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Old 11-13-2012, 09:28 AM   #41
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+1 To me health insurance serves two purposes - 1) avoid catastrophic financial loss if DW or I were to have an accident or major illness and 2) gain access to negotiated rates for medical services rather than being charged the rack rate and having to negotiate every time we need service.

My 2013 premiums will be 13% higher than 2012, principally due to mandated increases to benefits (all of which will be of no benefit to me in my personal situation so I am ending up subsidizing the expansion of benefits).

The problem is that too many medical care consumers are spoiled by getting almost free medical services for a low co-pay or co-insurance charge so the mindset isn't that if they have the human equivalent of oil changes, brake pads and rotors, etc. that they should pay for those things out of pocket and many consumers are so short-sighted that they will defer "maintenance" unless it is free or close to free.

I would like to see health insurance structured as two pieces - 1) a high deductible plan that allows consumers to avoid catastrophic financial loss and gain access to negotiated rates and 2) optional coverage for more routine items that is in effect similar to a budget plan for services. While I concede that the bronze/silver/gold plans amount to the same thing, I think it is less transparent than a HDHP with a budget plan rider.

Contraception is a good example. One of the expanded benefits that is driving my 2013 increase in premiums is mandated contraceptive benefits. Back in the old days, we paid for this out-of-pocket and it was our personal responsibility. It's not hugely expensive and there are outlets for those who have trouble affording it.

i believe under Obamacare you will NOT be able to get your plan anymore. all plans must conform to Obamacare rules
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Old 11-13-2012, 10:25 AM   #42
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I know human beings and houses are not the same but I'm going out on a limb here - who buys house insurance expecting it to repaint the walls, re-stain the deck, or pressure wash the sidewalk. All of those things are good for your house/property but you don't buy insurance for them. We've lost sight of the fact that health care (i.e. general wellness of your body) and health insurance are two different things. Yes they overlap but they're not the same.
Agree. That's part of what is wrong with all of it. We don't have health insurance, we have a paid for healthcare system, usually being paid for by ones employer.

It's complicated by the fact that the rules for Group plans are different from individual plans. In one you can't be denied coverage, then in the other insurance companies can cherry pick you they sell to.
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Old 11-13-2012, 10:28 AM   #43
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That's an interesting site. I looked at the various options, read the FAQs, checked various zip codes throughout MA... everything looks very expensive. DW and I chose a $10k deductible for our Georgia-based policy and I realize that's not available in MA. But even when I compare $4k deductible plans the GA plans are $200-300 less expensive. Then there's the co-insurance thing for MA - this medical insurance problem is way out of control!
The lower deductibles and higher cost of living in MA compared to GA accounts for the differences in premiums. Also MA is historically one of the most expensive states for healthcare.

I do not like the structure of most health insurance schemes or the funding mechanism, but the MA system is a compromise between those that wanted a single payer system and those that wanted to keep the system on a private insurance model with limited Government interference. It has been popular in MA, although there are difficulties with the size of the premiums, particularly for those with incomes that are just a bit above 3x poverty level so they don't get any subsidy.
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Old 11-13-2012, 10:33 AM   #44
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I know human beings and houses are not the same but I'm going out on a limb here - who buys house insurance expecting it to repaint the walls, re-stain the deck, or pressure wash the sidewalk. All of those things are good for your house/property but you don't buy insurance for them. We've lost sight of the fact that health care (i.e. general wellness of your body) and health insurance are two different things. Yes they overlap but they're not the same.
Only insuring for catastrophic illnesses might end up being more expensive if people decide not to treat chronic illnesses that could be easily treated early on, and then develop into acute conditions that are expensive to cure.
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Old 11-13-2012, 12:14 PM   #45
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Only insuring for catastrophic illnesses might end up being more expensive if people decide not to treat chronic illnesses that could be easily treated early on, and then develop into acute conditions that are expensive to cure.
True, but the same case could be made for preventative checkups compared to chronic illnesses. The question is where to draw the line and how to get people to take personal responsibility for their health.

The thing that bites me is that because many people are irresponsible and don't go in for preventative checkups or treat chronic illnesses the government mandates the level of benefits and then I will likely be denied from buying health insurance for only catastrophic illness if that is what I want and all that I need (and is working for me).

So once again, the irresponsible are coddled and the freedom of those who would be responsible is compromised.
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Old 11-13-2012, 12:15 PM   #46
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i believe under Obamacare you will NOT be able to get your plan anymore. all plans must conform to Obamacare rules
I think you are right and I'm not happy about it. See prior post.
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Old 11-13-2012, 12:20 PM   #47
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I think you are right and I'm not happy about it. See prior post.
I'm sure you'll be able to keep it.
"If you are happy with your present plan, you'll be able to keep it." We all heard it, and certainly this promise will be kept.
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Old 11-13-2012, 12:23 PM   #48
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I agree. One minor frustration is the PPACA categorizes the US into high, medium and low cost regions (to be used to determine cost of premium) but I can find no public source that shares that information with the rest of us.
The regions are supposed to be set up and maintained by the Several States. In California, AB 1083 sets the 19 regions to be used within the state and the mechanism to be used to revise the regions periodically. More here on AB 1083: http://openstates.org/ca/bills/20112012/AB1083/
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Old 11-13-2012, 12:26 PM   #49
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It's not fair to compare MA's accept all applicants health insurance costs with today's underwritten HI that can reject anyone who look vaguely like they might someday get sick. MA will be more expensive. And in 2014, that will spread to the rest of us. I will be bummed if I can't get an HSA high deductible plan, but at least I will be able to get insurance.

I'm not holding my breath for the details yet. Heck, we don't even know what our taxes will be in 2013. 2014 seems a long way off yet.
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Old 11-13-2012, 12:53 PM   #50
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I'm sure you'll be able to keep it.
"If you are happy with your present plan, you'll be able to keep it." We all heard it, and certainly this promise will be kept.


I'd forgotten about that.
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Old 11-13-2012, 02:38 PM   #51
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Since most Americans favor repeal of the law, it may be difficult to get the funding passed (in the House) to allow the federal government to set up exchanges. On the other hand, once some states set them up and the federal subsidy checks start flowing in, residents of the states dragging their heels may pressure their legislators to get off the dime so they can get the subsidies, too (especially since their own tax dollars are used to pay them)
Or...maybe not.

Poll: Support for Obamacare repeal is plummeting

Shows 33% want repeal post-election.

Link to the actual Kaiser article:

http://www.kff.org/kaiserpolls/upload/8382-F.pdf

I looked at your link. The healthcare repeal poll results given that are within the last 4 months are all from Rasmussen Reports. Since the devil is in the details with polls I went to that web page:

Health Care Law - Rasmussen Reports™

You will note that the Rasmussen Reports polling is based upon "likely voters" not the adult population at large. There are two issues with that. "Likely voters" aren't "most Americans." For example, I'm not a likely voter since I determined that given expected results in my locale I could not possibly make any difference in any race I could vote in. But, I am an American.

Second, well, I pretty much think that everyone knows that Rasmussen Reports' determination of who was a "likely voter" didn't turn out to be entirely accurate. I won't belabor that point here but those interested can look it up.

There is also a link to the survey question and the question on repeal doesn't differentiate as to why someone might want repeal. That is, there are people who oppose the Act because they think it doesn't go far enough and they would prefer to see a single payor system.

Another point is that the poll is pre-election. The link I gave earlier is interesting in showing the polling and how it has changed post-election.
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Old 11-13-2012, 03:05 PM   #52
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I'm sure you'll be able to keep it.
"If you are happy with your present plan, you'll be able to keep it." We all heard it, and certainly this promise will be kept.
I am hopeful that will be the case for a while. My BCBS individual 5500 deductible plan, just started an incentive plan to help pay part of your deductible if you stay under your limit for something like 3 years or so. I'm hoping they wouldn't have went to the effort of starting it this year if it wasn't going to be in effect 3 years down the road to benefit from it. Kind of odd they started this anyways as it is the cheapest plan where I live by far anyways, so it doesn't increase the incentive to stay with it.
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Old 11-13-2012, 03:08 PM   #53
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IMO, the time when football season 2013 starts is when to focus more on the health insurance exchanges as it's just too early right now to get anything concrete. At the high level, it's good to remember that the landscape might be pretty different come 2014, but that's about how far I wish to dive into the bits and pieces for now.
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Old 11-13-2012, 03:21 PM   #54
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Or...maybe not.
I wouldn't put KFF in the camp of impartial observers, either. Nor the WashPo. And since it's been just a week since the election and we are talking about a change in public attitudes toward PPACA since then, I'm afraid we'll have to wait and see more data.

It's interesting that the KFF poll shows no increase in those who want to keep the law as is or "expand it", it just shows an increase in those who refused to answer/were unsure and a decrease in those who wanted to scrap it/possibly go with something else. Still, less than 50% of the people polled supported the law as is or want to expand it. (So, to your earlier point, those who like the law as-is plus those who "think it didn't go far enough" still don't total a majority).

Maybe something happened on election day, and the PPACA will become popular. If so, it is something new, as the legislation, in its entirety, has very seldom shown any signs of support from a majority of Americans regardless of who did the poll. The past is not as significant as what happens next. As we move from sloganeering, posturing, and bumper stickers to a good, hard look at what we're getting, the public's reaction is bound to be . . . interesting.

But, I'll certainly concede that pollsters can be very wrong.
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Old 11-13-2012, 04:30 PM   #55
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News update. The elections are over and implementation of the PPACA is underway and moving along with a full head of steam.

Here's a brief that discusses grandfathered plans http://www.ncsl.org/documents/health...heredPlans.pdf I would imagine availability of current plans will depend mostly on insurance companies and their willingness to maintain the hundreds of different plans they currently offer. The overhead must be high and once they cannot exclude or deny insurance they may focus much more in internal efficiencies.

Public support has been strong for most of the provisions since the beginning, certainly all those covering guaranteed issue, no exclusions for preexisting conditions, and simplified policy language. It increased after the Supreme Court ruling.
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Old 11-13-2012, 04:52 PM   #56
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News update. The elections are over and implementation of the PPACA is underway and moving along with a full head of steam.

Here's a brief that discusses grandfathered plans http://www.ncsl.org/documents/health...heredPlans.pdf I would imagine availability of current plans will depend mostly on insurance companies and their willingness to maintain the hundreds of different plans they currently offer. The overhead must be high and once they cannot exclude or deny insurance they may focus much more in internal efficiencies.

Public support has been strong for most of the provisions since the beginning, certainly all those covering guaranteed issue, no exclusions for preexisting conditions, and simplified policy language. It increased after the Supreme Court ruling.
Based on my reading and understanding of your link, I am thinking my grandfathered underwritten plan must be profitable or they wouldn't be instituting incentives to stay in it long term. I got a small rebate check even though I only pay $76 a month anyways, so they must be making too much profit on it already. I assume then they don't want to risk losing you into the exchange program. More incentive for an insurance company to keep a group of healthier than normal population walled off from the exchange competitors, maybe? That is the only answer I can come up with.
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Old 11-13-2012, 05:38 PM   #57
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News update. The elections are over and implementation of the PPACA is underway and moving along with a full head of steam.
"News update:" The law still faces court challenges, there's no funding for some of its key provisions, and any success it achieves will require support in the Congress. So keeping an eye on public support for the law is important to us all (supporters and opponents alike), and definitely a subject worthy of discussion. In the past, sweeping legislation (Medicare, Medicaid, Social Security, etc) has generally been crafted to gain widespread support. Regardless of political viewpoint, I think we can all agree that's not what happened with PPACA. Without that support, implementation of the law will continue to face rough sledding. That's not a political statement, it's just a reflection of reality.

For those interested, the National Conference of State Legislatures maintains a site showing the PPACA implementation actions by state.

Click on your state for more info.
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Old 11-13-2012, 06:54 PM   #58
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The original purpose of this thread was to provide updates on the roll outs of state insurance exchanges, not speculate on whether this will be implemented or not. Implementations details are not yet available so we will have to postpone that part of the discussion. Challenges to the law are fair game, but really should be taken up in a new thread dedicated to that.
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Old 11-16-2012, 07:39 AM   #59
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An update: Secretary Sebelius has granted an additional extension that was requested by the RGA.

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The postponement came in response to a request from the Republican Governors Association and its chairman, Gov. Bob McDonnell of Virginia.

./.

In a letter to the Republican governors on Thursday night, Kathleen Sebelius, the secretary of health and human services, said they would have until Dec. 14 to decide whether they wanted to establish their own health insurance exchanges. The federal government will create an exchange in any state that is unable or unwilling to do so.
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Old 11-16-2012, 08:01 AM   #60
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Another update: Wisconsin's Governor Walker signaled yesterday that Wisconsin would not form a state-run exchange. That means the federal government will likely set up the exchange there, as in many other states.
From this link (Milwaukee Journal-Sentinal):
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"I'd much prefer control at the state level," Walker told The New York Times, "but the problem is, I don't think they are really state-run."
"Why do I want to take on the potential risk to my taxpayers if I don't really have any true authority about what's going to happen?" Walker added.
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