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Old 08-16-2016, 09:12 AM   #81
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This currently leaves Pinal County, AZ (between Phoenix and Tucson) without an on-exchange plan for 2017.
This is the big problem, what do those people do??
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Old 08-16-2016, 09:16 AM   #82
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This is the big problem, what do those people do??
The lack of exchange plans means they can buy insurance on the open market.
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Old 08-16-2016, 09:48 AM   #83
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Is Aetna going off-exchange because they'd be able to charge more?
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Old 08-16-2016, 10:04 AM   #84
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Is Aetna going off-exchange because they'd be able to charge more?
This morning I heard they had lost $200MM last quarter due to high expenses from overly sick people and not enough healthy ones.
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Old 08-16-2016, 10:10 AM   #85
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Is Aetna going off-exchange because they'd be able to charge more?
This is interesting, does Aetna have figures that show low income on exchange customers are heavy claimers due to suppressed medical care when they couldn't afford insurance. Realistically low income people will have a major problem paying off-exchange premiums.

Now in MN Blue Cross is exiting ALL individual plans both on and off exchange.
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Old 08-16-2016, 10:19 AM   #86
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Aetna is losing money?

Or just losing money on the individual market?

They have to be making money off group plans right?
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Old 08-16-2016, 10:22 AM   #87
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This is interesting, does Aetna have figures that show low income on exchange customers are heavy claimers due to suppressed medical care when they couldn't afford insurance. Realistically low income people will have a major problem paying off-exchange premiums.

Now in MN Blue Cross is exiting ALL individual plans both on and off exchange.


That certainly is a smart "business move" (Im only talking business). You know darn well what you are suggesting is the reason behind it. I would be shocked if anyone from the company would publicly admit it. They are too smart for that.


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Old 08-16-2016, 10:37 AM   #88
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Yes, it's a ballsy move on Aetna's part, if you know it and I know it, the regulators know it, the question is there anything they can do about it?
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Old 08-16-2016, 10:42 AM   #89
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Yes, it's a ballsy move on Aetna's part, if you know it and I know it, the regulators know it, the question is there anything they can do about it?


I bet their lawyers said this..."yes we can legally do it..Just damn sure dont say its the subsidized poor people with their low deductibles fixing all their body parts they abused on our wallet and we are not taking it anymore."


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Old 08-16-2016, 10:45 AM   #90
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If this catches on and spreads, I can see it undermining the entire ACA structure and causing havoc everywhere.
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Old 08-16-2016, 10:56 AM   #91
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And no one knows what premiums would be in a totally private system, just what they were in the pre-ACA world.
I'm not sure I understand this comment. The pre-ACA world was the totally private system. But: many were excluded from this system due to pre-existing conditions. Except if they were in a group plan (either through an employer or an association). But even those were totally private.

The individual market is fraught with problems.
* Actuaries needs to assess the claims that have been paid, and risk that the premium that submit to an insurance commissioner will be large enough to cover the cost of care.
* The private system will often remove itself from the competition to avoid a drain on its finances.
* That creates access to care problems as people cannot buy new coverage (cannot be seen by a healthcare professional), or afford the increased premiums as other carriers increase rates for perceived risks.

Just remember that insurance is all about financing health care, not access to health care. They are mirroring the costs and health experiences of the population in general. Costs? Well that's been debated ad nauseum here. It is a complex problem we tried to fix with a simple solution - the ACA.

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Old 08-16-2016, 11:08 AM   #92
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I'm not sure I understand this comment. The pre-ACA world was the totally private system. But: many were excluded from this system due to pre-existing conditions. Except if they were in a group plan (either through an employer or an association). But even those were totally private.

The individual market is fraught with problems.
* Actuaries needs to assess the claims that have been paid, and risk that the premium that submit to an insurance commissioner will be large enough to cover the cost of care.
* The private system will often remove itself from the competition to avoid a drain on its finances.
* That creates access to care problems as people cannot buy new coverage (cannot be seen by a healthcare professional), or afford the increased premiums as other carriers increase rates for perceived risks.

Just remember that insurance is all about financing health care, not access to health care. They are mirroring the costs and health experiences of the population in general. Costs? Well that's been debated ad nauseum here. It is a complex problem we tried to fix with a simple solution - the ACA.

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Well anyone with money can now buy off-exchange insurance as you mentioned many were excluded before ACA..so you are putting more high claims people on the off exchange program. So yes we don't what premiums will do in this circumstance as you said, the company will charge what is needs to not go broke.
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Old 08-16-2016, 11:33 AM   #93
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If this catches on and spreads, I can see it undermining the entire ACA structure and causing havoc everywhere.
Not really. There are around 30 million people using "ACA plans", roughly split into similar sized groups of Medicaid expansion, on-exchange, and off-exchange. So far no insurer has announced plans to withdraw from the Medicaid markets, and there have been only a couple of announcements that affect off-exchange - most notably BCBS Texas and Minnesota.

The underlying issue here is having insurance markets broken up into many pieces, and insurers that are allowed to parse through all the pieces and choose some but not others. There are simple fixes for this, but they are not easy to accomplish. One would be to offer the US Federal Employee Insurance Benefit on the exchanges. Another would be to do away with the excessive market segmentation and have one large state risk pool - or even one large national risk pool.
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Old 08-16-2016, 11:51 AM   #94
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So one of the alternatives to the ACA is to have insurers compete across state lines.

Well it sounds like insurers are or were in many states but now they're cherry-picking.
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Old 08-16-2016, 11:52 AM   #95
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I read this today. Hopefully is it good news for Florida. I also thought that 90% of Floridians get some kind of subsidy was interesting.

http://www.modernhealthcare.com/arti...NEWS/160619946
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Old 08-16-2016, 11:54 AM   #96
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The Affordable Care Act's exchanges have not been a bust for every health insurer. Florida's Blue Cross and Blue Shield affiliate made a profit of almost a half-billion dollars on the ACA's new individual plans last year.
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Old 08-16-2016, 11:58 AM   #97
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So one of the alternatives to the ACA is to have insurers compete across state lines.
Well, currently any insurer can sell anywhere they choose. They only need to register with the State Insurance Commission and comply with all the state requirements. Allowing insurers to sell into states without complying with local regs isn't going to reduce the cherry-picking that's going on, but it might threaten the integrity of the local insurance marketplace.
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Old 08-16-2016, 12:02 PM   #98
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Michael:

It is still interesting, as Florida has more old fogies like us between the ages of 60 and 65 (as well as older of course) that in theory use more Health Services.

Where are the companies in other states going wrong?
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Old 08-16-2016, 12:04 PM   #99
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Not really. There are around 30 million people using "ACA plans", roughly split into similar sized groups of Medicaid expansion, on-exchange, and off-exchange. So far no insurer has announced plans to withdraw from the Medicaid markets, and there have been only a couple of announcements that affect off-exchange - most notably BCBS Texas and Minnesota.

The underlying issue here is having insurance markets broken up into many pieces, and insurers that are allowed to parse through all the pieces and choose some but not others. There are simple fixes for this, but they are not easy to accomplish. One would be to offer the US Federal Employee Insurance Benefit on the exchanges. Another would be to do away with the excessive market segmentation and have one large state risk pool - or even one large national risk pool.
I agree with what you say, but I'm not as confident as you are about the long term scenario.BCBS has no individual plans in MN in 2017. They have been my insurer of choice for almost 40 years.I still have my group small business plan, but will have 2017 income that would get me some assistance with premiums. So even the off exchange third are being affected by this. I can either stay with the small business deductible premium or go the ACA route and switch carriers, that is until I don't have one to choose from. What I can't do is change anything and still be BCBS, at any cost. They don't want me.

I would go with the national pool which makes area cherry picking impossible but I don't get to decided how it works.
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Old 08-16-2016, 12:11 PM   #100
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Michael:

It is still interesting, as Florida has more old fogies like us between the ages of 60 and 65 (as well as older of course) that in theory use more Health Services.

Where are the companies in other states going wrong?
Interesting? Sure it is - it's an example of a a large insurer in a large state doing very well in the individual market. It leads one to conclude that one possible reason for some insurers decision to not sell in some marketplaces may be their own business management.

One thing that's different about the Florida individual market is that the major insurer, BCBS, has been extremely aggressive with price. Since 2014 their premiums have almost doubled for individual policies. What I don't get is that, if there are all these sick people consuming oodles of health care, why aren't the premiums of MediGap and Medicare Advantage starting to creep up as people age and move into Medicare.
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