Health Insurance Exchanges under the PPACA

[MooreBonds]

There are still many initiatives in the PPACA that will be implemented in 2013 and 2014. One that has been the subject of much discussion here is State Health Insurance Exchanges. The States can run their own exchanges, individually or in partnership with other States, or allow the Federal Gov’t to run them.

Each state must inform its intention by Nov 16.
...
8 No Significant Activity: Georgia, Kansas, Missouri, North Dakota, Ohio, Oklahoma, Wisconsin, Wyoming
...
8 Decision Not to Create State Exchange: Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas

Last week's election in Missouri for the state constitutional amendment Prop E will move Missouri into the "Not to Create State Exchange" list:

Shall Missouri Law be amended to prohibit the Governor or any state agency, from establishing or operating state-based health insurance exchanges unless authorized by a vote of the people or by the legislature?

 

[ERhoosier]

Paquette-

Thanks for link, but looks like info dates back to early 2011 (e.g. "The Secretary intends to issue regulations for public comment under Section 1321(a) in 2011, but is providing this guidance earlier to assist States and Territories with their overall planning, including legislative plans for 2011."). Obviously things have happened since then
As slow as Feds move, I'm thinking offering open enrollment by Oct '13 might be optimistic.

Sebelius (HHS) is already pushing back deadlines for States submitting their details on exchanges:
http://www.foxnews.com/politics/2012/11/09/states-will-get-more-time-to-work-on-health-care-plans/

 

[samclem]

Virginia will defer to a federally-run exchange.

Link to Washington Post article here.

There are about 10 states that have laws or constitutional amendments that prohibit state employees from either running a state exchange or enforcing the individual mandate. And, unless something has changed, Congress hasn't appropriated any money for the federal government to set up exchanges for the states.

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)

 

[M Paquette]

Paquette-

Thanks for link, but looks like info dates back to early 2011 (e.g. "The Secretary intends to issue regulations for public comment under Section 1321(a) in 2011, but is providing this guidance earlier to assist States and Territories with their overall planning, including legislative plans for 2011."). Obviously things have happened since then
As slow as Feds move, I'm thinking offering open enrollment by Oct '13 might be optimistic.

Sebelius (HHS) is already pushing back deadlines for States submitting their details on exchanges:
http://www.foxnews.com/politics/2012/11/09/states-will-get-more-time-to-work-on-health-care-plans/

It depends on the state. Some states decided to wait until after the recent election before beginning to even study what was needed. They will definitely need more time. Others were already working on an exchange before the PPACA was passed. California's exchange may go live in August 2013, with open enrollment starting October 1, 2013.

 

[ziggy29]

It depends on the state. Some states decided to wait until after the recent election before beginning to even study what was needed. They will definitely need more time. Others were already working on an exchange before the PPACA was passed. California's exchange may go live in August 2013, with open enrollment starting October 1, 2013.

I suspect a lot of states will consider exchanges but likely not implement them right away. Part of this is because, as you said, a lot of states waited until after the election before investing time and money into it, and part of it may be the "you go first" factor: states may want to see the cost and efficacy of other state plans before deciding whether it's worth doing for their own state. As long as they have the federal exchange as a fallback, there's no rush to be on the "bleeding edge," so you might as well let other states be the guinea pigs.

 

[ERhoosier]

IMHO- Might take until mid-2013 (or longer) to see just how this will shake out. Much bureaucratic work still needs to be done for Oct '13 open enrollment to be workable. Some say Repub's in House could still refuse any funding for PPACA. Even if House goes along, fed debt talks could still severely reduce funding for full implementation. Then there's issue of individual states dragging their feet. IMHO- More ?'s than answers for those planning to rely on PPACA for their ER HI.

 

[nun]

If you would like an example of an exchange just go on the MA Connector site
and browse around. You'll see the costs and benefits for all the plans available in MA. It makes buying insurance easy and there's no worry about the premiums being dependent on the state of your health. Direct cost comparisons is a great way to control costs.

https://www.mahealthconnector.org/portal/site/connector

 

[nun]

OK, I looked. I'm not familiar with the details in MA, but they seem reasonable to me ( better than being denied coverage ), $360 for a bronze plan. Didn't see any high deductible plans. Seems to be a wide range in price for basically the same coverage, $346 - $551, different companies.

I do plan on being "poor" enough for subsidies, unless they start means testing

For a single the max deductible in MA is $2k and the max annual out of pocket expense is $5k so there's no really high deductible plans offered. The range in cost between different providers for the same coverage reflects the hospitals in network, some hospitals are more expensive. Of course you can go out of network with a co-pay. MA has some of the most expensive (and arguably some of the best) healthcare in the country, but premium increases last year were 2% and they are soon going to be linked to the state's growth in GDP.

If you apply for subsidized Commonwealth Care you have to fill out a form and declare all your income sources and also prove you are an MA resident.

 

[MichaelB]

If you would like an example of an exchange just go on the MA Connector site
and browse around. You'll see the costs and benefits for all the plans available in MA. It makes buying insurance easy and there's no worry about the premiums being dependent on the state of your health. Direct cost comparisons is a great way to control costs.

https://www.mahealthconnector.org/portal/site/connector

I did that and was encouraged. The cost of a policy with similar coverage to what we have now was quite a bit lower and, for a similar amount of premium we could get much better coverage.

 

[nun]

I did that was encouraged. The cost of a policy with similar coverage to what we have now was quite a bit lower and, for a similar amount of premium we could get much better coverage.

It will be interesting to see what happens to geographical price differentials once the exchanges are implemented.

I've definitely found myself thinking that for 90% of my healthcare a lower cost suburban hospital network is just fine.......and if I get something exotic I can pay the co-pay and go to Mass General. I imagine a lot of people go through similar reasoning which must put pressure on the more expensive hospitals and insurance policies.

It's also nice to get enrolled right from the website with a mouse click.

 

[MichaelB]

It will be interesting to see what happens to geographical price differentials once the exchanges are implemented.

I've definitely found myself thinking that for 90% of my healthcare a lower cost suburban hospital network is just fine.......and if I get something exotic I can pay the co-pay and go to Mass General. I imagine a lot of people go through similar reasoning which must put pressure on the more expensive hospitals and insurance policies.

It's also nice to get enrolled right from the website with a mouse click.

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.

 

[nvestysly]

If you would like an example of an exchange just go on the MA Connector site
and browse around. You'll see the costs and benefits for all the plans available in MA. It makes buying insurance easy and there's no worry about the premiums being dependent on the state of your health. Direct cost comparisons is a great way to control costs.

https://www.mahealthconnector.org/portal/site/connector

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!

Going on a tangent here but I would certainly like to see the PPACA law changed to allow individuals to buy insurance (real insurance) rather than mix all this health care mumbo jumbo of co-pays, wellness care, etc. I just want insurance against major medical catastrophe. It's my responsibility to keep myself healthy, pay for regular doctor visits, etc. IMO insurance is for unexpected issues in life - not routine occurances.

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.

 

[nvestysly]

Back to the OP... I recently read an article in the local newspaper (Georgia) that our state is undertaking a crash course on whether they will engage in an exchange or not. I'll certainly be interested in seeing the outcome.

 

[JoeWras]

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.

I totally agree.

I've known people who think nothing of dropping $500 for car maintenance, but then won't go to the doctor for some illness because "they may have to pay."

We're screwed up.

I liked my near-catastrophic plan at Megacorp. Basically pay for most little stuff and let insurance worry beyond that. But now they've complicated it with co-insurance too. Going to take a spreadsheet to figure everything out.

 

[pb4uski]

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!

Going on a tangent here but I would certainly like to see the PPACA law changed to allow individuals to buy insurance (real insurance) rather than mix all this health care mumbo jumbo of co-pays, wellness care, etc. I just want insurance against major medical catastrophe. It's my responsibility to keep myself healthy, pay for regular doctor visits, etc. IMO insurance is for unexpected issues in life - not routine occurances.

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.

+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.

 

[gerrym51]

+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

 

[rbmrtn]

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.

 

[nun]

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.

 

[nun]

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.

 

[pb4uski]

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.

 

[pb4uski]

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.

 

[samclem]

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.

 

[M Paquette]

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/

 

[Animorph]

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.

 

[pb4uski]

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.