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Old 11-20-2015, 02:25 PM   #41
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Originally Posted by Bamaman View Post
The young, healthy citizens have ignored getting healthcare because they've not used doctors and hospitals in the past. They're going to be mad next year when their income tax returns are adjusted for penalties for not having healthcare. And the healthcare premiums are relatively expensive--with so much of their premiums going to cover the deficit spending of the older, sicker insureds.
Well you've kind of hit some of the main issues:
1) Young and healthy aren't signing up
2) Penalties are a heck of a lot cheaper than.....
3) expensive premiums;
4) Goto #2
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Old 11-20-2015, 02:52 PM   #42
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The young, healthy citizens have ignored getting healthcare because they've not used doctors and hospitals in the past.
I think the reason that young, healthy citizens are infrequently signing up is that there is a feeling that you're wasting your money on ACA insurance if you don't know you'll use it, and use it a lot. Folks just don't want to pay premiums for health care coverage that will exceed what they consume. Everyone wants to pay in a little and collect a lot.

It seems like the often spoken of fear of bankruptcy due to an expensive health issue isn't all that prevalent. Folks want to see that their benefit will be greater than their cost. Insurance can't survive on that basis. Most folks need to pay in more than they consume in order to cover the folks that need to consume a lot.
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Old 11-20-2015, 04:01 PM   #43
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I think the reason that young, healthy citizens are infrequently signing up is that there is a feeling that you're wasting your money on ACA insurance if you don't know you'll use it, and use it a lot. Folks just don't want to pay premiums for health care coverage that will exceed what they consume. Everyone wants to pay in a little and collect a lot.

It seems like the often spoken of fear of bankruptcy due to an expensive health issue isn't all that prevalent. Folks want to see that their benefit will be greater than their cost. Insurance can't survive on that basis. Most folks need to pay in more than they consume in order to cover the folks that need to consume a lot.

Probably because many who forego insurance have no fear of bankruptcy as they have little to be taken away from anyways. Although I am not a rich person asset wise, I dont want to lose what I have. So I do the obvious stuff including plenty of auto liability. But there will eventually be a number on any insurance where I would say....Im taking my chances.
To leave healthcare out of it take homeowners insurance. I pay about $1000 on a $170k or so house. Don't like writing the check but I will dutifully. Now raise homeowners insurance to $15k, Im not paying and taking my chances.


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Old 11-20-2015, 04:10 PM   #44
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I can understand why a young/immortal person would go barefoot when a policy could cost them thousands of dollars a year and their chances of needing it are minimal. I had no medical issues until I was fifty-eight myself. But, the system needs those healthy people in there paying premiums to make it work for the unhealthy or older population. It is called "spread of risk" in the insurance business.
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Old 11-20-2015, 04:15 PM   #45
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The data does not show that young people are not signing up. From this KFF brief, the biggest factors for not being insured are the high cost of insurance or insufficient income. The two reasons "Don't need insurance" and "prefer to pay penalty" represent 9% of all uninsured, while "too costly" alone is 48%.

The biggest problem with the ACA is the fact that healthcare is very expensive in the US, but this high cost is only really visible on individual ACA policies. Medicare and employer policies (and other sources) cost just as much, but those costs are not put on public display for all to see and discuss.
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Old 11-20-2015, 04:18 PM   #46
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Originally Posted by marko View Post
This came across just an hour ago:

Obamacare Architect: High Deductible Plans Overdone
Obamacare architect: High-deductible plans overdone
from the article (quoting Ezekiel Emanuel):
Quote:
He did acknowledge: "We've overplayed the high-deductible plans. People are feeling this is less and less insurance. And just more and more, 'I'm paying out of my pocket.'"
He's conflating "health insurance" with "health care". I see it here a lot too.

Health care would be something like an HMO that pays for all your health spending.

Buying health insurance would protect you against big things like a heart attack or coming down with some disease and the care resulting from that.

What you get and what the costs are for these two things are quite different.

Unfortunately, we've mashed this up in this country and that doesn't help the discussion one bit.

You end up with HDHP/HSA type plans that are the closed to real insurance, but they get larded up with freebies like annual physicals that drive the cost up beyond what true insurance would cost and a young healthy person might be willing to pay for.
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Old 11-20-2015, 05:10 PM   #47
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...........The biggest problem with the ACA is the fact that healthcare is very expensive in the US, but this high cost is only really visible on individual ACA policies. Medicare and employer policies (and other sources) cost just as much, but those costs are not put on public display for all to see and discuss.
Exactly. Having employer paid insurance for so long allowed the costs to climb with little notice from the insured. We were trading raises for higher health insurance premiums, but it wasn't obvious. In the short term, I can see anger directed at the ACA as being the "cause" of high insurance premiums but ultimately when the finger pointing is played out, provider costs will have to be addressed.
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Old 11-20-2015, 05:12 PM   #48
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To leave healthcare out of it take homeowners insurance. I pay about $1000 on a $170k or so house. Don't like writing the check but I will dutifully. Now raise homeowners insurance to $15k, Im not paying and taking my chances.
Of course, apart from the liability component your potential for loss in homeowners insurance is known and fixed (the value or replacement cost of the structure and possessions in it). If you are worth $5-10M or more it's easier to "self insure" in case the house burns down. With medical bills, there is no theoretical limit. It can get into 6 or 7 figures. So it's a lot harder to "self insure" for it.
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United Health may stop offering ACA Exchange plans
Old 11-20-2015, 08:08 PM   #49
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United Health may stop offering ACA Exchange plans

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Of course, apart from the liability component your potential for loss in homeowners insurance is known and fixed (the value or replacement cost of the structure and possessions in it). If you are worth $5-10M or more it's easier to "self insure" in case the house burns down. With medical bills, there is no theoretical limit. It can get into 6 or 7 figures. So it's a lot harder to "self insure" for it.

I agree... But, it appears the majority of people in US literally live pay check to pay check. They don't even think about self insuring risk, they just think they can barely afford the insurance they cant afford to use. .....So they just drop it.
I like a previous poster writing said, people are "conflating healthcare with health insurance". And that is true... We have health insurance. Insurance is based on rating and usage. The more you use the higher your premium should be. Just ask any one who seems to have trouble burning their house down often or having care wrecks frequently. They will pay out the wazoo or be uninsurable.
In my mind we should have healthcare, and I am even willing to pay more to have that....But we don't. Which means my premium should be preferred customer rates because I don't use it or make any claims.


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Old 11-20-2015, 08:36 PM   #50
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There is a problem with the cost of healthcare that is not being addressed... the high deductibles are one of them...

I have mentioned it before, but there is (was?) a group called RAM (IIRC) on 60 minutes... this is a group of doctors who go around the country giving out free healthcare... one of the people shown that had a number of problems (I also think one of his kids) actually had insurance.... but still could not afford to go to the doc...

Yes, if you are poor, just having access to insurance is not enough...
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United Health may stop offering ACA Exchange plans
Old 11-20-2015, 08:38 PM   #51
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United Health may stop offering ACA Exchange plans

Here is ultimately the ACA plans undoing.... I have repeated this before but no one has ever really challenged it as they keep saying people will have to "pay the penalty". As people will figure out after this year..."there is no penalty". There are 15 exemptions with the 14th one being a catch all. If you have a pulse, you can find an exemption. When people get their tax returns confiscated or actually realize the exemptions they wont buy the insurance if they believe they cant afford it. And even if some miracle comes that you are not smart enough to use exemption #14 which is simply a "hardship" and provide documentation "if possible", you deserve quite frankly to pay double the penalty. Heck you can also go to jail one day a month and then be exempted... And above all that....If you are too lazy to not claim a "hardship" by providing no documentation, you can simply not have a refund and you don't pay the penalty. People are going to figure this out that it is a law with no teeth...


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Old 11-20-2015, 08:40 PM   #52
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Also, as someone else mentioned.... I am surprised that the margins are so low considering how much insurance actually costs...


There has to be a bunch of really sick people out there that cost a heck of a lot of money... my insurance costs next year will be over $10K... but if it is like this year I will 'use' a few hundred of services... now, if we do have some major problem, I will have to pay the almost $14K OOP.... we have never come close to this amount of service...


I will just leave it at that as I do not want to contribute to the closing of this interesting thread...
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Old 11-21-2015, 07:06 AM   #53
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I think any new program has startup problems. Studying the history of Medicare confirms this. Give ACA a few years.
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Old 11-21-2015, 07:36 AM   #54
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......... Give ACA a few years.
I think we have no choice. I don't see anyone clamoring to go back being uninsurable.
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Old 11-21-2015, 11:26 AM   #55
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Yep, I think we're basically in hope-and-pray mode (or whatever you want to call wishful thinking) WRT the ACA future. There's just so many unknowns at this point as to whether there will be enough of a balanced risk pool to keep it affordable and in a competitive market. We've already seen networks shrinking and insurers pulling out of markets along with excessive price increases in many areas.

The sad truth is that with today's political environment I think it would take a complete collapse of the market to get anything done further reform-wise, and even then it's a stretch.
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Old 11-21-2015, 12:44 PM   #56
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I think we have no choice. I don't see anyone clamoring to go back being uninsurable.
There's going to be a push for repeal for a long time.

And some advocate allowing pre existing conditions is unfair to insurers.
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Old 11-21-2015, 12:51 PM   #57
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A perfect example of the process being confusing is what happened today with me. My brother emailed me this morning saying his insurance is dropping out of state at end of year. He asked me which one I had so he can get it. He lives across the state. He has no clue, that you just don't buy "what I have". He has no clue about coverage areas, in network, out of network, making sure his preferred medical providers are in the plan he buys, etc... This is not going to be able to answered with an email. We are going to have to have a bit of a discussion...


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I just went through this with my brother. Except his question was "Do you have Medicare Part A and B, and if so, why do you have it?"

Best of luck.
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Old 11-21-2015, 12:58 PM   #58
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There's going to be a push for repeal for a long time.

And some advocate allowing pre existing conditions is unfair to insurers.
I think a push or not depends a lot on who gets elected next year. If the side that is for the ACA is elected, that'll be at least 4 more years of the ACA as law of the land. If the side that is for repeal gets elected, then all bets are off (or the push to repeal might be a, "Oh, never mind").

I read about a month ago a thought (article or blog) that expressed, wouldn't it be nice if there was a super HSA. As things stand now, the very wealthy don't benefit from subsidies and the poorer can't afford to utilize an HSA and the eligible HSA deduction is no real benefit to them.

I didn't post a link to article/blog as that started out like "This political side thinks such and such and the other side thinks this", so I avoided the Porky. But IMO, the thought of a super HSA is intriguing.
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Old 11-21-2015, 12:58 PM   #59
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Health care insurance is the US is very complex. Each state regulates it differently, prices and costs are secret and variable, and the health care insurance industry has evolved by focusing on exclusion, so it has thousands of different groups and networks to manage. Most individuals got their coverage from employer, who dealt with all this complexity. So many are now seeing it for the first time as individuals, and conclude this complexity (and cost) is recent.

In fact, the ability to easily compare policies is new, the result of minimum coverage mandates. Same for comparing provider networks, which we can do now because insurers must enable that. Before these mandates it was much more difficult to compare policies.

Rounding back to the original topic, is this a case where UHC has too many sick people on it's policies, or could it be UHC management is having a rough time executing their business strategy in the individual market and they are throwing the blame elsewhere?
Or it's a trial balloon.
Or it's an inexperienced management in charge of the individual market casting blame.
Or . . .

As others have said, they are not a big part of the individual market. I surmise they didn't price properly and 1) did not get enough members to cover their overhead, 2) thought they were getting young and healthy and got less healthy and more claims, and/or 3) underestimated what they thought they knew about the ACA regulations.

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Old 11-21-2015, 01:29 PM   #60
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We have had UHC insurance through MegaCorp for many years. And insurance in retirement is part of the package.

I have seen UHC buy companies, use them up, spit them out. Make alliances, then break alliances.

We just got a letter in the mail that says:

'Beginning January 1, 2016, your plan will feature the UnitedHealthcare Value Pharmacy Network, which does not include CVS PHARMACY.'

In other words, they could not cut the deal with CVS that they wanted, so they cut them out. So, we need to switch to a different pharmacy. Of course, UHC would like to have us buy direct from OptumRX, which happens to be a company they bought. There are other local pharmacies that are, for the moment, still allowed.

I suspect that UHC is simply publicizing the possible change to apply what they see as pressure to the ACA system. If they can't make their margin, they will drop that part of the business. This way they have made disclosure that it might happen.
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