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Old 04-04-2013, 12:19 PM   #261
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The pool of insureds will be larger but much sicker, so the insurance companies will have to compensate somehow, but their reimbursements will be much lower, so that cost will be borne by someone
The pool probably will be sicker, in large part because the tax/penalty for going uninsured wasn't steep enough.

But yes, I would tend to agree that we will see some shorter-term volatility in pricing until the insurers have a handle on pricing it appropriately. Though I would expect some volatility into 2015 as well, as they may need some claims history under PPACA to figure out where they need to price their products to be remain both competitive and profitable.
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Old 04-04-2013, 12:24 PM   #262
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2014 is the key year to see how costs change, how the exchanges are going to work, etc. I think a number of large insurance companies are either going to go out of business or merge with others.
That's actually been predicted (by Weiss Ratings) for this year. Aetna and Coventry Health Care merged last summer. I think such corporate movements will continue to the happen, as they have happened in the past.

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The pool of insureds will be larger but much sicker
That's not likely, as one main impact of ACA is the health insurance requirement imposed on younger adults, who, relying on their youth and health, used to take their chances and go without health insurance. I remember working with a young guy 15 years ago. He had a good job, working as a junior programmer in a major health care provider's (if you can believe it) corporate offices. His choice was to take the money he would have spent on health insurance and instead spend it on ski trips. It was rather unfortunate when he broke his leg skiing.

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Private group insurance will go the way of the dodo, it will be cheaper for companies to drop the coverage they offer to their employees and go into an exchange.
It's always been cheaper not to offer health insurance. Yet companies did offer it. ACA represents only an incremental change in that. Our insurance plan here at work has been effectively ACA-compliant for years. My guess is that I can plan on having health insurance provided to us at work for the ten years until I retire.
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Old 04-04-2013, 12:24 PM   #263
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Two thoughts on this.... first, the vast majority of people are not going to even care one way or the other... most working people will get their insurance from their company... if you do not, then you are likely not making a lot of income and would qualify without doing anything... you then have the people who might benefit, but are clueless... so the potential market for this produce is small (or smallish)...
....
Besides many people working in small companies where it's possible that those companies will drop employee health coverage (I know of two nearby already thinking about that), there are millions (a large number) of people who are self employed consultants, tech specialists, etc. who will be impacted by this program.
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Old 04-04-2013, 12:27 PM   #264
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That's not likely, as one main impact of ACA is the health insurance requirement imposed on younger adults, who, relying on their youth and health, used to take their chances and go without health insurance.
But because the penalty (or tax if you prefer) for going uninsured is *much* lower than the cost of even a qualified Bronze plan, they may still rely on their youth and health, pay the tax and stay out of the pool.

Frankly (and I admit this is a little bit of editorializing) I think that if they really wanted to more or less totally remove adverse selection, the penalty needed to be equal to the subsidized cost of the lowest priced qualifying plan. That would seem to remove all financial incentives to go uninsured. As I recall, the insurance companies welcomed "no underwriting" and "guaranteed issue" as long as everyone was required to "play". Many insurers have noted, though, that the penalties for not playing aren't enough to get everyone into the pool. If costs rise because the pool of insured is sicker, this could be a big reason why.
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Old 04-04-2013, 12:43 PM   #265
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But because the penalty (or tax if you prefer) for going uninsured is *much* lower than the cost of even a qualified Bronze plan, they may still rely on their youth and health, pay the tax and stay out of the pool.
True, but the penalty will still motivate some more people to do the right thing. I haven't seen any data showing that more "sicker" people will materialize from somewhere (remember: we've already been paying for indigent care through pass-through fees applied to every bill for services to an insured) and enter into the nation's health care system, and I surely haven't seen any data showing that the number of such people will exceed the number of younger people moving into the system because the penalty motivates them to do so.
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Old 04-04-2013, 12:46 PM   #266
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Frankly (and I admit this is a little bit of editorializing) I think that if they really wanted to more or less totally remove adverse selection, the penalty needed to be equal to the subsidized cost of the lowest priced qualifying plan.
Not to get too far afield, but I still think there are free-market ways to induce people to buy this insurance that don't involve govt taxes/fines. If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.


Make "Insured/uninsured" status public information and a lot of industries will use it in their calculations. It won't be a total answer, but part of the answer. It could be instituted as part of the implementation of the rest of the law, when we find out (no surprise) that a large number of people are still not signing up.
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Old 04-04-2013, 12:54 PM   #267
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If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.
Brilliant! I'd suggest that every place where there is, or by all rights should be, an exculpatory clause posted ("You should not ride this amusement park ride if you have a bad back." "You should be in good health to ski"), should be required to check proof of health insurance. Besides amusement parks and ski areas, I'd suggest shooting ranges, health clubs, child play areas, etc.
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Old 04-04-2013, 12:57 PM   #268
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Not to get too far afield, but I still think there are free-market ways to induce people to buy this insurance that don't involve govt taxes/fines. If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.

Make "Insured/uninsured" status public information and a lot of industries will use it in their calculations. It won't be a total answer, but part of the answer. It could be instituted as part of the implementation of the rest of the law, when we find out (no surprise) that a large number of people are still not signing up.
In theory I really like this approach. In practice I don't think it would be a solution.

Our state requires you have liability insurance to buy a car and that rule is well enforced. Problem is there is no way to prevent the buyer from dropping coverage immediately after the purchase. The only way they are found out is after having an accident. Yes, it's against the law, but it doesn't seem to stop a huge number of people from doing it.
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Old 04-04-2013, 12:58 PM   #269
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Brilliant! I'd suggest that every place where there is, or by all rights should be, an exculpatory clause posted ("You should not ride this amusement park ride if you have a bad back." "You should be in good health to ski"), should be required to check proof of health insurance. Besides amusement parks and ski areas, I'd suggest shooting ranges, health clubs, child play areas, etc.
Would it be possible to have a reasoned conversation without the excessive sarcasm?
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Old 04-04-2013, 01:14 PM   #270
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Not to get too far afield, but I still think there are free-market ways to induce people to buy this insurance that don't involve govt taxes/fines. If that 20YO young buck that is tempted to go without insurance finds no one will give him a (reasonably-priced) loan for that new F150 he wants, or that he's having trouble getting a job because he hasn't signed up for insurance on his own, or that his overall credit score is dinged (affecting his car insurance rates, mortgage rates, etc) because he's a greater financial risk if he doesn't have health coverage, it would be another factor (plus the IRS fines) in getting him to join the collective.

Make "Insured/uninsured" status public information and a lot of industries will use it in their calculations. It won't be a total answer, but part of the answer. It could be instituted as part of the implementation of the rest of the law, when we find out (no surprise) that a large number of people are still not signing up.
Individual Insurance status is protected by HIPAA. An individual would have to volunteer that information.
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Old 04-04-2013, 01:18 PM   #271
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In theory I really like this approach. In practice I don't think it would be a solution.
I agree, but together with the fines (taxes) and the subsidies, it could help.

And there's a more controversial step: After we've done all the above, as a society, to help a person to do the responsible thing and take steps within their means and ability to get coverage, I think it will be time to re-examine the idea of "on demand" health care for those who don't do their part. That can be part of implementation, too. It needn't be immediate, and it's likely to be a natural result of the public "discussion" we have on this subject. I think people will get fed up when all we're asking is very reasonable (and heavily subsidized) actions.
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Old 04-04-2013, 01:23 PM   #272
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But because the penalty (or tax if you prefer) for going uninsured is *much* lower than the cost of even a qualified Bronze plan, they may still rely on their youth and health, pay the tax and stay out of the pool.

Frankly (and I admit this is a little bit of editorializing) I think that if they really wanted to more or less totally remove adverse selection, the penalty needed to be equal to the subsidized cost of the lowest priced qualifying plan. That would seem to remove all financial incentives to go uninsured. As I recall, the insurance companies welcomed "no underwriting" and "guaranteed issue" as long as everyone was required to "play". Many insurers have noted, though, that the penalties for not playing aren't enough to get everyone into the pool. If costs rise because the pool of insured is sicker, this could be a big reason why.
If I understand this correctly and I have read this on more than one occassion, when it gets down to it, there is no penalty. I have been told here that Mass. does it differently, but for the federal program, the only means of collection is through withholding tax refunds and that is the sole means. Adjust your withholding correctly, and the fine will never be collected.
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Old 04-04-2013, 01:24 PM   #273
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Would it be possible to have a reasoned conversation without the excessive sarcasm?
Huh? No sarcasm was expressed or implied there. I really think SamClem's idea was a good one. If you are incurring greater risk of physical harm, then why wouldn't that be the right spot for the kind of thing Sam referred to?

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Individual Insurance status is protected by HIPAA. An individual would have to volunteer that information.
There are definitely some things that could be changed in HIPAA, but I think all that is really necessary is allowing the imposition of the requirement to present proof of insurance, and allowing denial of service if that's refused, if that's not already permitted.
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Old 04-04-2013, 01:25 PM   #274
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Individual Insurance status is protected by HIPAA. An individual would have to volunteer that information.
Folks with insurance would want it publicized (in this construct) anyway, so they'd give permission for their entry into the database when they sign up. It's a plus for them under any condition I can envision. If they don't want it publicized I suppose they could decline (and pay the higher mortgage rates, car insurance, etc). All that needs to be changed is to allow this information to be used by entities in making their own decisions about a person's creditworthiness, etc.

We're not talking about publicizing whether a person has an STD or a heart murmur, we're talking about making public a bit of financial information. Just like whether an individual has automobile liability coverage.

And, HIPAA is a law, it can be changed.
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Old 04-04-2013, 01:48 PM   #275
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If I understand this correctly and I have read this on more than one occassion, when it gets down to it, there is no penalty. I have been told here that Mass. does it differently, but for the federal program, the only means of collection is through withholding tax refunds and that is the sole means. Adjust your withholding correctly, and the fine will never be collected.
This is semantics. It increases your tax liability by the amount of the "penalty." Sure, if you have enough withheld to cover it you're done paying it, but the point is that one way or another you pay it. And it's still a lot cheaper than buying health insurance, so if you are young, healthy and feeling invincible...
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Old 04-04-2013, 01:59 PM   #276
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This is semantics. It increases your tax liability by the amount of the "penalty." Sure, if you have enough withheld to cover it you're done paying it, but the point is that one way or another you pay it. And it's still a lot cheaper than buying health insurance, so if you are young, healthy and feeling invincible...
I am missing something here, Ziggy, so help me out with it. Now, I am too old to consider not purchasing, but the process itself interests me. If you adjust your withholdings to match exactly what you owe based on your income, or slightly less and pay in a few bucks, how would you ever pay the penalty? I don't mean withhold extra to include the tax, I mean to only cover their income. There is no penalty for not paying the penalty, and the only means of collecting it is withholding refunds, so where is my thinking off or misinterpretation of the coming process?
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Old 04-04-2013, 02:22 PM   #277
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If I understand this correctly and I have read this on more than one occassion, when it gets down to it, there is no penalty. I have been told here that Mass. does it differently, but for the federal program, the only means of collection is through withholding tax refunds and that is the sole means. Adjust your withholding correctly, and the fine will never be collected.
I disagree. I think the IRS can be pretty good at garnishing wages, freezing assets, or otherwise collecting taxes due, and SCOTUS has determined that the penalty is a tax.
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Old 04-04-2013, 02:29 PM   #278
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I you go to this link it lists all approved forms of plans in california.


http://www.healthexchange.ca.gov/Sol...0av%20calc.pdf


there are different classes for subsidized plans and unsubsidized plans.

all plans cannot be subsidized/tax creditts

the ones that can receive a subsidy/tax credit say the level of poverty rate they apply to

the subsicized ones start at the 5th one down then seem to be intermixed and what they apply to at top


this has been approved for California- i don;t know if similiar will apply to all states
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Old 04-04-2013, 04:35 PM   #279
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I disagree. I think the IRS can be pretty good at garnishing wages, freezing assets, or otherwise collecting taxes due, and SCOTUS has determined that the penalty is a tax.
See that is where my confusion was occurring,as articles I have read specially said the IRS cannot do what you mentioned. This got me digging and I found this on fact check website, that goes deeper than what I have read. Eventually they will have to sue you after you do not pay the tax and then do not pay the fine for not paying the tax. Interesting huh?

Refusal to Pay

The law prohibits the IRS from seeking to put anybody in jail or seizing their property for simple refusal to pay the tax. The law says specifically that taxpayers “shall not be subject to any criminal prosecution or penalty” for failure to pay, and also that the IRS cannot file a tax lien (a legal claim against such things as homes, cars, wages and bank accounts) or a “levy” (seizure of property or bank accounts).

The law says that the IRS will collect the tax “in the same manner as an assessable penalty under subchapter B of chapter 68” of the tax code. That part of the tax code provides for imposing an additional penalty “equal to the total amount of the tax evaded, or not collected.” It also requires written notices to the taxpayer, and provides for court proceedings.

So it may turn out that the IRS will be suing those who fail to pay the tax for double the amount. But so far, the IRS has not spelled out exactly how it will enforce the new penalty with the limited power the law gives it.
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Old 04-04-2013, 04:43 PM   #280
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Actually, now that you mention it I do recall that there were limitations on their authority with respect to collection of the penalty in the act that made it different from their authority with respect to income taxes. Thanks for reminding me of that. However, I think as a practical matter that if taxpayers get collection notices from the IRS with respect to the penalty that unless it becomes widely known that they have little teeth to collect that many or even most taxpayers would just pay up.
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