Obamacare - It's gonna cost a lot more if you smoke

[killingme]

Unfortunately costs will be going up for many, many other groups too. After the news a week or so ago about Californias premiums the following came to light Rate Shock: In California, Obamacare To Increase Individual Health Insurance Premiums By 64-146% - Forbes . So in fairness, this could definately be considered sticker shock. At the end of the day someone has to pay and unfortunately it is not limited to individuals with poor lifestyles.

I just hope that at that same days end the new law, taxes, penalties, warts and all, will be a benefit to everyone.

 

[hsv_climber]

Well...there is that little thing happening like electronic medical records. It will be in your file at your general practitioner, probably a box checked and probably a report sent to the IRS and insurance companies eventually that can be cross scanned and checked.

Are you saying that smokers won't be allowed to quit anymore
And how can a general practitioner know that info anyway? Would not he/she needs an authorization to perform a test?

Bottom line: short of forcing everyone to take a test, there is no way for the insurance company to know if a person is a smoker or not.
My prediction - "official" number of smokers in US will be cut 10x next year.

 

[Texas Proud]

Also, I can't see charging smokers or heavy drinkers or obese people more for insurance when most studies show they cost less for health care over their lives than slender, non-smoking, non-drinking boring people. They die younger, faster, and cheaper. There may be some costs of treatment while they are alive, but over a life time they cost less.

Just quoting you as an example.....


The problem with this thinking is that for an insurance company... a smoker will probably cost more TODAY than a non-smoker... they are not as concerned with the total lifetime cost of the insured....

If I were an insurance company, I would want all my customers to be healthy at least until they turn 65 and are off my dime....


So, smokers, drinkers and such are unhealthy at an age when the insurance companies pay.... healthy people are unhealthy at an age when the gvmt pays....

 

[marko]

Here's the real question: Does Obamacare cover Medical Marijuana smoking in states where it is legal? If so, how do they reconcile that?

IIRC, heavy Marijuana smoking is worse for your lungs than tobacco.

 

[Texas Proud]

Are you saying that smokers won't be allowed to quit anymore
And how can a general practitioner know that info anyway? Would not he/she needs an authorization to perform a test?

Bottom line: short of forcing everyone to take a test, there is no way for the insurance company to know if a person is a smoker or not.
My prediction - "official" number of smokers in US will be cut 10x next year.

I would bet that there is some language that would allow an insurance company to not pay claims if they can prove you are a smoker... so if you come down with lung cancer and they can see that you were a smoker from the x-rays etc.... well, too bad for you....

 

[MichaelB]

Unfortunately costs will be going up for many, many other groups too. After the news a week or so ago about Californias premiums the following came to light Rate Shock: In California, Obamacare To Increase Individual Health Insurance Premiums By 64-146% - Forbes . So in fairness, this could definately be considered sticker shock. At the end of the day someone has to pay and unfortunately it is not limited to individuals with poor lifestyles.

I just hope that at that same days end the new law, taxes, penalties, warts and all, will be a benefit to everyone.

This Forbes piece by Avik Roy has been cited more than many other as proof of dramatic price increases resulting from implementation of the PPACA. It is the base for the WSJ article linked earlier in this thread. There are a fair number of rebuttals. The problem is we could draw some meaningful conclusions from it but instead find mostly hyperbole and excessive posturing.

The fact is that most of the policies to be sold on the California exchange will have premiums similar to those already in force for the 90% of Californians that have insurance today through group policies. Because group policies tend to cost less as the group size increases, there was an expectation that the individual policy premiums would be a bit higher. Instead, they are slightly lower.

Comparing those prices to quotes from an online insurance broker is inconclusive, because those policies are all subject to underwriting and all of us can be denied coverage at that price. An individual holding a policy at that price will certainly see a sizable increase in premium at the exchange. That case, however, cannot be projected to the public at large, because over 90% of the population either pays the current exchange rate or has no insurance.

The media seems obsessed it portraying this as either wildly successful or failing dismally. What matters now is implementation and how we are affected. A much more relevant question is what happens to the policyholder with an underwritten policy with low premiums. What is the premium cost of the national care policy on the California exchange? What factors are keeping the premiums levels low in California and how do they affect us?

 

[hsv_climber]

I would bet that there is some language that would allow an insurance company to not pay claims if they can prove you are a smoker... so if you come down with lung cancer and they can see that you were a smoker from the x-rays etc.... well, too bad for you....

But does the question on the application says: "Were you a smoker?" or "Are you a smoker?" ?
If the question is "are you a smoker?" then stop smoking a few weeks before that X-ray is all it should take.

 

[ERD50]

But does the question on the application says: "Were you a smoker?" or "Are you a smoker?" ?
If the question is "are you a smoker?" then stop smoking a few weeks before that X-ray is all it should take.

Or just don't smoke (or inhale?) while answering that question on the application.

What is the meaning of the word 'are'?

-ERD50

 

[ChiliPepr]

But does the question on the application says: "Were you a smoker?" or "Are you a smoker?" ?
If the question is "are you a smoker?" then stop smoking a few weeks before that X-ray is all it should take.

Actually, just look at your hand... if there is a cigarette in it you are a smoker... As my father used to say.. "I quit smoking forty times a day...."

 

[sheehs1]

Are you saying that smokers won't be allowed to quit anymore
And how can a general practitioner know that info anyway? Would not he/she needs an authorization to perform a test?

Bottom line: short of forcing everyone to take a test, there is no way for the insurance company to know if a person is a smoker or not.
My prediction - "official" number of smokers in US will be cut 10x next year.

No, not saying that. Just assuming that when your general practitioner asks they get an answer that is somewhat honest. I suppose I'm thinking most go to the general practitioner often enough to have a relationship and for the general practitioner to know their health.
Besides, even my practitioner in this rural area is now computerized, asks questions and checks the boxes. Assuming most others are as well...

 

[sheehs1]

Or just don't smoke (or inhale?) while answering that question on the application.

What is the meaning of the word 'are'?

-ERD50

Had to laugh at this one ERD50.!
Answer would be : "Today I'm not" so the applicant is momentarily being truthful!

 

[Texas Proud]

But does the question on the application says: "Were you a smoker?" or "Are you a smoker?" ?
If the question is "are you a smoker?" then stop smoking a few weeks before that X-ray is all it should take.

Or just don't smoke (or inhale?) while answering that question on the application.

What is the meaning of the word 'are'?

-ERD50

Well, since you asked....

The application that I had to answer at my last mega asked 'have you smoked at any time in the last 12 months'.... (or something similar)....


This created a big stink from some guys as they would smoke a cigar maybe two or three times a year... but did not want to pay the premium increase....

 

[Rustward]

<snip>
If the question is "are you a smoker?" then stop smoking a few weeks before that X-ray is all it should take.

No personal experience with this, but my understanding is the "stopping" part can be quite difficult for some.

 

[Bikerdude]

Funny how smokers are the one group the government allows to be discriminated against.

I wonder when a BMI surcharge will kick in.

Well, when someone else is subsidizing your healthcare costs, they usually reserve the right to tell you to live in a manner that reduces their cost.

 

[samclem]

Well, when someone else is subsidizing your healthcare costs, they usually reserve the right to tell you to live in a manner that reduces their cost.

In this PPACA setup, the biggest subsidies flow from healthy people (who are charged relatively more than the value of what they are expected to receive) to sick people and from higher income people (who receive no subsidies) to those who have lower incomes. It might be that the healthy and those with high incomes, as the "billpayers", will feel they should get an extra vote in telling people how to live, but I doubt very much they'll get this.

And, drivers of cars subsidize the increased healthcare costs of motorcycle riders.

 

[marko]

In this PPACA setup, the biggest subsidies flow from healthy people (who are charged relatively more than the value of what they are expected to receive) to sick people and from higher income people (who receive no subsidies) to those who have lower incomes. It might be that the healthy and those with high incomes, as the "billpayers", will feel they should get an extra vote in telling people how to live, but I doubt very much they'll get this.

And, drivers of cars subsidize the increased healthcare costs of motorcycle riders.

Any data to back up your claims of the healthy, wealthy car drivers providing the biggest subsidies vs the gov't? (not challenging, just asking)

I think it remains to be seen how much the gov't will be forking over. I wonder what percentage of the population (of many income ranges) will be receiving some subsidy...THIS FI person plans to!

 

[MichaelB]

Money flowing from those paying premiums to those receiving insurance benefits is not a subsidy, it is the purpose of insurance. The only individuals paying more are smokers, all others are paying the full cost. Some get premium assistance, but this is paid by taxpayers and not other premiums.

The biggest subsidy, much greater than the total value of premium assistance, is the tax break given to everyone receiving insurance through employment. It is the single largest tax break and far greater than all the premium subsidies that will be paid once the healthcare reform is fully implemented.

 

[Bikerdude]

The biggest subsidy, much greater than the total value of premium assistance, is the tax break given to everyone receiving insurance through employment. It is the single largest tax break and far greater than all the premium subsidies that will be paid once the healthcare reform is fully implemented.

And a great incentive it is for one to seek employment.

 

[samclem]

Money flowing from those paying premiums to those receiving insurance benefits is not a subsidy, it is the purpose of insurance. The only individuals paying more are smokers, all others are paying the full cost.

Some people will pay >more< than full cost. A healthy person in a group plan today is often paying lower rates (total premiums--employer and employee) for the same coverage than he/she will pay under PPACA. The higher rates these people will pay under the new law go to subsidize the artificially low rates to be paid by sick people. That's how community rating works, right? And why we went through all this drama to make everyone enroll, so they could carry the load for others. I'm not saying it is bad or good, but that's how this system is set up.

Some get premium assistance, but this is paid by taxpayers and not other premiums.

It is a subsidy, which is what we are talking about.

The biggest subsidy, much greater than the total value of premium assistance, is the tax break given to everyone receiving insurance through employment. It is the single largest tax break and far greater than all the premium subsidies that will be paid once the healthcare reform is fully implemented.

Since you brought it up: Whether it is a subsidy or not (this goes to the point of "tax expenditures", etc), it definitely warps the pricing structure of insurance, hides its true cost, and causes inefficiencies in the labor market. The failure to address this is another problem with the present legislation. But I'm not sure why this is something we think should be discussed in a thread about PPACA's implementation, this legislation is what it is, and highlighting its deficiencies risks the pig.

Any data to back up your claims of the healthy, wealthy car drivers providing the biggest subsidies vs the gov't? (not challenging, just asking)

I'm just looking at who pays and their bang-for-the-buck. If a sick, low-income earner engaged in high risk behaviors is paying $0 for health insurance and a high income healthy person who has lower risk factors is paying $10K plus per year, we can look at their respective costs and benefits and make a rough judgement of whose risk is being pushed where.

 

[sheehs1]

I'm just looking at who pays and their bang-for-the-buck. If a sick, low-income earner engaged in high risk behaviors is paying $0 for health insurance and a high income healthy person who has lower risk factors is paying $10K plus per year, we can look at their respective costs and benefits and make a rough judgement of whose risk is being pushed where.

+1
A healthy low income person is still getting the subsidy an unhealthy one gets while an unhealthy high income earner, say who smokes, is paying more.
It remains to be seen what an unhealthy one who smokes will pay.

To not acknowledge this is the basic premise on affordability "for all" is to not understand why it was set up the way it was. Risk is being pushed towards those that can pay whether that is thru taxation or premiums in order to afford giving subsidies to those that don't or simply can not pay.

Not saying I agree or disagree. It's the way it is. Some call it a transfer of wealth. Some call it the right thing to do.

Fundamentally I think everyone should have access to good and appropriate health care. For me the basic problem is the industry was way out of hand before this started. A two night stay in the hospital costing over $20,000 for pneumonia or some other non surgical reason was and is ridiculous. Not to mention anything requiring surgery.

 

[Malcolm2]

Charging higher rates for smokers, obese people and others with specific poor lifestyle or living habits has been practiced in the workplace for over a decade and now is not uncommon. Employers are encouraging employees to enroll in wellness programs and monitoring weight, and giving premium discounts for these things. Any group plan that gives a discount for smoking cessation, weit loss or wellness enrollment had the higher rate built into the premium.

Encouraging someone to participate in a wellness program for a token benefit is a far cry from determining at policy commencement that this person is a high risk (and charging a higher premium) because of smoking, alcohol use, obesity, sedentary lifestyle, etc. This has NOT been done before.

Although I agree that people should bear their own risks for using drugs, smoking, not exercising or being obese, it is a slippery slope we should not allow the government to control. Next step will be DNA screening for same reasons. Then high sugar drinks will be banned (like our friend Bloomberg tried and failed to do in NY).

 

[MichaelB]

Some people will pay >more< than full cost. A healthy person in a group plan today is often paying lower rates (total premiums--employer and employee) for the same coverage than he/she will pay under PPACA. The higher rates these people will pay under the new law go to subsidize the artificially low rates to be paid by sick people. That's how community rating works, right? And why we went through all this drama to make everyone enroll, so they could carry the load for others. I'm not saying it is bad or good, but that's how this system is set up.

The rate the insurance company charges is subject to MLR at the group level, so there is no subsidy anywhere. different rates between plans have many explanations but cross subsidy is not one, given the MLR restrictions.

Within any insured group the lucky ones, those that don't collect, subsidize the unlucky ones, those that do. That isn't really a subsidy, though, it's more of a reason to buy insurance.

Individuals that are unable to pay the full premium receive assistance from the taxpayer via the Federal Gov't, not other group members.

 

[H2ODude]

Just an observation on the smoking/BMI issue as a reason to charge more. My mother and father were both smokers; she died at 70 from lung cancer and he at 77 from emphysema. Their end of life choices (hospice, no heroics and premium profits for the healthcare industry courtesy of Medicare) appeared reasonably low cost. Now, fast forward to today with MIL who lives with us and was not a smoker. At 87 has enjoyed hospital stay after hospital stay, 7-8 drug prescriptions, and continued SS payments. So cost to society (well, and us for providing food, board, transport, etc) for her much greater. As for the BMI issue, I'd think the cost for treating the multitude of health problems associated with obesity would be more significant and longer term than a doomed smoker.

All the above merely my observation and opinion; no data to back it up. Just seems like a smoker will generally incur an earlier, lower cost demise with termination of medicare and SS costs sooner than a high BMI individual who can use the healthcare system to sustain themselves a good while with many chronic conditions. For whatever that observation is worth!

 

[haha]

For me the basic problem is the industry was way out of hand before this started. A two night stay in the hospital costing over $20,000 for pneumonia or some other non surgical reason was and is ridiculous. Not to mention anything requiring surgery.

Have you noticed that this issue has not been addressed in the new and wondrous legislation?

Ha

 

[Bikerdude]

All the above merely my observation and opinion; no data to back it up. Just seems like a smoker will generally incur an earlier, lower cost demise with termination of medicare and SS costs sooner than a high BMI individual who can use the healthcare system to sustain themselves a good while with many chronic conditions. For whatever that observation is worth!

I believe that was the argument the big tobacco company's used with the Chinese government officials.