King v Burwell (ACA Subsidies) Decision Announced

[Texas Proud]

If age is considered during the underwriting and policies priced accordingly, then the pricing and the costs are in line with the risk, not artificially low. I suppose it is "artificially low" if the beginning assumption is that the "group" should be priced to include risks of the general population of potential members.

It's a strange setup as we have it now in the exchanges. We are shifting costs off the old to the young. We are shifting costs off women to men. We are shifting costs off low income people to higher income people. The only place where something close to rough underwriting is allowed is tobacco use. But underwriting is not allowed for many other voluntary decisions and behaviors that increase health costs.

I think Justice Roberts is very concerned that the Supreme Court be popular. I think he wants he and the court to be viewed as "above the fray." I wish his priorities were different.

I just want to chime in here on a group rating... since I handled it at my last job... note: we were a small firm of about 25 employees and IIRC 70 people covered...

They actually do underwriting... if you want to change from one insurance company to another they require the group to provide all information for them to price the product... if you had a group with all 20 something, the rate would be much less than one with everybody over 50 with chronic problems...

Even on renewal, they look at the prior years payout... we would get a fancy book about how many was in the group... the % of people that maxed out their deductible, how many were in each quartile etc. etc... lots of info on the costs they paid... and the rate for the next year reflected all that info...

Now, if you work for a big mega, they usually self insure so it is not an underwriten 'policy'...

 

[Brat]

There would be no men if it weren't for women. Basically our society needs us all, parsing risk based on gender is not wise.

 

[samclem]

There would be no men if it weren't for women. Basically our society needs us all, parsing risk based on gender is not wise.

And there would be no women if not for men. Hey, I'm a big fan of women.

 

[Big_Hitter]

Basically it says that the authors worded it that way to incentivize states to set up their own exchanges but didnt want low income people excluded from getting a subsidy. If you think about it that makes no sense. The authors were basically bluffing. They said to the states..."If you dont set up an exchange, your low income people wont get a subsidy....but we dont want any low income people excluded for getting a subsidy". Bluffing doesnt work if you aren't willing to be called on your blubyff which is what happened.

That's my take as well

 

[Big_Hitter]

Thanks.

It's a good thing there's no longer any need to continue trying to determine or debate what was intended when the ACA was drafted and passed into law. The US Supreme Court did that for us and the matter has been settled. Now we can move on to other things.

Agreed. Let's get our guaranteed issue hi in er!

 

[NW-Bound]

I actually read the statements submitted by the members of Congress who drafted the ACA act. It's here: http://object.cato.org/sites/cato.org/files/documents/congress_aee_amicus.pdf.

They said that they never intended to limit the subsidy to only state health insurance exchanges.

So, it was as I thought. A booboo that happened when they worked and worked on the draft, kept revising it, then in the end got tired of it and left wording mistakes in there. Just like the non-sensical subsidy schedule cliff.

Now, nobody would come up and admit that anything was a mistake, would he? No, it's not a bug, it's a feature. No, no, no, Wait! It's NOT a feature. Not the state exchange thing, but the cliffs are.

 

[brewer12345]

I actually read the statements submitted by the members of Congress who drafted the ACA act. It's here: http://object.cato.org/sites/cato.org/files/documents/congress_aee_amicus.pdf.

They said that they never intended to limit the subsidy to only state health insurance exchanges.

So, it was as I thought. A booboo that happened when they worked and worked on the draft, kept revising it, then in the end got tired of it and left mistakes in there. Just like the non-sensical subsidy cliff.

Now, nobody would come up and admit that anything was a mistake, would he? No, it's not a bug, it's a feature. No, no, no, Wait! It's NOT a feature. Not the state exchange thing, but the cliffs are.

So its like Microsoft drafts all the bills? I could buy that.

 

[bmcgonig]

shouldn't be

There can be for sure. In CA, Blue Shield has a very limited network for ACA. Lots of docs take the original Blue Shield but not ACA version. If you're not getting subsidies there's no reason to go thru the Obamacare stuff, just go to the company etc.


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[Texas Proud]

There can be for sure. In CA, Blue Shield has a very limited network for ACA. Lots of docs take the original Blue Shield but not ACA version. If you're not getting subsidies there's no reason to go thru the Obamacare stuff, just go to the company etc.


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Do not know about CA, but the BCBS plans that I could buy outside of the exchange are the same that are inside the exchange.... at least they have the same number attached to them....

 

[photoguy]

There have been a few news stories about inflated provider lists for exchange insurers in California but I've found it difficult to interpret the numbers. For example,

In examining Blue Shield, the state found that 8.8% of doctors listed were not taking exchange coverage and 18.2% were not at the location listed by the insurer.

From LA Times Top insurers overstated doctor networks, California regulators charge - LA Times

But there's no mention if the errors are for HMO, EPO, or PPO. Furthermore, they didn't compute the error rate on the non-exchange plans (maybe it's similar, maybe it's much lower).

 

[eytonxav]

Do not know about CA, but the BCBS plans that I could buy outside of the exchange are the same that are inside the exchange.... at least they have the same number attached to them....

For DD's policy with BCBSTX that is the case. I am not sure whether the insurance cards have any special labeling or intelligence in the number that would indicate to a Dr that the policy is being subsidized through the fed exchange. We did not buy her policy through the exchange.

 

[explanade]

Thanks.

It's a good thing there's no longer any need to continue trying to determine or debate what was intended when the ACA was drafted and passed into law. The US Supreme Court did that for us and the matter has been settled. Now we can move on to other things.

Some supporters of health care reform though wonder if the ACA had been dismantled, maybe they could come up with something better, more towards single payer.

But that's wishful thinking. IN the current political environment, it was either the ACA or go back to the status quo ante, which means pre-existing conditions and inconsistent individual insurance.


There is still a lot of talk about repeal, and some talk about repeal and replace, though the alternatives discussed are mainly about expanding HSA, possibly tax credit/deductions and selling insurance across state lines. Also tort reform, even though malpractice awards are a tiny fraction of total health care spending.

 

[explanade]

There have been a few news stories about inflated provider lists for exchange insurers in California but I've found it difficult to interpret the numbers. For example,



From LA Times Top insurers overstated doctor networks, California regulators charge - LA Times

But there's no mention if the errors are for HMO, EPO, or PPO. Furthermore, they didn't compute the error rate on the non-exchange plans (maybe it's similar, maybe it's much lower).

First year on ACA (actually 4 months of 2014), I found a plan which included my existing doctor, whom I'd been seeing for 5 years or so.

Next year, that plan was no longer in the exchange. I think I could have still gotten it but it was more expensive.

Switched to Anthem plan for 2015 and they didn't have my same doctor. But looking at the doctors, they seemed no worse or better, at least looking at how long they practiced, their education, board certifications and reviews where available.

Had chosen my previous doctor out of a directory of the local medical clinic and while I was okay with the care he'd provided over the years, there was no indication that I would do worse by going with the cheaper plan and its network.

Lot of people would prefer to retain their doctor but most lay people aren't in a position to evaluate how good doctors are, I suppose. Probably comes down to how comfortable you are with the provider.

 

[Mulligan]

Some supporters of health care reform though wonder if the ACA had been dismantled, maybe they could come up with something better, more towards single payer.



But that's wishful thinking. IN the current political environment, it was either the ACA or go back to the status quo ante, which means pre-existing conditions and inconsistent individual insurance.





There is still a lot of talk about repeal, and some talk about repeal and replace, though the alternatives discussed are mainly about expanding HSA, possibly tax credit/deductions and selling insurance across state lines. Also tort reform, even though malpractice awards are a tiny fraction of total health care spending.

It will never happen, but I would run through the city streets streaking like Will Farrell in "Old School" if they would greatly increase HSA or make premiums payable with pretax dollars. That would shave the ol monthly bill by a third for me.


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[audreyh1]

Do not know about CA, but the BCBS plans that I could buy outside of the exchange are the same that are inside the exchange.... at least they have the same number attached to them....

That's what I see in TX

 

[samclem]

Also tort reform, even though malpractice awards are a tiny fraction of total health care spending.

It's the same with profits for health insurers--it's a small part of their revenues, between 2-3%, and an even smaller share of health care spending, but from the talk you'd think they take half of the health care pie.

In the case of both insanities (our malpractice and health insurance systems), the big costs aren't the direct ones (i.e. malpractice awards), but the indirect ones (defensive medicine/tests, etc).

 

[explanade]

Millions of Americans are declining to sign up for the ACA, even if they have to pay penalties.

Many are unable to afford premiums (though some may be eligible for subsidies) but believe they can pay cash or find other ways to pay or find programs which offer health care to those without insurance.

Meet the Health-Law Holdouts: Americans Who Prefer to Go Uninsured - WSJ

But some have the means to pay premiums yet refuse for philosophical reasons:

Some actively like going it alone. Bob McConnell, 60, of Fort Mill, S.C., describes himself as an investor who is generally well off. Married and with two children, he says he saves money by haggling directly with doctors and labs over fees. He also objects to the law on philosophical grounds, seeing it as an intrusion on his privacy.

“Effectively, I am self-insuring,” he says. At his local pharmacy, he uses coupons he couldn’t apply if he had a plan through the Affordable Care Act, he says. “It costs less than the pharmacy benefit plan I was covered under as the copays were steep and I had to pay full retail without coupons for a couple essential name-brand products.”

 

[razztazz]

Millions of Americans are declining to sign up for the ACA, even if they have to pay penalties.

Many are unable to afford premiums (though some may be eligible for subsidies) but believe they can pay cash or find other ways to pay or find programs which offer health care to those without insurance.

Meet the Health-Law Holdouts: Americans Who Prefer to Go Uninsured - WSJ

But some have the means to pay premiums yet refuse for philosophical reasons:

Well, of course. If people have infinity bucks or are convinced they do, they can afford to morally dump on everything and everybody as some kind of a bad thing.... for them. And that means it must be bad. Sure. Give everybody infinity bucks and we won't need Obamacare or a lot of other things.

PS: I don't need the ACA.

 

[MRG]

Millions of Americans are declining to sign up for the ACA, even if they have to pay penalties.

Many are unable to afford premiums (though some may be eligible for subsidies) but believe they can pay cash or find other ways to pay or find programs which offer health care to those without insurance.

Meet the Health-Law Holdouts: Americans Who Prefer to Go Uninsured - WSJ

But some have the means to pay premiums yet refuse for philosophical reasons:

Others are uneducated about the law. I've talked to a few self employed folks who didn't know what the law requires them to do. The same group doesn't understand the importance of HI. The blissful ignorance of youth.

 

[samclem]

Others are uneducated about the law.

I'm not doubting that people have indicated this to you, but after years of national dialogue, a blitzkrieg of advertising in every medium, direct appeals by the President, the inclusion of references to the ACA in the IRS forms every working person must fill out under penalty of law, and discussion between co-workers and family members for four years, I do not believe any mentally competent adult in the US does not know that the law exists and how to easily find out what their responsibilities are. If they are ignorant, it is deliberate. What is my/our ongoing responsibility to these people: mentally competent, non-institutionalized people who won't take responsibility for themselves? If they lack the means to pay for the insurance, that is now covered. Will there ever come a time when the excuses end?

Teacher: "Class, let's go over this week's vocabulary words. Jimmy, what's the difference between "ignorance" and "arrogance"?

Jimmy: "I don't know, and I don't care!"

 

[clifp]

I am not a fan of ACA, and I still think we haven't even begun paying for the true cost of the law. That said I think over turning based on some sloppy drafting would have been a bad idea.

I took advantage of the no precondition part of ACA by buying a high deductible plan this year. If I get ill with a chronic condition, I'll buy a more expensive plan with better coverage next year. In the past I was stuck with my good but not great plan.
because I was afraid to drop it.

As I result I'm paying $2,500 a year less into the health care, while using virtually the same amount of services (annual doctor visit and maybe an urgent care visit). I did this not because I couldn't afford the higher price plan but because there was so little reason for me to not do so. If 4 million do the same as I did that's $10 billion less into the health care system, and I wonder how long the system can handle that much less revenue.

 

[Texas Proud]

Going back to the OP...

I was reading a pundit yesterday and his comment was interesting on the outcome of the case... there was all the talk about how the decision would repeal the law etc. etc...

He basically said... the law before the decision would have been the exact same law after the decision... not a single word would have been changed... not a single part 'repealed'.... all that was happening was defining what the words meant...

I know if it had gone the other way it would have been bad for people getting credits.... but the law would not have changed one bit... everything required by the law would still be required....

 

[Texas Proud]

Just as an FYI... I went to ehealthinsurance.... and all the plans they showed were ACA plans.... they even said if it was a bronze, silver etc. etc...


Now, if I want I could go and buy a short term plan that is not an ACA plan... they would do underwriting, they have a max cap, and I am sure there are other issues with them.... but, I could get a much better plan for cheaper... I actually did get one of these for a short time last year... but they would not accept me because of pre-existing condition....

If you do not get a subsidy, it might be the way to go.... there are some plans that are much cheaper... or a bit cheaper but very small deductible...

If I were young and only getting a $4 subsidy, I would go to this market....

 

[utrecht]

I'm not doubting that people have indicated this to you, but after years of national dialogue, a blitzkrieg of advertising in every medium, direct appeals by the President, the inclusion of references to the ACA in the IRS forms every working person must fill out under penalty of law, and discussion between co-workers and family members for four years, I do not believe any mentally competent adult in the US does not know that the law exists and how to easily find out what their responsibilities are. If they are ignorant, it is deliberate. What is my/our ongoing responsibility to these people: mentally competent, non-institutionalized people who won't take responsibility for themselves? If they lack the means to pay for the insurance, that is now covered. Will there ever come a time when the excuses end?

Teacher: "Class, let's go over this week's vocabulary words. Jimmy, what's the difference between "ignorance" and "arrogance"?

Jimmy: "I don't know, and I don't care!"

I disagree. I dont watch the news at all and I cant think of any place other than this forum where Ive heard about ACA at all. Ive never heard any friends talk about it. If I wasn't on this forum, I dont think I would know anything about Obamacare at all.

There are lots of people living in places with no TV and no internet. There are lots of low income people (who this would help the most) who I would bet know nothing about the law at all. And the ones who do, most likely dont understand 90% of it. Hell, I only understand about 25% of it.

 

[samclem]

If I were young and only getting a $4 subsidy, I would go to this market....

You'd have to also consider the cost of the government [-]fine[/-] tax [-]responsibility payment [/-], too, right? But it still could be a better deal.