Health Care Mandate - To Supreme Court to Decide

[ziggy29]

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Originally Posted by bridgezon I'd also like to add to the discussion that I think that one reason that employers are not hiring new people and are working fewer people harder is because of employer health care. I'm surprised that I never hear this as part of the debate about the economy. It could also make it more profitable to hire younger people, to outsource, to automate, etc.

It is certainly a factor in whether or not they hire someone as a full time, "permanent" (i.e. W-2) employee or as a contractor paid with 1099 wages. Up to a certain point it's more profitable to just work existing employees longer and harder (even if they are hourly) since that's fewer health insurance premiums to pay. Your health insurance benefits don't rise by 25% when you work 50 hours instead of 40 -- even if you weren't abused by salaried exempt laws and actually got paid by the hour.

[Stella_Barbone]

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Originally Posted by bridgezon We're going to lose our Cobra insurance in about 8 months. I've been investigating coverage and was told that there are 5 states that cannot deny someone coverage or charge more on the basis of pre-existing conditions. So how does this work in New Jersey, for example, without a mandate? I realize premiums are higher in these states.

There are 35 states that have established high risk pools for people with pre-existing conditions under the Affordable Care Act. These are meant to be transitional until the ACA exchanges are up and running in 2014. Massachusetts has the lowest incidence of uninsured people followed by Hawaii while poor Texas brings up the rear with 26% of its citizens uninsured. There are 11 states with some form of guaranteed issue; Vermont, Rhode Island, Oregon, Ohio, New York, New Jersey, Michigan, Massachusetts, Maine, Idaho, and Florida. Hawaii requires employers to provide coverage for all employees working more than 20 hours per week (and has the lowest health care costs in the nation!), but doesn't have guaranteed issue. The Kaiser Family Foundation has a summary of health care on a state by state basis at the website statehealthfacts dot org.

[chinaco]

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Originally Posted by samclem ... It could also be a good model for Medicare--just open the exchanges to the Medicare age group and let oldsters use their government Medicare entitlement as a voucher to buy from whichever provider they'd like. That shouldn't be controversial.

I don't have a problem with a voucher plan if there was total health care reform (across the board for everyone).

But... the people pushing the voucher approach are not interested in doing that. They are just interested in reducing medicare and medicaid.

If... they were really interested in fixing it... they would go "all-in"!

The mistrust, is because they are not willing to consume their prescribed solution themselves!

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Originally Posted by samclem I still think it's possible the vast majority of people could be induced to buy health insurance even without an individual mandate. Once the US puts in place a system that goes the extra mile to make individually-purchased health insurance more affordable, then folks without insurance will feel some increased pressure to get aboard. ...

Well, one thing we know for sure... most people that will get it free or really cheap will do it.

If the consequences are not very severe... people will try to game the system.

[scrabbler1]

Having worked in the actuarial area in the personal auto insurance industry for 23 years, I saw firsthand how the strength of an individual mandate is important to keeping overall rates down and maintain fairness to everyone in the system.

In the 1980s and into the 1990s, technological improvements made it easier for state to strengthen their compulsory insurance laws and give them more teeth to prevent car owners from slipping through the cracks and gaming the system, driving up rates for others who play by the rules. I evaluated the effects of various compulsory insurance law changes and saw how they reduced the rates everyone paid for Uninsured Motorists (UM) coverage, the "subsidy" those with insurance paid, in effect, to provide insurance for those who did not buy insurance of their own (i.e. the "free riders").

Whether it is an individual mandate or a single payer system (I prefer the latter), we need to have everyone paying into the system (to the degree they can reasonably afford to pay), especially the younger, healthier people who would likely skip out if there were no mandate, only to enter the system if they become sick (i.e. "free riders"), driving up costs fore everyone else the same way uninsured motorists drive up costs for everyone else.

[ERD50]

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Originally Posted by chinaco But... the people pushing the voucher approach are not interested in doing that. They are just interested in reducing medicare and medicaid.

That's a rather broad brush, no? I don't even see the connection at all.

Is that a fair characterization of the Swiss system?

-ERD50

[MichaelB]

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Originally Posted by bridgezon We're going to lose our Cobra insurance in about 8 months. I've been investigating coverage and was told that there are 5 states that cannot deny someone coverage or charge more on the basis of pre-existing conditions. So how does this work in New Jersey, for example, without a mandate? I realize premiums are higher in these states.

Hi Bridgezon, welcome to the forum. Please stop by and introduce yourself here

Healthcare insurance is regulated by states, so you need info specific to your state. Stella Barbone suggested the Kaiser Family Foundation website, which is very helpful. You can find it here. You should also consider contacting an insurance agent to look into conversion or continuation options.

[bridgezon]

We don't have any pre-existing conditions now, although I've heard that anything can be a pre-existing condition. Nothing major but we just want to be sure we don't get denied if we develop something. I think this would mean that we shouldn't move to Florida or Pennsylvania for the time being.

[Hamlet]

I'm still not clear on what aspects of the Swiss system is superior to what was just passed in this country.

It's framework seems remarkably similiar.

An individual mandate, requirements that insurance companies accept everyone, detailed requirements for what the insurance policies cover, and massive subsidies to the lower income population.

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Originally Posted by ERD50 That's a rather broad brush, no? I don't even see the connection at all. Is that a fair characterization of the Swiss system? -ERD50

[ERD50]

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Originally Posted by Hamlet I'm still not clear on what aspects of the Swiss system is superior to what was just passed in this country. It's framework seems remarkably similiar. An individual mandate, requirements that insurance companies accept everyone, detailed requirements for what the insurance policies cover, and massive subsidies to the lower income population.

It's been hashed out many times in past threads. I already am spending too much time posting here, I'm not going to repeat that all again.

The differences are extremely important - breaking the ties to health ins & employment is just one of them.

-ERD50