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Old 05-30-2013, 02:49 PM   #21
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The transitional reinsurance should have a modest, positive impact, but probably does less to lower rates and more to help an insurer enter a market while avoiding an extremely risky outcome.

What the program does is charge all the insurers a fee which is then used to compensate any insurers that suffers excessive payouts due to adverse selection, determined when their insured base has a risk profile that is substantially worse than the average of the region.

Anyone interested in more detail can read good summaries by Health reform GPS here Final Rule: Notice of Benefit and Payment Parameters for 2014 – Health Reform GPS: Navigating the Implementation Process and here Interim Final Rule: Alternative Approaches to Cost-Sharing Reduction Payment and Risk Corridor Calculations – Health Reform GPS: Navigating the Implementation Process
Sounds like a necessary program. Lets say for simplicity that there are only 2 insurance companies in the exchange with same price scheme. By a quirk, all the unhealthy people sign up with "A", and all healthy people sign up with "B". For the first couple years in essence, Company "B" will have to contribute money back to "A"?
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Old 05-30-2013, 04:55 PM   #22
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Originally Posted by shotgunner View Post
MSN reports today that the cost of a Silver plan sold in the California health exchange have come in lower than estimated.

Obamacare prices roll in lower than forecast- MSN Money
I do wonder if the lower the than expected rate has more to do with CA being an active buyer in their state exchange rather than Obamacare itself. I think the plan rates vs one's expectations will vary a lot by state. MA & NY (also a GI market) residents, for ex, will probably be pleased w/rates & could see a break in price. At the same time, I've seen models forecasting avg 30%+ increases across markets.
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Old 05-30-2013, 06:21 PM   #23
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It's easy to get a spectacular rate increase. Pick someone young currently on a catastrophic-only plan with no well-care benefits, and caps on annual payouts. (those eHealthInsurance.com plans. Oh, and there's underwriting. Better be in perfect health...) Now compare the annual premiums for that against the cost for a 'catastrophic' PPACA plan which includes:

Quote:
Essential Health Benefits Package
The Secretary will specify the “essential health benefits” included in the “essential health benefits package” that Qualified Health Plans (QHPs) will be required to cover (effective beginning in 2014). Essential health benefits, as defined in Section 1302(b) of the Patient Protection and Affordable Care Act,5 will include at least the following general categories:
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness and chronic disease management
Pediatric services, including oral and vision care.
Blood pressure tests
Childhood immunizations
Colonoscopies


Women's preventive health services were defined in detail via federal regulations published August 1, 2011, requiring broad coverage, without copayments or deductibles of:
Annual preventive-care medical visits and exams
Contraceptives (products approved by the FDA) - with exemptions for religious employers and a temporary enforcement safe harbor. [see recent developments and changes]
Domestic violence screenings for interpersonal and domestic violence should be provided for all women
H.I.V. screenings
Breast feeding counseling and equipment, including breast pumps at no charge.
Gestational diabetes in pregnant women screening
DNA tests for HPV as part of cervical cancer screening
Mammograms
The non-PPACA plans have a bit less coverage. For example, the Mega-Life plan that was pushed at DD's college, before the PPACA laws, offered:
Quote:
• Outpatient surgery – not covered
• Outpatient facility charges – not covered
• Prescription drugs – not covered
• Chemotherapy – not covered
• Cat scans,EKG,Angiogram,MRI,Upper/Lower G.I. , etc. (1000 coverage per day)
• Hospitalization - pays up to 2,500 per year.
You get the idea. One hour in the ER, or one day in the hospital, and you are looking at a huge out of pocket expense. The Mega-life plans were called on the carpet by the state insurance commissioner because they only spent about 10% of the (admittedly low) premiums on medical care. They just didn't cover very much. That also kept the rates low.

For DD, we got a 'huge' rate increase for her individual insurance, one of those really scary percentages this editorial talks about. It's about $60 a month. Considering that unsubsidized individual insurance for the three of us is over $1000 a month, and the rates for DW and I dropped slightly, it's a wash for our budget.

For self-righteous indignation junkies jonesing for a fix, though, filtering out these big percentage numbers has to be a real mainline spike, because... "A 60% rate hike? Why, that's almost double! How can these people look at themselves in the mirror after doubling or tripling the cost of insurance for the poor working man?"
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Old 05-30-2013, 07:28 PM   #24
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Originally Posted by M Paquette View Post

It's easy to get a spectacular rate increase. Pick someone young currently on a catastrophic-only plan with no well-care benefits, and caps on annual payouts. (those eHealthInsurance.com plans. Oh, and there's underwriting. Better be in perfect health...) Now compare the annual premiums for that against the cost for a 'catastrophic' PPACA plan which includes:

The non-PPACA plans have a bit less coverage. For example, the Mega-Life plan that was pushed at DD's college, before the PPACA laws, offered:

You get the idea. One hour in the ER, or one day in the hospital, and you are looking at a huge out of pocket expense. The Mega-life plans were called on the carpet by the state insurance commissioner because they only spent about 10% of the (admittedly low) premiums on medical care. They just didn't cover very much. That also kept the rates low.

For DD, we got a 'huge' rate increase for her individual insurance, one of those really scary percentages this editorial talks about. It's about $60 a month. Considering that unsubsidized individual insurance for the three of us is over $1000 a month, and the rates for DW and I dropped slightly, it's a wash for our budget.

For self-righteous indignation junkies jonesing for a fix, though, filtering out these big percentage numbers has to be a real mainline spike, because... "A 60% rate hike? Why, that's almost double! How can these people look at themselves in the mirror after doubling or tripling the cost of insurance for the poor working man?"
I personally have not minded a plan where I am responsible for the first $5500, but then 0% after that on everything in exchange for a lower premiums, but those college plans you mentioned are just plan shameful.
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Old 05-30-2013, 07:49 PM   #25
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I personally have not minded a plan where I am responsible for the first $5500, but then 0% after that on everything in exchange for a lower premiums, but those college plans you mentioned are just plan shameful.
MA is a good example of how exchanges can work. Premiums have only risen by a couple of percent over the last two years and they are now capped at the level of MA economic growth which was 3.6% last year. Absolute costs are high in MA, but not as a fraction of the median income, which is higher than many states. The great thing is I can easily shop around and I know what I'm getting. MA has a fairly high minimum level of coverage and the most inexpensive non-subsidized plan is for a 51 year old male is $350/month and has a $2k deductible, $5k out of pocket max, and 20% copay.
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Old 05-30-2013, 09:59 PM   #26
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Originally Posted by Mulligan View Post
Sounds like a necessary program. Lets say for simplicity that there are only 2 insurance companies in the exchange with same price scheme. By a quirk, all the unhealthy people sign up with "A", and all healthy people sign up with "B". For the first couple years in essence, Company "B" will have to contribute money back to "A"?
Good example, and pretty well sums up the purpose of the program.
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Old 05-30-2013, 10:24 PM   #27
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Good example, and pretty well sums up the purpose of the program.
This part of the Act intrigues me and will be interesting to watch play out. After thinking about it, the competition for customers seems as though it could be counter intuitive to the classic model of competition for businesses in relation to their success. In our economy if the company provides a needed product, good service, at a competitive price they generally will enjoy success. In this exchange model, success by providing good service at a competitive price could sway many of the unhealthy people to swarm towards a particular insurance company. A company with cheaper prices, but poorer service or networks may find healthy people looking for cheap premiums to avoid additional cost, even if it is only nominally different in price. The insurance companies in the past I assume bypassed this problem by selecting who they wanted to accept. If a company gets too many unhealthy people early on and provides good service, there would be no reason for them to change providers, but you know the insurance company would hope some would after 2016, or they will be at a price disadvantage due to higher costs. This is just interesting to me, in respect to how this plays out in relation to the classic "business model" and in no way a comment on the healthcare act itself.
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Old 06-03-2013, 10:33 PM   #28
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Well as another posted earlier not only are the rates in CA possibly not cheaper, it looks like they were not comparing apples to apples.

Review & Outlook: ObamaCare Bait and Switch - WSJ.com
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Old 06-03-2013, 11:10 PM   #29
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Well as another posted earlier not only are the rates in CA possibly not cheaper, it looks like they were not comparing apples to apples.

Review & Outlook: ObamaCare Bait and Switch - WSJ.com
Sheesh, I think we are getting ahead of ourselves discussing premiums. After all it has only been a year, not enough time for over 40% of all Americans surveyed to even know the Act is law of the land. Incredible...

Forty-two percent of Americans don’t know that the Affordable Care Act is still in effect, a new Kaiser Family Foundation tracking poll shows.
Among those people:
12 percent think Congress got rid of it. (It’s true the Republican-controlled U.S. House has tried literally dozens of times.)
7 percent think the Supreme Court did. (It’s true that both Fox News and CNN wrongly reported that in the minutes after the ruling last summer.)
23 percent said they didn’t know enough to say whether the law existed or not. That’s a record high since KFF began tracking public awareness three years ago.
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Old 06-04-2013, 05:54 AM   #30
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Well as another posted earlier not only are the rates in CA possibly not cheaper, it looks like they were not comparing apples to apples.

Review & Outlook: ObamaCare Bait and Switch - WSJ.com
A WSJ article from the opinion page with lots of partisan rhetoric, and doesn't really add anything meaningful to the discussion, nationwide or California. Here's an article by Ezra Klein that discusses the same Avik Roy analysis mentioned in the Journal piece.
The shocking truth about Obamacare’s rate shock

There are such huge differences between health care policies today, any analysis that does not account for this is suspect. It may flame the passions but will do little to help people understand the impact or make choices.
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Old 06-04-2013, 08:13 AM   #31
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Mulligan and MichaelB. I ran across this very late last night. Since the thread heading was about "rates, specifically CA rates being less than expected, it seemed appropriate to offer up the link that there are opposing views.

So not sure MichaelB what you mean regarding it not add anything meaningful. Sorry you saw it as partisan. I actually did not, as I see clearly it is not an apples to apples comparison. That is simply a fact.

If nothing else, perhaps they are trying to prepare people for the rate shock that will probably happen. Also, I suppose I am still hoping mine will not be as expensive as I fear it will be. Not holding out much hope on that one.
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Old 06-04-2013, 08:23 AM   #32
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If nothing else, perhaps they are trying to prepare people for the rate shock that will probably happen.
Putting aside that I've already been living under a system comparable to ACA for almost seven years, I don't fear for such a shock simply because none of the articles advocating fear have yet indicated the vector from which such added cost would come beyond those that are already well-understood (i.e., those which effectively convert the human cost associated with preexisting conditions, exceeding lifetime caps, etc., into financial costs). I'm always suspicious of vagueness in such situations.
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Old 06-04-2013, 08:31 AM   #33
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I think sheehs1 has a good point.

The way I see it, a lot of the arguments are over what we're allowed to argue about.

One side say something like I pay $x for my health insurance and it's going up.

Another side says, you can't compare your old policy with the new one, the new one is so much better!

But I don't need that "much better" policy.

Yes you do! You should be grateful that you have this new policy.

But I was offered a "much better" policy before and chose not to buy it. Now I have no choice.

and so on...
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Old 06-04-2013, 08:54 AM   #34
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The way I see it, a lot of the arguments are over what we're allowed to argue about.
Without saying whether you're wrong or not with regard to whether or not post-ACA is better than pre-ACA drive, how does that matter drive specific decisions about what you can do now? Don't get me wrong: I've got no problem with the qualitative (and arguably pointless) discussion about whether or not post-ACA is better than pre-ACA, and I'll be happy to provide balance whenever the criticisms of ACA come up, but there's really no escaping the reality that neither side of the matter is actionable information.
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Old 06-04-2013, 09:12 AM   #35
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Originally Posted by sheehs1 View Post
Mulligan and MichaelB. I ran across this very late last night. Since the thread heading was about "rates, specifically CA rates being less than expected, it seemed appropriate to offer up the link that their are opposing views.

So not sure MichaelB what you mean regarding it not add anything meaningful. Sorry you saw it as partisan. I actually did not, as I see clearly it is not an apples to apples comparison. That is simply a fact.

If nothing else, perhaps they are trying to prepare people for the rate shock that will probably happen. Also, I suppose I am still hoping mine will not be as expensive as I fear it will be. Not holding out much hope on that one.
I was just teasing you Sheehs, as actually I share same concerns. About the time you posted your comment, I was scanning the headlines, and saw that survey. It is amazing to me with all the media availability, that almost half the people still do not no its the law. The rate argument on increases can be spun from all sorts of angles. But in reality it appears to me it is becoming fairly clear, subsidies aside. 1) Younger and middle age people in underwritten policies are going to be paying more 2) People currently stuck in high risk pools will pay less 3) "Blue" states, in general, probably won't notice the premium increases as much as the "Red" states due to the fact of underwriting rules.
But in reality, it all boils down to the individual and what he/she pays now in relation to what it will cost.
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Old 06-04-2013, 09:28 AM   #36
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I was just teasing you Sheehs, as actually I share same concerns. About the time you posted your comment, I was scanning the headlines, and saw that survey. It is amazing to me with all the media availability, that almost half the people still do not no its the law. The rate argument on increases can be spun from all sorts of angles. But in reality it appears to me it is becoming fairly clear, subsidies aside. 1) Younger and middle age people in underwritten policies are going to be paying more 2) People currently stuck in high risk pools will pay less 3) "Blue" states, in general, probably won't notice the premium increases as much as the "Red" states due to the fact of underwriting rules.
But in reality, it all boils down to the individual and what he/she pays now in relation to what it will cost.
I agree Mulligan. Over half the people even if they have heard the term don't know the details. The rates will be what they will be.
I didn't believe the article that CA came in lower than expected as I felt that was truly a political article to ward off the shock of the general public. I could be proven wrong on that but who knows.

It will be interesting to see in the next few months what all of our rates actually are. Hoping others post. I certainly will post mine.
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Old 06-04-2013, 09:28 AM   #37
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I think sheehs1 has a good point.

The way I see it, a lot of the arguments are over what we're allowed to argue about.

One side say something like I pay $x for my health insurance and it's going up.

Another side says, you can't compare your old policy with the new one, the new one is so much better!

But I don't need that "much better" policy.

Yes you do! You should be grateful that you have this new policy.

But I was offered a "much better" policy before and chose not to buy it. Now I have no choice.

and so on...
+1
Yep.
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Old 06-04-2013, 09:36 AM   #38
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This part of the Act intrigues me and will be interesting to watch play out. After thinking about it, the competition for customers seems as though it could be counter intuitive to the classic model of competition for businesses in relation to their success. In our economy if the company provides a needed product, good service, at a competitive price they generally will enjoy success. In this exchange model, success by providing good service at a competitive price could sway many of the unhealthy people to swarm towards a particular insurance company. A company with cheaper prices, but poorer service or networks may find healthy people looking for cheap premiums to avoid additional cost, even if it is only nominally different in price. The insurance companies in the past I assume bypassed this problem by selecting who they wanted to accept. If a company gets too many unhealthy people early on and provides good service, there would be no reason for them to change providers, but you know the insurance company would hope some would after 2016, or they will be at a price disadvantage due to higher costs. This is just interesting to me, in respect to how this plays out in relation to the classic "business model" and in no way a comment on the healthcare act itself.
I'm curious about this myself. It will be rather interesting to see which company people flock towards. It would also be interesting if the companies would post a pie chart of the make up of their customers so customers could decided which company to choose but without a health care designation that would be impossible. With no underwriting there will be no health care "status" levels.
With the way the law is written, I have not one clue how a company can predict whether it will go in the red each year or not. That is counterintuitive to every single business model. Certainly there has to be something that we are not aware of regarding that...wouldn't you think?
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Old 06-04-2013, 09:41 AM   #39
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I agree Mulligan. Over half the people even if they have heard the term don't know the details. The rates will be what they will be.
I didn't believe the article that CA came in lower than expected as I felt that was truly a political article to ward off the shock of the general public. I could be proven wrong on that but who knows.

It will be interesting to see in the next few months what all of our rates actually are. Hoping others post. I certainly will post mine.
That will make an interesting new thread to start when we finally get there. It will be also interesting to find out who gets their grandfathered plans dropped, and the ones that will allow an extension of their grandfathered plans through next year only. I have a suspicious eye already on insurance companies, but I wouldn't be surprised if they do this: Extend the individual plan through the next year enrollment cycle. Then use this time to aggressively recruit the ones currently in their fold that do not make any health claims.
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Old 06-13-2013, 10:42 AM   #40
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how is household annual income calculated?

I am guessing it is line 37 "adjusted gross income" from 1040 form...but why does it not just say that?
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