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Old 05-03-2013, 01:20 PM   #481
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Good. You still need to adjust for "regional cost factor", which KFF does. For our calculations I assume the highest rate.
I can't find the regional cost factors .... can you help me locate them ?
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Old 05-03-2013, 02:36 PM   #482
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What logic is there to commit to do something and then neglect your commitment?
A number of states feel that Obamacare was "put upon them", in a manner of speaking. Muck like stimulus, there is money rolling around that is tempting to take. However, in the mass of research I have done, there appears to be not set promise that the fed govt can fund these state-run exchanges on a consistent basis year after year. One could argue that they HAVE to because its the law. Well, you need to have enough money generated to do so, and not so sure that will happen. It's not like the fed govt has never broken a promise......

As with some other govt programs that have started up, there is an initial flood of money, and then over time the spigot dries up. For instance, in Wisconsin, there was a bunch of money offered to build a high speed train, like $200 million. However, it was for construction only, NO monies given going forward for track improvements, operational expenses, etc. So, our governor said no. he did not want to create an unfunded $8-$10 million a year taxpayer hole..........

The states are NOT required to set up their own exchanges themselves. The govt would of course "like" them to do so, for obvious reasons. Under the law, the fed govt is the final say and HAS to set up the exchanges, so taxpayers like us in Wisconsin are awaiting further orders.........

But what do I know, I have an ARM designation, a degree in finance with an emphasis in insurance and risk management, and have been a licensed agent for over 20 years...........
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Old 05-03-2013, 02:43 PM   #483
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A number of states feel that Obamacare was "put upon them", in a manner of speaking.
Then they should have told the federal government, "You do it!" If they didn't want to set up the exchange themselves, they shouldn't have promised to. They were given that option. Instead, they promised they'd do it themselves. It's a matter of honorably living up to what you committed to. Regardless of that, there is also the matter that living in community with others implies not always getting your own way. A state should surely not be acting like a two year old, in this regard.
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Old 05-03-2013, 02:46 PM   #484
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Reuters) - The nation's largest health insurers are far from leaping at the chance to join new state health insurance exchanges under President Barack Obama's reform law, making it likely that some markets will have little or no competition next year.

Analysis: Big insurers wary of entering new Obamacare markets | Reuters

Interesting that the big insurance carriers are not jumping to include states that they don't already serve.
Consider that to enter a new area, a company under the current situation has to set up a network of physicians, hospitals, and other providers, negotiate prices with them etc. If they don't have a large network, few will enroll, and unless many enroll the cost of setting up the network will not be made back. So its not suprising that many will not enter new areas.
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Old 05-03-2013, 02:48 PM   #485
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It's here and it's going to be implemented. the people who will be "hurt" by poor implementation will be the ones who have to enroll in it. the government should spend the money to implement it smoothly
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Old 05-03-2013, 03:30 PM   #486
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It's here and it's going to be implemented. the people who will be "hurt" by poor implementation will be the ones who have to enroll in it. the government should spend the money to implement it smoothly
Actually, those that will be hurt if it is implemented and funded in its current form, which is quite doubtful, will be those whose policy costs go through the roof, must find new doctors, or lose their 40 hour jobs. For those families like mine that receive a quote of $18K/year many will choose not to purchase a policy until they get sick. Can't blame them.
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Old 05-03-2013, 03:33 PM   #487
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A well-functioning system will help policy holders of all inclinations.
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Old 05-03-2013, 04:12 PM   #488
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Actually, those that will be hurt if it is implemented and funded in its current form, which is quite doubtful, will be those whose policy costs go through the roof, must find new doctors, or lose their 40 hour jobs. For those families like mine that receive a quote of $18K/year many will choose not to purchase a policy until they get sick. Can't blame them.

i am not saying we want the acapa. what i am saying is that it's here and the law. the government should spend the money to make it go smoothly.
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Old 05-03-2013, 04:22 PM   #489
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It's gonna take five years or maybe ten to fairly evaluate the success or failure of the program since it is based upon a theory of prevention. T'was good enough for Ben Franklin then, and is still now - "An ounce of prevention is worth a pound of cure".
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Old 05-03-2013, 05:22 PM   #490
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I think the " train wreck " is that the average person for who the ACA was designed are woefully unaware of their responsibilities under the law. 42% of Americans aren't even aware that it still exists. Also, If I was an insurer, I would hesitate in setting up exchanges until I had an idea what the market was for the exchange.
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Old 05-04-2013, 05:52 AM   #491
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Also, If I was an insurer, I would hesitate in setting up exchanges until I had an idea what the market was for the exchange.
I'm not sure I understand what you're saying here. First: Insurers don't set up exchanges. Insurers offer their services within the exchanges. Second: I think the insurers know that the exchanges are going to eat into their profits because they represent a formal way for customers to comparison shop, based on more common terms and conditions than have been the case in the open marketplace before. The calculus that the insurers are doing involve deciding whether to specialize, at least in specific states, on serving just the open market, or also aiming to serve the general (exchange) market. It's a bit like deciding between being a private equity firm or a consumer brokerage. The former supports a higher level of service quality, at a higher price to consumers, and therefore with bigger margins. The latter supports a more basic level of service quality, at a lower price to consumers, with larger quantities making up for smaller margins.
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Old 05-04-2013, 08:16 AM   #492
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I should have said that if I were an insurer I would hesitate to be a part of an exchange before I knew what I was getting into. There could be a tremendous amount of adverse selection involved in the exchanges.
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Old 05-04-2013, 09:27 AM   #493
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Since i'm the only person on this board that actually is already using an exchange-i purchased a policy from the massachusettes health connector and am currently using it. as most of you know the ACAPA was modeled on the massachusettes plan.

i do not know if massachusetes has to change much for the ACAPA.

but currently

it has 1 site but 2 portals. you go to one section if you want a subsidized plan and another for unsubsidized.

all of the insurance plans offered on either subsidized or unsubsidized are from current insurance providers in the state.

i think what many want to know is what plans they will get. i think that most likely the exchangs in whahever part of the country your in will get access to plans from providers ALREADY in that locale. they already have the networks in a particular area-they just have to tweak it -put a different name on it and sell it on the exchange. it is unlikely that a provider that does NOT currently provide in an area will come in and create an entire new network. as time goes on maybe.

here is the page for mass connector https://www.mahealthconnector.org/portal/site/connector
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Old 05-04-2013, 09:47 AM   #494
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I should have said that if I were an insurer I would hesitate to be a part of an exchange before I knew what I was getting into. There could be a tremendous amount of adverse selection involved in the exchanges.
If the rates are equivalent to current premiums for higher risk underwritten policies, which they appear to be, adverse selection is more theoretical than real. The large insurance companies already operate in all 50 states. For them it is easy now to say they are not sure what their participation will be. It costs nothing, lowers the expectations for their investors, and may give them room to negotiate.
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Old 05-04-2013, 04:36 PM   #495
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If the rates are equivalent to current premiums for higher risk underwritten policies, which they appear to be, adverse selection is more theoretical than real. The large insurance companies already operate in all 50 states. For them it is easy now to say they are not sure what their participation will be. It costs nothing, lowers the expectations for their investors, and may give them room to negotiate.
You don't think there are going to be significant numbers of people who opt out of being insured until they are diagnosed with needing care? If one can sign up for home insurance after their house burns down, why would they pay premiums beforehand?
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Old 05-04-2013, 04:42 PM   #496
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You don't think there are going to be significant numbers of people who opt out of being insured until they are diagnosed with needing care? If one can sign up for home insurance after their house burns down, why would they pay premiums beforehand?
i beleive under ACAPA rules there are 2 issues with this.

1.there are only certain sign up periods-oct 1 to 12/31 unless for first implementation which is 10/1/13-3/31/14.

2. although insurance companies cannot turn you down for pre-existing conditions they can impose a waiting period i belive up to 6 months
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Old 05-04-2013, 04:52 PM   #497
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i beleive under ACAPA rules there are 2 issues with this.

1.there are only certain sign up periods-oct 1 to 12/31 unless for first implementation which is 10/1/13-3/31/14.

2. although insurance companies cannot turn you down for pre-existing conditions they can impose a waiting period i belive up to 6 months
My guess is that they will need more aggressive and expensive care if they are still around after six months. Most will receive care nonetheless as it is the provider who will have to turn them away. For this to work we are going to have to take premiums out of paychecks like SS and Medicare.
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Old 05-04-2013, 09:04 PM   #498
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There is plenty of hard data, certainly enough to make credible comparisons and present informed analysis. Estimates of premium prices, however, need to include basic elements such as levels of coverage, actuarial value and cost sharing. Otherwise the numbers used (and conclusions) have little meaning. The data is out there and available today, but it's not being used. That's why I look at sources such as KFF.
If there's plenty of reliable "hard data" out there I, (along with many, many pundits from both Parties), have yet to find it.

KFF states a result run in their HI "Subsidy Calculator" is NOT definitive, but only "..illustrates how families in varying circumstances MAY (emphasis added) be affected by the tax credits and limits on age rating included in the law". Premiums noted by KFF are CBO estimates, not actual premium prices. This caveat appears in Notes section below the results after you run a scenario in the KFF calculator.
Subsidy Calculator | The Henry J. Kaiser Family Foundation

Clarity is also lacking in Gov't's own ACA website, (Healthcare.gov). Follow the site to ' Health Insurance Basics..Your Insurance Company and Costs of Coverage'. There is a search function for rate increase filings in any state you select, (BTW-most rate reviews are already completed). We all know there will only be 3 basic policy levels under ACA- Bronze, Silver, & Gold. But there is still a big range of rate increases listed for private carries in most states. I have not run searches for all 50 individual states, but for Midwest states the increases for 2014 range from ~10-40+% ...for largely the same specific HI products (policies) offered in 2012. And as referenced earlier, it is still not clear that enough big carriers will indeed enter the Exchange market to provide much-needed price competition. From what I hear this is NOT a 'negotiating tactic' by carriers but deliberate corporate decisions to stay out until the dust settles. Even if it means remaining on sidelines for 2014 Exchanges. And, IIRC, HHS has still not yet issued final interpretive reg's on precisely how certain critical issues will be implemented (e.g.actual Medical Loss Ratio calculation).
Your Insurance Company & Costs of Coverage | CompanyProfiles.Healthcare.gov
As many have reported, the gross costs of HI coverage under ACA continue to be raised by CBO with each new analysis.
http://cbo.gov/sites/default/files/c...0Estimates.pdf
Curiously,this CBO report projects increases in Medicaid/CHIP spending, but decrease in subsidies due to DEcrease in private HI premiums (which is contrary to data from Healthcare.gov noted above).

Obviously ACA is the law & unlikely to be repealed. IMHO- all have an interest in as smooth a transition as possible- if only because the health of millions is potentially at stake. Unfortunately, today no one seems able to even ballpark what a specific person or family will pay for their 2014 HI under their state Exchange (exc for MA which already has an approved Exchange). This uncertainty makes it easy for pundits to keep selling headline-grabbing editorials on the subject
But very difficult for ER's to budget accurately for HI costs
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Old 05-04-2013, 09:30 PM   #499
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You don't think there are going to be significant numbers of people who opt out of being insured until they are diagnosed with needing care? If one can sign up for home insurance after their house burns down, why would they pay premiums beforehand?
No, I don't think so. To do what you suggest would be risky if someone has any assets to speak of. Unless their diagnosis coincides with the open enrollment period, they would be screwed until the next open enrollment period and would be responsible for their own medical bills until the next open enrollment period. If you don't have much it might be a risk worth taking.
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Old 05-04-2013, 09:48 PM   #500
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No, I don't think so. To do what you suggest would be risky if someone has any assets to speak of. Unless their diagnosis coincides with the open enrollment period, they would be screwed until the next open enrollment period and would be responsible for their own medical bills until the next open enrollment period. If you don't have much it might be a risk worth taking.
Very few people have any assets to speak of. The very reasons why those who are healthy and earn above 400% of the poverty limit don't buy insurance now is why they won't buy insurance under the exchanges. Except under the ACA, they can buy if they get sick. Maybe the adverse selection will be insignificant. Heck, we are giving free insurance coverage to tens of millions. I'm just saying there will be a boat load of people opting for the penalty. Just my opinion.
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