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Old 08-02-2016, 01:49 PM   #21
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Aetna released their quarterly earnings today and made the following announcement.

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Aetna said Tuesday it is canceling plans to expand into more states next year and will reassess its involvement in the 15 states where it currently offers coverage on the individual exchanges. It expects to lose $300 million (pre-tax) on its Obamacare business this year.

"...in light of updated 2016 projections for our individual products and the significant structural challenges facing the public exchanges, we intend to withdraw all of our 2017 public exchange expansion plans, and are undertaking a complete evaluation of future participation in our current 15-state footprint," said CEO Mark Bertolini in a second-quarter earnings statement.
Source: Aetna latest insurer to question Obamacare's future - Aug. 2, 2016
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Old 08-02-2016, 02:59 PM   #22
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What happens if there are no ACA-compliant insurance plans (off or on the marketplace) left in your area? Do you still have to pay the penalty? Will there be any other health insurance plans available in the new void?
Had the same thought. Since there is no public option, what happens if the private insurers all decide not cost effective and walk away?
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Old 08-02-2016, 03:02 PM   #23
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Well single payer would work since we already have that with Medicare, and we'll probably get there someday if/when the ACA collapses. It's not like there are many realistic alternatives at this point given the expectations that people now have for guaranteed coverage.

Humana leaving GA would mean there is exactly one insurer (Harken) that covers the massive conglomerate of docs and hospitals in this area, WellStar. And Harken is basically just a UHC experiment that is also having to jack rates substantially in 2017.
I think this is whole point of ACA...it was destined to fail...and thus, single payer will kick in.

Since you are in Georgia, you are as aware as I am that almost everything around here is either owned by Wellstar or Northside. Almost all the local "small" docs and their practices have been swallowed whole by WS and NS. The only real exception is Emory...but as I understand, they *really* limit the insurance they accept.
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Old 08-02-2016, 03:04 PM   #24
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GF had Cigna year 1 and we had nothing but problems. Year 2 was Blue Cross/Blue Shield of Arizona. Now they are pulling out of AZ. Guess it is back to Cigna. Yikes!
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Old 08-02-2016, 03:10 PM   #25
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Had the same thought. Since there is no public option, what happens if the private insurers all decide not cost effective and walk away?
When the ACA was still being legislated there was some discussion about opening the Federal Employee Health Benefit program to areas where there was inadequate private insurance.

The problem is, these insurers - BCBS, Aetna, Humana, UHC, etc - all continue to participate in all these states, but are limiting themselves to group, Medicaid and Medicare. The individual markets are too granular, segments are too small.
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Old 08-02-2016, 03:42 PM   #26
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When the ACA was still being legislated there was some discussion about opening the Federal Employee Health Benefit program to areas where there was inadequate private insurance.

The problem is, these insurers - BCBS, Aetna, Humana, UHC, etc - all continue to participate in all these states, but are limiting themselves to group, Medicaid and Medicare. The individual markets are too granular, segments are too small.
For my situation, at least BCBS is sticking around for next year. They are asking for a huge premium hike though .
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Old 08-02-2016, 04:00 PM   #27
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Full circle. Before the ACA, if you had a pre-existing condition you might well find that no one wanted to insure you, but it kept rates lower for the well.
Now, pre-existing or not, people will be on the same footing: no healthcare.

I think I'd better surf the Web to understand more about getting major healthcare overseas, like in Thailand as a poster recently describes.

For sudden health problems, one has to live there as an expat. Darn. I do not want to do that.
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Old 08-02-2016, 04:06 PM   #28
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Now, pre-existing or not, people will be on the same footing: no healthcare.

I think I'd better surf the Web to understand more about getting major healthcare overseas, like in Thailand as a poster recently describes.

For sudden health problems, one has to live there as an expat. Darn. I do not want to do that.
This is only individuals not eligible for healthcare from employers, Medicare, Medicaid, or TriCare. About 15% of US population.

If we could "self-insure" and pay health care providers the same rates the insurers get it would be different. Self-payers, however, are charged 10x - 15x more, for no good reason (other than unbridled greed) with no regulation or guardian angel to help.
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Old 08-02-2016, 04:12 PM   #29
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Besides that, nothing is really done about cost control. People only talk about shifting the cost around. They figure that as long someone else is picking up the tab, it's all honky-dory.

I'd better stop now before it raises my blood pressure.
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Old 08-02-2016, 05:13 PM   #30
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This is only individuals not eligible for healthcare from employers, Medicare, Medicaid, or TriCare. About 15% of US population.

If we could "self-insure" and pay health care providers the same rates the insurers get it would be different. Self-payers, however, are charged 10x - 15x more, for no good reason (other than unbridled greed) with no regulation or guardian angel to help.
+1000

I am part of that 15% that needs access to non-employer healthcare and don't qualify for medicare, medicaid, VA, or tri-care.

I discovered with our HUGE medical bills last year, the difference between negotiated rates and non-negotiated rates. In effect I am self insuring by purchasing a (very) HDHP. $4500 deductible for individual, $9k for the family. Our medical bills came close to the $9k... with the 2 kids both approaching, but not exceeding the $4500. For this plan where I had almost $9k OOP for 3 of us (2 kids and myself) I paid $550/month... This year it's over $600 a month.

But - that premium gets me access to the negotiated rates. My son had a short hospitalization. It was $850 a day rather than $3k/day if we didn't have insurance. When he took a baseball to the face the ER would have been $7k all in (including x-rays etc...) we got out for about $1500 when it all settled out. Similar for the face bone specialists and for the ophthalmologist he had to see as follow up. And all of this was in a closed network, docs as employees, system.... Kaiser Permanente.
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Old 08-02-2016, 07:02 PM   #31
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Sounds like a game of chicken.
Perhaps since we have Medicare, the Medicare should be expanded and allowed to negotiate with drug companies on prices, so that folks without private insurance at X% of the poverty level cost can get insurance at some cost Y.

Sort of like our Northern Neighbors, who all have coverage whether employed or not.
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Old 08-02-2016, 07:35 PM   #32
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If we could "self-insure" and pay health care providers the same rates the insurers get it would be different. Self-payers, however, are charged 10x - 15x more...
I was reviewing DF's bill from his recent hospitalization.

"Total cost: $151,244"

But there was a line item: "Calculated contractual adjustment: $140,547"

My goodness.
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Old 08-02-2016, 08:17 PM   #33
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... Sort of like our Northern Neighbors, who all have coverage whether employed or not.
But some of them cannot or have a heck of a time to find healthcare providers, like one of our friends with his aneurysm.

See: Aneurysm.

Nemo2 turned out OK, but 4 years ago when I was faced with a life threatening disease and time was of essence, I was seen by a specialist after 2 days, who set the extensive and intensive course of treatment and surgery going within a week.
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Old 08-02-2016, 08:32 PM   #34
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A long time ago, I read that the 3 goals of health insurance were to be : universal, accessible, and affordable.
No country has been able to meet more than 2 of those criteria, and Obamacare proves the point.
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Old 08-03-2016, 06:22 AM   #35
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If we could "self-insure" and pay health care providers the same rates the insurers get it would be different. Self-payers, however, are charged 10x - 15x more, for no good reason (other than unbridled greed) with no regulation or guardian angel to help.
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Originally Posted by rodi View Post
I discovered with our HUGE medical bills last year, the difference between negotiated rates and non-negotiated rates.

But - that premium gets me access to the negotiated rates. My son had a short hospitalization. It was $850 a day rather than $3k/day if we didn't have insurance. When he took a baseball to the face the ER would have been $7k all in (including x-rays etc...) we got out for about $1500 when it all settled out.
The self-payer is also allowed to negotiate down the billed charge. While they will not be able to get the final price down to the insurance rate in the vast majority of cases, there are anecdotal cases of cash prices being lower.

Quote:
When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront. When she needed an MRI to investigate further, she was offered a similar choice—she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.

Many hospitals also offer discounts if patients pay in cash on the day of service, because it saves administrative work and collection hassles. Cash prices are officially aimed at the uninsured, but people with coverage aren’t legally required to use it.
Reference: How to Cut Your Health-Care Bill: Pay Cash - WSJ
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Old 08-03-2016, 06:29 AM   #36
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On the news yesterday I heard that Aetna is exiting from ACA, as they lost too much money on individual plans. Last Sunday's newspaper said rates in Michigan will be up 17% next year.
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Old 08-03-2016, 06:59 AM   #37
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We will happily leave and move North if the ACA Goes Pear Shaped Next or the following year. But we have that option. The money we save will go into Raincoats and brollies.
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Old 08-03-2016, 07:02 AM   #38
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On the news yesterday I heard that Aetna is exiting from ACA, as they lost too much money on individual plans. Last Sunday's newspaper said rates in Michigan will be up 17% next year.
Aetna announced it is cancelling its ACA expansion into new markets, but will continue in current markets. Health insurer Aetna backs off ACA expansion plans - Ap - Independent Tribune
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Old 08-03-2016, 07:38 AM   #39
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...The problem is, these insurers - BCBS, Aetna, Humana, UHC, etc - all continue to participate in all these states, but are limiting themselves to group, Medicaid and Medicare. The individual markets are too granular, segments are too small.
What I don't get is why the individual market isn't the same as having one big, diverse group. The plus is that the insurer gets to adjust premiums for age (unlike group) with a corresponding minus that they need to bill and collect individually (somewhat unlike group). Perhaps we need to have the marketplaces do signup and premium billing and collections and reinsure the claim risk and claim administration to the health insurers, similar to how some large groups work.

From what I understand the crux of the problem is medical costs, and the medical cost problem in turn creates problems with health insurance... if insurers price it at expected claim costs plus 20% for overhead and profit the price exceeds what consumers are willing to pay... subsidies or not.
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Old 08-03-2016, 07:49 AM   #40
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What I don't get is why the individual market isn't the same as having one big, diverse group.
It is all about what the market can bear. We all need healthcare, why not capitalize on it an make the most they can? Look at their TOTAL profits, not just the ACA numbers.

Not to get Political this is just an example. Many People and Corporations in the US (and Other Countries too) maximize profits based on other's misfortunes (RE Companies like TE is a prime one), they even admit it. The problem with healthcare is people are often not in control of what ails them. I find that Insurance companies making obscene profits from people's misfortunes very similar and deplorable.

This is the main reason a "Single" payer system is the ONLY way to go. It would be Non Profit.
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