Are we allowed to talk about it yet?

[W2R]

There's nothing to talk about quite yet.

Even if it actually comes to vote, even if it actually passes the house, it still has to go to the Senate.

The Senate almost certainly will make changes. The changes will need to be reviewed and voted upon by both the House and Senate.

Whatever is on the agenda for tonight will not be whatever does or doesn't make its way into law.

Once there is an actual change to current healthcare law, then we should have a lot of discussion about the impact. Until then, your guess is as good as mine.

+1

This is what I am thinking as well although I am no expert on this process. I do know that these health care bills are so important and relevant for our forum members. Hopefully the forum can handle discussing politely without too much scare-mongering, and will choose to refrain from political slams or implications, and so on. It is a delicate balance, and possibly at some point we might need to close the thread and delay discussion until the bill is passed and we know more. But we hope not.

 

[EastWest Gal]

This white paper by Milliman provides the rational and analysis for risk pools and the Federal Invisible Risk Pool. It spells out pretty clearly how they might be structured. https://thefga.org/wp-content/uploads/2017/04/The-Federal-Invisible-High-Risk-Pool.pdf

In it, they identify 8 conditions that automatically classify as "high risk".

I have nothing but questions in my head about this. I won't have time to read the bill or even this white paper in entirety today. But read just below the 8 health conditions that put someone in the high risk pool. It states that all providers must accept as payment in full the Medicare reimbursement rate, with no balance billing, for reimbursements exceeding $10K. That is a helpful nugget, but I'm not sure how well that will work. Does that mean no provider can opt out of Medicare? Does that mean that insurers, which usually pay better than Medicare, will be paying doctors and hospitals less than their contracts state, which opens up the possibility of breach of contract suits, not to mention the stated goal was to reduce government involvement in healthcare, not increase it. What if a physician does not accept Medicare or there is no stated Medicare reimbursement rate for a procedure, such as repair of complex congenital heart disease in an infant?

Also, will insurers put others in their high risk pools, and what about the cancers not listed, as well as a gazillion other very expensive diagnoses? You know, metabolic disorders, cystic fibrosis, lupus, every cancer not listed including common ones?

There's are too many questions to even begin to answer.

I'm sad about the age ratio, which the states can waive, the potential to waive essential benefits, the ability of insurers to put you into a high risk pool for anything, a way for states to opt out of covering pre-existing conditions, and so on? The way this is going some of us may need to go back to work full time just to have health insurance at all, like it was before. And with fewer employers offering retiree health insurance, more will need to work until Medicare age.

Of course this is just one vote. Then there's the Senate, and reconciliation. It feels ill-considered and jammed through, though.

We will be stuck with higher premiums, less coverage. Insurance companies are already reporting high profits even as they jacked up our premiums to obscene levels. Why do I feel like we are about to be screwed?

 

[MichaelB]

I have nothing but questions in my head about this. I won't have time to read the bill or even this white paper in entirety today. But read just below the 8 health conditions that put someone in the high risk pool. It states that all providers must accept as payment in full the Medicare reimbursement rate, with no balance billing, for reimbursements exceeding $10K. That is a helpful nugget, but I'm not sure how well that will work. Does that mean no provider can opt out of Medicare? Does that mean that insurers, which usually pay better than Medicare, will be paying doctors and hospitals less than their contracts state, which opens up the possibility of breach of contract suits, not to mention the stated goal was to reduce government involvement in healthcare, not increase it. What if a physician does not accept Medicare or there is no stated Medicare reimbursement rate for a procedure, such as repair of complex congenital heart disease in an infant?

Also, will insurers put others in their high risk pools, and what about the cancers not listed, as well as a gazillion other very expensive diagnoses? You know, metabolic disorders, cystic fibrosis, lupus, every cancer not listed including common ones?

There's are too many questions to even begin to answer.

All valid questions, but they cannot be answered, because implementation details are not part of this.

 

[Fedup]

I have nothing but questions in my head about this. I won't have time to read the bill or even this white paper in entirety today. But read just below the 8 health conditions that put someone in the high risk pool. It states that all providers must accept as payment in full the Medicare reimbursement rate, with no balance billing, for reimbursements exceeding $10K. That is a helpful nugget, but I'm not sure how well that will work. Does that mean no provider can opt out of Medicare? Does that mean that insurers, which usually pay better than Medicare, will be paying doctors and hospitals less than their contracts state, which opens up the possibility of breach of contract suits, not to mention the stated goal was to reduce government involvement in healthcare, not increase it. What if a physician does not accept Medicare or there is no stated Medicare reimbursement rate for a procedure, such as repair of complex congenital heart disease in an infant?

Also, will insurers put others in their high risk pools, and what about the cancers not listed, as well as a gazillion other very expensive diagnoses? You know, metabolic disorders, cystic fibrosis, lupus, every cancer not listed including common ones?

There's are too many questions to even begin to answer.

I'm sad about the age ratio, which the states can waive, the potential to waive essential benefits, the ability of insurers to put you into a high risk pool for anything, a way for states to opt out of covering pre-existing conditions, and so on? The way this is going some of us may need to go back to work full time just to have health insurance at all, like it was before. And with fewer employers offering retiree health insurance, more will need to work until Medicare age.

Of course this is just one vote. Then there's the Senate, and reconciliation. It feels ill-considered and jammed through, though.

We will be stuck with higher premiums, less coverage. Insurance companies are already reporting high profits even as they jacked up our premiums to obscene levels. Why do I feel like we are about to be screwed?

You should read more without getting way too emotional. Wordings like getting screwed is to that effect. From what I've read, Arkansas implemented the high risk pool with very limited cost, $55 million, if I remember correctly, and was able to reduce premiums overall.

 

[easysurfer]

I don't see why you would say that, given that anyone can be put in the pools. You must have a clean medical history.

I said that because overall, my medical history is pretty clean. Not perfect, but better than the average person my age. So, I'd think after reading, I won't be placed as high risk by some ticky tacky rule.

 

[GTFan]

You should read more without getting way too emotional. Wordings like getting screwed is to that effect. From what I've read, Arkansas implemented the high risk pool with very limited cost, $55 million, if I remember correctly, and was able to reduce premiums overall.

High-Risk Pools For Uninsurable Individuals | The Henry J. Kaiser Family Foundation

Scroll down to the PCIP section to see how expensive it is when all comers are eligible with only a 6-month waiting period restriction (new pools would have none).

PCIP was operational in all 50 states by the fall of 2010. By late 2012, just over 100,000 individuals were enrolled and program expenses had consumed nearly half of the $5 billion appropriation. For the final 12-month period for which PCIP expense data were reported, net losses for the program were over $2 billion.

The feds had to cut off enrollment in early 2013 to avoid running out of allocated funds This was an entirely too common outcome for state pools as well.

Limited funding is a real issue with the current proposal, even if you agree that the FIHRP can reduce premiums overall.

 

[MichaelB]

High-Risk Pools For Uninsurable Individuals | The Henry J. Kaiser Family Foundation

Scroll down to the PCIP section to see how expensive it is when all comers are eligible with minimal restrictions.

That analysis sums up the history of past individual state efforts to implement risk pools but does not consider the initiative currently under consideration. It is not an analysis of the current bill.

 

[hesperus]

It allows voluntary ceding into the FIHRP of other lives at the discretion of the carriers, subject to eligibility requirements.

There's the sticky part. I might feel as if the sword of Damocles were hanging over my head if I had a parent who had one of the high risk illnesses. Not to mention that the insurers hold absolute power in 'deciding' who else might be placed into the HR pool. It sure feels like a slippery slope...

 

[REWahoo]

Those of you who want to turn this thread into a hog-calling contest need to take your posts over to Agriculture.com

 

[hesperus]

Those of you who want to turn this thread into a hog-calling contest need to take your posts over to Agriculture.com

explain 'hog calling'

Let's keep this dialogue civil

 

[MichaelB]

Why not just talk about the bill. Some other time for all that other stuff.

 

[Tadpole]

That analysis sums up the history of past individual state efforts to implement risk pools but does not consider the initiative currently under consideration. It is not an analysis of the current bill.

As far as I know there is no updated analysis; at least, no CBO analysis. Do you know what is different in the current legislation under consideration?

 

[MichaelB]

As far as I know there is no updated analysis; at least, no CBO analysis. Do you know what is different in the current legislation under consideration?

Different compared with what? The KFF article linked did not get into details on any specific high risk program, it's just a short narrative with a general summary.

I am not advocating anything; like other members, just trying to understand and assess. My suggestion is to look at what is proposed and try to understand the details.

 

[Mulligan]

Why not just talk about the bill. Some other time for all that other stuff.

This bill is important to me, but I am beaten down from the constant changes and such....So I am just going to ask and be lazy...Is doubling the HSA contribution limits still a possibility on this latest go around?

 

[ShokWaveRider]

Does it say anywhere in the current proposal that just passed the house, whether it will be graduated in? Other than Medicaid Expansion to end in 2020, I cannot see anything about when the current subsidies will end.

After this year, I will be 64 and then only have 1 year to Medicare, I am curious if any of this will be in effect for January 1 2018. My DW does not have any pre-existing conditions and does not take any medications.

<< MOD EDIT >>

 

[ShokWaveRider]

If I understand about High Risk Pools, they are only open as long as the money is projected to last or a certain number of folk apply. I remember looking into it years ago, when I was thinking of ER and all the Pools I looked at were closed as there were too many people in them. so membership is finite........ It think anyway.

 

[JoeWras]

This bill is important to me, but I am beaten down from the constant changes and such....So I am just going to ask and be lazy...Is doubling the HSA contribution limits still a possibility on this latest go around?

I told you in the other thread that I was working on that!

Seriously, according to PBS article, the HSA doubling is in there. This is important to me since it looks like I might go OMY again next year.

Search HSA on this:

What's in the House GOP health care bill? | PBS NewsHour

 

[foxfirev5]

With 5 and 4 years until Medicare DW and I are hoping my retiree medical doesn't get trashed with the overall shift in public policy. We're already out of luck with minor preexisting conditions. I guess the only thing we can do is continue with our diet and exercise programs and quit watching the news.

 

[kgtest]

There's nothing to talk about quite yet.

Even if it actually comes to vote, even if it actually passes the house, it still has to go to the Senate.

The Senate almost certainly will make changes. The changes will need to be reviewed and voted upon by both the House and Senate.

Whatever is on the agenda for tonight will not be whatever does or doesn't make its way into law.

Once there is an actual change to current healthcare law, then we should have a lot of discussion about the impact. Until then, your guess is as good as mine.

+1 amendments and revisions

 

[rodi]

There's nothing to talk about quite yet.

Even if it actually comes to vote, even if it actually passes the house, it still has to go to the Senate.

The Senate almost certainly will make changes. The changes will need to be reviewed and voted upon by both the House and Senate.

Whatever is on the agenda for tonight will not be whatever does or doesn't make its way into law.

Once there is an actual change to current healthcare law, then we should have a lot of discussion about the impact. Until then, your guess is as good as mine.

+2.
Even though this just passed - it is not at all close to what the final bill will look like. The Senate is a different group. They will pass their own version. Then teams from both sides of the legislature will conference and come up with reconciliation bills (compromises between the two, likely very different, bills.) Then this reconciliation has to pass both legislative bodies.

I am waiting for CBO analysis and am waiting for what will come out of the Senate. We've got lots of time to figure it all out.

 

[Mulligan]

I told you in the other thread that I was working on that!



Seriously, according to PBS article, the HSA doubling is in there. This is important to me since it looks like I might go OMY again next year.



Search HSA on this:



What's in the House GOP health care bill? | PBS NewsHour

Joe, I thought you was going to tell me, your letter is what influenced them to increase the deduction, lol.
Thanks for the brief summary link. It was short enough for my small brain to soak in.
We know things will get adjusted in senate if even approved....But with that being said, I guess I am being more cynical as I am older. It appears to just be a constant game of cost shifting since ACA originated without any real solutions for the underlying costs... One first blush, I lose points on old age ratio premium caps to younger people. But score on larger HSA deductions and maybe some old age premium assistance. Im sure this weak self analysis will change by the time the senate gets a hold of it.

 

[Cobra9777]

Glad to see the HSA provisions are still there. That's the only dog I have in this hunt.

 

[rodi]

[ Mod hat on ]

The moderator team would like to keep this thread and discussion open. We will be editing out any and all comments that stray off topic.

Hot topic also enabled.

[ Mod hat off ]

 

[kimcdougc]

This white paper by Milliman provides the rational and analysis for risk pools and the Federal Invisible Risk Pool. It spells out pretty clearly how they might be structured. https://thefga.org/wp-content/uploads/2017/04/The-Federal-Invisible-High-Risk-Pool.pdf

In it, they identify 8 conditions that automatically classify as "high risk".

Interesting article. Too bad they don't write it in layman's terms so it is easier to understand. Thanks for posting.

Now I guess it is just a wait and see game.

 

[RetireAge50]

I treat this like the stock market. When the market price changes I update the plan going forward.