What's the future of the ACA?

[scrabbler1]

I think they killed it last year when they got rid of the mandate that everyone have insurance. With out the healthy in the pool the costs will eventually soar to the point it will be unaffordable.
I could work my MAGI to qualify for lower cost than my partially subsidized MegaCorp plan, but I think within another year a subsidized ACA plan will be more than my current and I worry Mega will not let me back on my current plan. My current is expensive, but very inclusive...even has a small dental component which turned out to be better than expected.

The key to making the ACA work was the deal by which pre-existing conditions could not be used to exclude coverage in return for the individual mandate requiring coverage to be bought by everyone. This is what made the ACA fairly stable. But with the individual mandate gone, this deal has been badly compromised as healthier people begin dropping out of the market, leaving a pool of sicker people facing higher rates than they would have faced otherwise over time.

 

[explanade]

Couple of things.

1. NJ has passed an individual mandate law imposing penalties for lapses in coverage. Other states are expected to follow.

2. Pharma are raising prices, just did with the New Year.

https://arstechnica.com/science/201...w-year-with-price-hikes-on-hundreds-of-drugs/

They have no fear of legislative action, probably because they figure they can get enough votes to protect their interests or doesn’t see Congress passing any new major laws, given how split it is.

 

[ivinsfan]

Couple of things.

1. NJ has passed an individual mandate law imposing penalties for lapses in coverage. Other states are expected to follow.

2. Pharma are raising prices, just did with the New Year.

https://arstechnica.com/science/201...w-year-with-price-hikes-on-hundreds-of-drugs/

They have no fear of legislative action, probably because they figure they can get enough votes to protect their interests or doesn’t see Congress passing any new major laws, given how split it is.

Pharma is going to get while the getting good, I firmly believe that someday their spigot of income is going to be cut severely.

 

[Svensk Anga]

Pharma is going to get while the getting good, I firmly believe that someday their spigot of income is going to be cut severely.

Sure and when that happens, their R&D spending will decline. If you were hoping for a new drug for your somewhat rare condition or just a better drug for your common condition hopefully with fewer/milder side effects, you will be SOL. And when the current generation of antibiotics is no longer effective against the super bugs, tough luck.


I think the US heath care system has been subsidizing drug development for the whole world. We do not want the spigot cut off, but other countries could pick up more of the tab.

 

[explanade]

They spend more on marketing than R&D and they’re hiking prices on drugs developed decades ago.

They’re not even pretending that the hikes are to recoup R&D or for future R&D.

They’re practically saying “because we can.”

The other villains are the pharmacy benefit managers taking their own cuts.

 

[Popeye]

Sure and when that happens, their R&D spending will decline. If you were hoping for a new drug for your somewhat rare condition or just a better drug for your common condition hopefully with fewer/milder side effects, you will be SOL. And when the current generation of antibiotics is no longer effective against the super bugs, tough luck.


I think the US heath care system has been subsidizing drug development for the whole world. We do not want the spigot cut off, but other countries could pick up more of the tab.

We should model a law on a most favored customer clause the govt puts in contracts. US should pay no more than other developed nations. If a med is $5 in Europe it should be $5 here.

 

[Cessna152]

IBTL!

 

[pb4uski]

- The Texas court ruling will be overturned
- The ACA will stay pretty much as it until the next election
- Premiums will rise less than many folks anticipate

I believe we aren't supposed to discuss politics, so I'll leave it at that.

I think you are right.... especially on the last part... the penalty of $0 will have a minimal impact on premiums as people will continue to need and buy health insurance... the penalty was so minor it was not an affective deterrent to those who did not want to buy health insurance.

The recent rise in premiums has nothing to do with ACA but is more increases in the cost of health care services which are at least 80% of premiums by law... when the cost of those health care services goes up premiums follow.

 

[pb4uski]

....healthier people begin dropping out of the market, leaving a pool of sicker people facing higher rates than they would have faced otherwise over time.

I disagree. Penalties were negligible before and we still saw healthy people buying health insurance.... because they wanted it and needed it even though it is expensive.

I put in a family of 4 with household income of $100,000 for both place where I live and in each case the penalty was nil because the cost of health insurance was unaffordble. If I double the income to $200,000 in each case the penalty was $4,468. In each case bronze level coverage would be over $16,000 a year so I think if someone was health and really didn't want insurance they would just pay the penalty.... or better yet they could manage their withholdigns and estimated payments so they owed money and pay the tax but not the ACA penalty since the IRS had no collection authority to chase people for the penalty.

 

[GTFan]

They spend more on marketing than R&D and they’re hiking prices on drugs developed decades ago.

They’re not even pretending that the hikes are to recoup R&D or for future R&D.

They’re practically saying “because we can.”

The other villains are the pharmacy benefit managers taking their own cuts.

Or they're busy buying up companies to create drug monopolies then slashing R&D while jacking prices.

See: Documentary 'Drug Short' about Valeant Pharmaceuticals

Congress could fix this, but money talks.

 

[scrabbler1]

I disagree. Penalties were negligible before and we still saw healthy people buying health insurance.... because they wanted it and needed it even though it is expensive.

That's not what insurers here in New York thought when they filed their 2019 rate increases back in June. I posted this link to begin the long thread last year about 2019 rate increases.

https://www.dfs.ny.gov/about/press/pr1806011.htm

Insurers filed for a 24% increase overall, with half of that (12%) due to the repeal of the mandate and the other half (12%) separate from the repeal of the mandate.

Back in 2010-2011, before the ACA, I saw increases of 20% and 25% in those 2 years (50% overall) before I finally dropped that policy and opted for, temporarily, a bare-bones, hospital-only policy to get me to 2014 when the exchanges came in. My rate for a Silver plan dropped to less than what I was paying in 2009. The mandate surely dropped the rates because there were more healthier people like me (this was before I got sick in 2015) were back in the main insurance pool.

 

[Rianne]

Can a U.S. doctor prescribe a med to be purchased in a different country? I understand U.S. citizens go to Canada to get meds, but do they do it illegally or do they know the name of the drug/dosage amount and buy it?
If I told my doc to send my prescription to a Canadian pharmacy, can he do that?

 

[gstillson]

They spend more on marketing than R&D and they’re hiking prices on drugs developed decades ago.

They’re not even pretending that the hikes are to recoup R&D or for future R&D.

They’re practically saying “because we can.”

The other villains are the pharmacy benefit managers taking their own cuts.

One reason they spend so much on marketing is the relatively short life of a drug patent before generics wipe out all profit.

It is not like they have 30 years to recoup the R&D costs. Plus other companies will jump on the bandwagon once a type of drug is proven with their slightly modified formulation.

But feel free to sink your next billion or three into a pre clinical trial drug which has a 99% chance of failing and burning up all your cash.

 

[explanade]

One reason they spend so much on marketing is the relatively short life of a drug patent before generics wipe out all profit.

It is not like they have 30 years to recoup the R&D costs. Plus other companies will jump on the bandwagon once a type of drug is proven with their slightly modified formulation.

But feel free to sink your next billion or three into a pre clinical trial drug which has a 99% chance of failing and burning up all your cash.

There is no way to depict pharma as economically struggling in any way.

Their CEOs are taking in 8-figure compensation annually.

https://medium.com/@RosenthalHealth...rise-pharma-ceos-salaries-do-too-a5ce444c9bf6

So spending a billions on marketing and clinical trials still result in a lucrative business.

 

[gstillson]

There is no way to depict pharma as economically struggling in any way.

Their CEOs are taking in 8-figure compensation annually.

https://medium.com/@RosenthalHealth...rise-pharma-ceos-salaries-do-too-a5ce444c9bf6

So spending a billions on marketing and clinical trials still result in a lucrative business.

The CEO of Microsoft makes over 25 million per year. The CEO of Boeing makes 18.5 million per year. The CEO of Kroger makes 11.7 million per year.

What was your point again?

 

[explanade]

The CEO of Microsoft makes over 25 million per year. The CEO of Boeing makes 18.5 million per year. The CEO of Kroger makes 11.7 million per year.

What was your point again?

Point is pharma spends all it does on market8ng and R&D and still pays its CEOs more than $25 million.

Their business model is fantastically profitable despite those expenditures.

Only apologists want to cry about clinical trial costs. Pharma companies aren’t going bankrupt because of those costs or any reason.

Instead, several of them pay $30 million a year to their CEOs, after spending those sums.

 

[Rianne]

I'd like to know what a CEO earning $250K a week does in a week. Seriously, what can they possibly be doing that is worth that kind of money?

 

[gstillson]

Point is pharma spends all it does on market8ng and R&D and still pays its CEOs more than $25 million.

Their business model is fantastically profitable despite those expenditures.

Only apologists want to cry about clinical trial costs. Pharma companies aren’t going bankrupt because of those costs or any reason.

Instead, several of them pay $30 million a year to their CEOs, after spending those sums.

So their business model is profitable. Wow. That is an interesting concept to attract investors.

I can give you a list miles long of Pharma companies that HAVE gone bankrupt because of trial costs.

Here is a little chart of one. Note how happy you would have been to be an investor in this "fantastically" profitable venture. This is for Celsion, which reverse split adjusted was trading for around $1000 a share in 1999 and now trades for $1.73. Fantastic, huh?

 

[aja8888]

So their business model is profitable. Wow. That is an interesting concept to attract investors.

I can give you a list miles long of Pharma companies that HAVE gone bankrupt because of trial costs.

Here is a little chart of one. Note how happy you would have been to be an investor in this "fantastically" profitable venture. This is for Celsion, which reverse split adjusted was trading for around $1000 a share in 1999 and now trades for $1.73. Fantastic, huh?

In 1999 just about everything traded for $1000/share. Even companies that delivered cans of beans.

 

[candrew]

I'd like to know what a CEO earning $250K a week does in a week.

It might be a fair guess that during any given week, many CEO's are busy driving stock buybacks to extract capital from the corporation instead of contributing capital for corporate needs and increasing employee pay.

 

[joeea]

I think you are right.... especially on the last part... the penalty of $0 will have a minimal impact on premiums as people will continue to need and buy health insurance... the penalty was so minor it was not an affective deterrent to those who did not want to buy health insurance.

The recent rise in premiums has nothing to do with ACA but is more increases in the cost of health care services which are at least 80% of premiums by law... when the cost of those health care services goes up premiums follow.

I agree. And I believe the insurance companies are getting a better handle on pricing premiums for these products.

Unless the rules are changed again abruptly (something that is less likely now with a divided Congress but may still be possible through "Executive actions"), I think this will be relatively stable for the next 2 years.

 

[explanade]

So their business model is profitable. Wow. That is an interesting concept to attract investors.

I can give you a list miles long of Pharma companies that HAVE gone bankrupt because of trial costs.

Here is a little chart of one. Note how happy you would have been to be an investor in this "fantastically" profitable venture. This is for Celsion, which reverse split adjusted was trading for around $1000 a share in 1999 and now trades for $1.73. Fantastic, huh?

So what are you a shareholder or a former employee?

Most people have heard of Merck, Pfizer, etc.

They’re the ones raising prices on OLD drugs, not a damn thing to do with trial costs.

Or are you claiming there are billions in ongoing trial costs for a long-established pharma product like insulin?

If they can’t make it a go when plenty are fantastically profitable, then they should go bankrupt and out of business.

Especially at this time when they’re all raising prices on every drug out there.

 

[youbet]

I'd like to know what a CEO earning $250K a week does in a week. Seriously, what can they possibly be doing that is worth that kind of money?

Those CEO's are doing the same kind of things that other MegaCorp CEO's, entertainers and athletes that make similar compensation do........ They make money for the owners of the businesses. Whether those profits, in any of the cases, would pass muster in an ethics class is another question.

 

[youbet]

I personally believe the Medicare Advantage plans will be the blueprint for Medicare for all and it's the reason the marketing for Advantage has been so aggressive.

Yep. I've been on Medicare for several years now and it seems too good to be true. Because of IRMAA, Medicare is quite expensive for DW and I but we feel it's an improvement over the employer provided policies we had while working. I don't think it would be possible to give the masses the flexibility of treatment choices and the unrestricted access to providers that we 65+ Medicare geezers enjoy today.

Aren't the national health care plans in countries like Canada and the UK more like a Medicare Advantage plan than Medicare? You know, lot's of "management" of care and provider choices made for the consumer and that sort of thing?

 

[MRG]

Can a U.S. doctor prescribe a med to be purchased in a different country? I understand U.S. citizens go to Canada to get meds, but do they do it illegally or do they know the name of the drug/dosage amount and buy it?
If I told my doc to send my prescription to a Canadian pharmacy, can he do that?

Don't know how that process works. I did run out of atenonol(BP med) while in Amsterdam. A very nice gentleman came to my room with an old fashioned black bag. It was full of drugs. Gave me 6 atenolol for 100 guilders. He was a doc, gave me a receipt in Dutch to take back to my American health insurance. Guess what they did?

ETA: I don't think so. They wouldn't have a medical license in another country.