Health Care Mandate - To Supreme Court to Decide

[Hamlet]

Employer provided health care is already in the process of self-destructing. The push toward temp/part-time/consultant/contract/outsourced/etc jobs has resulted in a greater percentage of unisured every year.

I don't know that the ACA makes that any worse(or better, depending on your point of view), it just allows the people who are losing their group coverage to effectively buy coverage on the individual market (at least that is the intent)

IMO, the biggest advantage of the Swiss system over what we might get under the ACA is the ACA's continued linkage between employers and health care. Luckily, the ACA will destroy employer provided health care in the US (it is much cheaper for employers to simply drop coverage,pay the fine, and let the employees buy their own insurance with a big government subsidy. The much larger need for subsidies as this process continues is a reason the estimates for the cost of the ACA are far too low).

 

[ziggy29]

If insurance companies are forced to take all applicants, without an individual mandate you will have a strong incentive to simply wait until you are sick to buy insurance.

IMO, you simply can NOT eliminate underwriting without universal coverage.

 

[samclem]

[the ACA] just allows the people who are losing their group coverage to effectively buy coverage on the individual market (at least that is the intent)

That's the intent, and I hope that's the result. We can't say it's doing anything of the sort yet.

 

[WhoDaresWins]

I for one was disappointed to see this set back to the health care mandate. Is there any AAA rated country (which we are apparently no longer) that does not have some kind of affordable health safety net for the entire populace?

I see this (universal health insurance) as something that improves the fabric of American society and brings us up a notch or two in terms of being a civilized example to the rest of the world.

 

[Hamlet]

Maybe. I think we are going to see some inter-generational friction in the years ahead.

At a certain point, the youth of this country are probably going to object to constantly having massive transfers from their paychecks to the elderly.

Funny how no one ever suggests that car insurance should not be priced by age.

That is a very good thing. Employer provided insurance generally does the same. And family plans involve a giant subsidy of large families by couples and those who have smaller families. No problem there either.

 

[samclem]

Is there any AAA rated country (which we are apparently no longer)

There are three major rating agencies, two of them rate the US in their highest category.

The reason our bonds are losing their status is because our government spends much more than it takes in. How does even more government spending make our bonds a better credit risk?

 

[WhoDaresWins]

There are three major rating agencies, two of them rate the US in their highest category.

The reason our bonds are losing their status is because our government spends much more than it takes in. How does even more government spending make our bonds a better credit risk?

I think it is be cheaper to ensure a healthy, well cared for society. Just as a well-educated society is a catalyst for the good.

I am not in favor of a government agency to be in charge of all this. I believe some incentive to the insurance underwriters is more the answer. I have excellent health insurance supplied at no cost to me by my employer. I don't think anyone should be cut off from access to health care just because they are either too well off to qualify for Medicaid or don't have access to employer sponsored health care. I think everyone should pay something (other than the abjectly poor), but is should be affordable.

 

[FIRE'd@51]

As others have said, without a mandate and guaranteed-issue insurance, people will game the system.

I know this isn't "politically correct" to say, but if guaranteed-issue insurance (with appropriate subsidies) can be provided for all, why do we need a mandate. Simply refuse to treat those who refuse to purchase insurance, unless they can pay for the treatment themselves. If I decide not to buy insurance for my house, and it burns down, no one is going to help me out.

 

[GregLee]

Simply refuse to treat those who refuse to purchase insurance, unless they can pay for the treatment themselves.

A few hundred years ago, that would have worked. Times have changed, and now we don't think it's okay to let people die in misery because it was their own fault. Sorry if you don't care for our new, less judgmental, and gentler society.

 

[ERD50]

ERD -- I don't think many of us have said or implied that opposition to the AHCA is opposition to universal health care.

I assume this was my quote you were responding to:

It's why I get frustrated when some people characterize the bill opponents as being against everything.

You may be correct. I don't know that 'many' make the characterization, I merely said 'some' do. And I'm frustrated by those that do, and that is where my frustration was aimed. It may just be a vocal minority (newspaper editorials/comments, other forums, etc).

And family plans involve a giant subsidy of large families by couples and those who have smaller families. No problem there either.

Actually, I have a problem with it, even though I've benefited from it. I have a fractionally larger than average family. I can't think of any reason why our company health insurance charges the same for a family of 2 as a family of 10. If someone wants to have ten kids, I think they should be responsible for the costs. Why should a childless couple subsidize the health care for another family? I don't get it.

-ERD50

 

[ziggy29]

Sorry if you don't care for our new, less judgmental, and gentler society.

Which is, in itself, a rather judgmental statement. Don'tcha think?

 

[M Paquette]

Copy the Swiss system (vouchers for all, individual choice on how to use them), and start from there. Adjust as needed.

-ERD50

The Swiss system requires the purchase of private insurance by all. If in-country 90 days or more one must buy at least the Basic policy.

Of course they have a different constitution and body of law than we do.

 

[donheff]

The Swiss system requires the purchase of private insurance by all. If in-country 90 days or more one must buy at least the Basic policy.

Of course they have a different constitution and body of law than we do.

Even if the SC rules against the mandate a voucher approach could pass muster because we would not need a mandate that individuals purchase anything. The tax base would have to be expanded substantially (capturing the current funds going to insurance from individuals and employers plus whatever is needed to cover the rest). This wouldn't necessarily mean more money but the funds would initially go to government only to be returned to everyone in the form of a flat voucher sufficient to cover a basic insurance policy. Individuals could choose the policy of their choice, no mandate needed since they couldn't use the voucher for anything else. Should they choose not to use the voucher, they would be on their own. They could potentially purchase HC with their own funds. If they entered a hospital they could be required to provide payment in cash or by enrolling in a basic insurance policy at that time. With no preexisting condition exceptions that should not be a problem. An alternative would be some sort of tax credit sufficient for a basic policy. Neither concept carries any likelihood of making it in today's society which is why I favor working from the current system.

 

[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.

 

[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.

 

[ziggy29]

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]

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]

... 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!

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]

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]

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.

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]

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