Health Insurance Exchanges under the PPACA

[Katsmeow]

Since most Americans favor repeal of the law, it may be difficult to get the funding passed (in the House) to allow the federal government to set up exchanges. On the other hand, once some states set them up and the federal subsidy checks start flowing in, residents of the states dragging their heels may pressure their legislators to get off the dime so they can get the subsidies, too (especially since their own tax dollars are used to pay them)

Or...maybe not.

Poll: Support for Obamacare repeal is plummeting

Shows 33% want repeal post-election.

Link to the actual Kaiser article:

http://www.kff.org/kaiserpolls/upload/8382-F.pdf

I looked at your link. The healthcare repeal poll results given that are within the last 4 months are all from Rasmussen Reports. Since the devil is in the details with polls I went to that web page:

Health Care Law - Rasmussen Reports™

You will note that the Rasmussen Reports polling is based upon "likely voters" not the adult population at large. There are two issues with that. "Likely voters" aren't "most Americans." For example, I'm not a likely voter since I determined that given expected results in my locale I could not possibly make any difference in any race I could vote in. But, I am an American.

Second, well, I pretty much think that everyone knows that Rasmussen Reports' determination of who was a "likely voter" didn't turn out to be entirely accurate. I won't belabor that point here but those interested can look it up.

There is also a link to the survey question and the question on repeal doesn't differentiate as to why someone might want repeal. That is, there are people who oppose the Act because they think it doesn't go far enough and they would prefer to see a single payor system.

Another point is that the poll is pre-election. The link I gave earlier is interesting in showing the polling and how it has changed post-election.

 

[Mulligan]

I'm sure you'll be able to keep it.
"If you are happy with your present plan, you'll be able to keep it." We all heard it, and certainly this promise will be kept.

I am hopeful that will be the case for a while. My BCBS individual 5500 deductible plan, just started an incentive plan to help pay part of your deductible if you stay under your limit for something like 3 years or so. I'm hoping they wouldn't have went to the effort of starting it this year if it wasn't going to be in effect 3 years down the road to benefit from it. Kind of odd they started this anyways as it is the cheapest plan where I live by far anyways, so it doesn't increase the incentive to stay with it.

 

[easysurfer]

IMO, the time when football season 2013 starts is when to focus more on the health insurance exchanges as it's just too early right now to get anything concrete. At the high level, it's good to remember that the landscape might be pretty different come 2014, but that's about how far I wish to dive into the bits and pieces for now.

 

[samclem]

Or...maybe not.

I wouldn't put KFF in the camp of impartial observers, either. Nor the WashPo. And since it's been just a week since the election and we are talking about a change in public attitudes toward PPACA since then, I'm afraid we'll have to wait and see more data.

It's interesting that the KFF poll shows no increase in those who want to keep the law as is or "expand it", it just shows an increase in those who refused to answer/were unsure and a decrease in those who wanted to scrap it/possibly go with something else. Still, less than 50% of the people polled supported the law as is or want to expand it. (So, to your earlier point, those who like the law as-is plus those who "think it didn't go far enough" still don't total a majority).

Maybe something happened on election day, and the PPACA will become popular. If so, it is something new, as the legislation, in its entirety, has very seldom shown any signs of support from a majority of Americans regardless of who did the poll. The past is not as significant as what happens next. As we move from sloganeering, posturing, and bumper stickers to a good, hard look at what we're getting, the public's reaction is bound to be . . . interesting.

But, I'll certainly concede that pollsters can be very wrong.

 

[MichaelB]

News update. The elections are over and implementation of the PPACA is underway and moving along with a full head of steam.

Here's a brief that discusses grandfathered plans http://www.ncsl.org/documents/health/GrandfatheredPlans.pdf I would imagine availability of current plans will depend mostly on insurance companies and their willingness to maintain the hundreds of different plans they currently offer. The overhead must be high and once they cannot exclude or deny insurance they may focus much more in internal efficiencies.

Public support has been strong for most of the provisions since the beginning, certainly all those covering guaranteed issue, no exclusions for preexisting conditions, and simplified policy language. It increased after the Supreme Court ruling.

 

[Mulligan]

News update. The elections are over and implementation of the PPACA is underway and moving along with a full head of steam.

Here's a brief that discusses grandfathered plans http://www.ncsl.org/documents/health/GrandfatheredPlans.pdf I would imagine availability of current plans will depend mostly on insurance companies and their willingness to maintain the hundreds of different plans they currently offer. The overhead must be high and once they cannot exclude or deny insurance they may focus much more in internal efficiencies.

Public support has been strong for most of the provisions since the beginning, certainly all those covering guaranteed issue, no exclusions for preexisting conditions, and simplified policy language. It increased after the Supreme Court ruling.

Based on my reading and understanding of your link, I am thinking my grandfathered underwritten plan must be profitable or they wouldn't be instituting incentives to stay in it long term. I got a small rebate check even though I only pay $76 a month anyways, so they must be making too much profit on it already. I assume then they don't want to risk losing you into the exchange program. More incentive for an insurance company to keep a group of healthier than normal population walled off from the exchange competitors, maybe? That is the only answer I can come up with.

 

[samclem]

News update. The elections are over and implementation of the PPACA is underway and moving along with a full head of steam.

"News update:" The law still faces court challenges, there's no funding for some of its key provisions, and any success it achieves will require support in the Congress. So keeping an eye on public support for the law is important to us all (supporters and opponents alike), and definitely a subject worthy of discussion. In the past, sweeping legislation (Medicare, Medicaid, Social Security, etc) has generally been crafted to gain widespread support. Regardless of political viewpoint, I think we can all agree that's not what happened with PPACA. Without that support, implementation of the law will continue to face rough sledding. That's not a political statement, it's just a reflection of reality.

For those interested, the National Conference of State Legislatures maintains a site showing the PPACA implementation actions by state.

Click on your state for more info.

 

[MichaelB]

The original purpose of this thread was to provide updates on the roll outs of state insurance exchanges, not speculate on whether this will be implemented or not. Implementations details are not yet available so we will have to postpone that part of the discussion. Challenges to the law are fair game, but really should be taken up in a new thread dedicated to that.

 

[MichaelB]

An update: Secretary Sebelius has granted an additional extension that was requested by the RGA.

The postponement came in response to a request from the Republican Governors Association and its chairman, Gov. Bob McDonnell of Virginia.

./.

In a letter to the Republican governors on Thursday night, Kathleen Sebelius, the secretary of health and human services, said they would have until Dec. 14 to decide whether they wanted to establish their own health insurance exchanges. The federal government will create an exchange in any state that is unable or unwilling to do so.

 

[samclem]

Another update: Wisconsin's Governor Walker signaled yesterday that Wisconsin would not form a state-run exchange. That means the federal government will likely set up the exchange there, as in many other states.
From this link (Milwaukee Journal-Sentinal):

"I'd much prefer control at the state level," Walker told The New York Times, "but the problem is, I don't think they are really state-run."
"Why do I want to take on the potential risk to my taxpayers if I don't really have any true authority about what's going to happen?" Walker added.

 

[rbmrtn]

Looks like we're pretty much ready to flip the switch.

Intent letter: http://www.mid.ms.gov/pdf/ExchDecLtr.pdf

Site: One, Mississippi - Your Health Insurance Marketplace

Looks like ehealthinsurance is going to be providing most of the supporting structure for these exchanges.

 

[JoeWras]

NC goes for hybrid approach

I don't fully understand this, but NC has chosen a hybrid of state and federal run exchange.

NC to build state-federal online insurance market :: WRAL.com

 

[rbmrtn]

I don't fully understand this, but NC has chosen a hybrid of state and federal run exchange.

NC to build state-federal online insurance market :: WRAL.com

I had not of the partnership exchange either; kaiser has some updated info on it

Health Insurance Exchanges - Kaiser State Health Facts

"As of July 30, 2012, three states, Arkansas, Delaware, and Illinois, are planning to pursue a state-federal
partnership exchange. A state opting for a partnership exchange can choose to operate plan management
functions, consumer assistance functions, or both, leaving the federal government to assume responsibility for
all other exchange components in the state. While only a few states have committed to a partnership exchange
to date, this option may become an increasingly viable strategy for states that have delayed establishing an
exchange. Additionally, states with small populations, such as Montana and Wyoming, are considering the
partnership model because it would allow the state to benefit from the economies of scale that arise from sharing
costs and resources with the federal government. States that are not ready to run a fully state-based exchange
beginning in 2014 may transition from a partnership exchange to a state-based exchange at a later date."

http://www.kff.org/healthreform/upload/8213-2.pdf

 

[JoeWras]

Thanks rbmtn. That explains it better. Also explains why our governor says this gives flexibility for the next governor and legislature.

 

[samclem]

No state-sponsored exchange for Maine

Update: According to an announcement yesterday by Governor LePage, Maine will not be setting up a state-run exchange and will leave it to the feds.

From a piece in the Bangor Daily News:

AUGUSTA, Maine — Maine will let the federal government take the reins on setting up a mandated online health insurance market, according to comments Gov. Paul LePage made Thursday to a national news outlet.
States must decide whether to set up the markets, called exchanges, or let the federal government step in to do it for them.

For Mainers wondering why, it looks like LePage's reasons paralleled those of Gov Walker in Wisconsin:

LePage sent a letter to U.S. Department of Health and Human Services Commissioner Kathleen Sebelius, saying Maine would not set up an exchange.
“The [federal health reform law] is full of federal mandates; as such, even a state-based health insurance exchange is actually controlled by the federal government,” LePage wrote. “In the end, a state exchange puts the burden onto the states and the expense onto our taxpayers, without giving the state the authority and flexibility we must have to best meet the needs of the people of Maine.”

For those looking for a recap, the link at the MichaelB's original post is still good. KFF is keeping the map up to date--it looks like 15 states have announced they won't do state-run exchanges, 17 states will do them, and 5 states will do partnerships. The rest remain undecided.

 

[Olbidness]

Will a State running its own plan or federal run affect where a person chooses to declare residency? It seems likley since retirees choose states based upon income tax this would be another variable.

 

[samclem]

Will a State running its own plan or federal run affect where a person chooses to declare residency? It seems likley since retirees choose states based upon income tax this would be another variable.

Based on what I'm seeing, there probably wont be much difference between states on the level and cost of care provided within the exchanges. A major theme among many governors is the rigidity of the federal mandates and rules, that indicates there may not be much difference between the state plans. The availability of medical providers in a particular location (city vs rural, etc) may be a bigger factor than the state lines.

But--for those folks that will depend on Medicaid, the choice of state of residence is likely to be much more important. Some states are going along with an expansion of Medicaid, some likely will not.

And the state taxes will likely be an issue for many of us. To the degree states are refusing to expand Medicaid or set up their own PPACA exchanges, they are attempting to limit the size of the bill to residents of their state. Those tax bills will need to be paid by someone. Folks shopping around for a place to retire will look carefully at these issues.

 

[ziggy29]

What I'm still trying to figure out is: What is the benefit of a state-run exchange instead of using the federal exchange? I've not figured that out, and I assume there must be some benefit or else all the states would be using the federal exchange instead of investing the time and money into creating their own.

Does creating your own exchange require that you accept the expansion of Medicaid? That would seem like the only reason to do it as far as I can see -- if a state wants that expansion (and for a while, federal funds to pay for it), they might have to use their own exchange? Just a guess, I'm still not sure...

 

[imoldernu]

What I find fascinating, is that most of this medicare "stuff" applies to those who are 65+....
Most of the folks posting on this forum are under 65... and the complexities involved in choosing are daunting. In my senior communities the average age is probably closer to 70 to 75 with many who are well into their 80's and 90's.

Think of your mom or dad receiving (as we just did from our provider) books and pamphlets totalling more than 300 large, closely spaced pages of information... and another 200 pages with Plan D information... One set for DW and one set for me. And that only included info from one provider. To compare between two or three other providers, and it turns into more than a 15 minute decision process.

...and then making an educated decision.

We've given in, and at our advancing age, will stick with what we have... thus avoiding angst and depression.

 

[marko]

So many unknowns in key/critical areas.


With only 13 months before launch, I just don't see how something this enormous will be ironed out well enough for a practical implementation.

I do know that I was told that if I wanted to "...go learn to play the guitar or 'do art', I could now do that without worrying about having to get a job with HI...". So I've got that going for me.

 

[ziggy29]

With only 13 months before launch, I just don't see how something this enormous will be ironed out well enough for a practical implementation

This is, for me, a reason why if I were running a state, I think I'd want to use the federal exchange first and see how the state exchanges work for people in their states. If they are more cost-effective, more responsive to the needs of the state's residents, then I'd think it would be worth rolling out a state exchange. But because states can always implement their own exchanges in the future (this isn't a binding one-time decision), there seems no need to rush. Let other states be the guinea pigs...

 

[youbet]

What I find fascinating, is that most of this medicare "stuff" applies to those who are 65+....
Most of the folks posting on this forum are under 65... and the complexities involved in choosing are daunting. In my senior communities the average age is probably closer to 70 to 75 with many who are well into their 80's and 90's.

.

I haven't seen comments on this thread that relate to Medicare....... Medicaid (expanded) and so-called Obama-care, and the subsequent development of insurance exchanges, are being discussed, but not Medicare.

I do agree with you, as a fellow post-65 geezer, that making Medicare choices is not trivial. I don't think that will be impacted by the implementation of state/federal/joint exchanges however.

 

[samclem]

But because states can always implement their own exchanges in the future (this isn't a binding one-time decision), there seems no need to rush. Let other states be the guinea pigs...

There is one complicating factor: States were offered "federal" money (one-time, or limited time, I think) to be used in setting up their state exchanges. Waiting might mean that a state will have to fund startup costs out of pocket.
I think some of the states saw the dough and reflexively grabbed it and started running. IMO, it's more prudent to wait, let some other states make their mistakes and maybe get some more flexibility from DC, then press ahead when the situation is more clear and they can use the "best practices" discovered elsewhere.

 

[Olbidness]

Based on what I'm seeing, there probably wont be much difference between states on the level and cost of care provided within the exchanges.

Under our current Health Care System there is variablity state to state in costs and premiums. I have not seen how this would change under this new system. Insurers still have to compete based on costs.

A single payer system with price controls, preimiums nation wide would be equal but with low cost States subsidizing high cost States.

I'm not sure about any of this.

 

[youbet]

I'm not sure about any of this.

Life's like that.........