically mentioned to be aware of your grandfathered plan status and what that entails by dropping it for another plan. And yet, who would bother to do the underwriting just for 4 months, and then be put into the exchange?
It's almost like they want everything to appear as it always has been, then drop the bomb at the last second. They definitely are not wanting to tip their hand on anything it seems concerning next year. I also found it interesting I got hit with my biggest rate increase this year. The previous 3 years it had increased a combined amount from $71 to $76. Now it jumped to over $87. I realize that is still cheap compared to others for a $5500 deductible, but I am 48, so I do not think I crossed an age band, but they won't divulge that either, just listed as one of possible reasons why my rate increased.

 

[bUU]

They rounded up the usual lengthy list of suspects for reasons of the rate increase

So it sounds like there is nothing different going on - that, just like they've done year after year in the past, they're increasing their rates again this year.

The only difference next year is that if their rates are "too high", they will have to refund some money. They haven't had to do that in the past. I bet that really eats at them, perhaps enough to foster disinformation and deceptions that get picked up and carried by the media, leading folks to believe that the changes are bad, when the reality is that the changes are merely bad for them. That sounds like a reasonable thing to do, i.e., for the insurance company to try to do things that would tend to work to reverse changes that harm the insurance company profits.

 

[Mulligan]

So it sounds like there is nothing different going on - that, just like they've done year after year in the past, they're increasing their rates again this year.

The only difference next year is that if their rates are "too high", they will have to refund some money. They haven't had to do that in the past. I bet that really eats at them, perhaps enough to foster disinformation and deceptions that get picked up and carried by the media, leading folks to believe that the changes are bad, when the reality is that the changes are merely bad for them. That sounds like a reasonable thing to do, i.e., for the insurance company to try to do things that would tend to work to reverse changes that harm the insurance company profits.

I got a refund of $21 last year, so I think they have to refund already. I could get more info from a psychic than I can from BCBS. Their customer service agent couldn't even confirm I even have a grandfathered plan, though I should. After thinking about it, maybe I have been a little to hard on them as any company will always pass through the costs of government mandates. When I went to the doctor 3 years ago, I had to pay for the doctor visit. This time it was paid for by my insurance though I have been on the same plan. The visit to my doctor was $105 (I get one "free" wellness visit per year now, even though I was not aware of it, as I assumed my plan was grandfathered and wouldn't pay for that). If you divide that "free" doctor visit by 12 months, that is almost $9, so really I guess my rate increase was only about $2 per month.

 

[bUU]

You're correct: That portion of ACA has already gone into effect. Thanks for the correction.