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Merc14

Lawmakers/Aides try to get out of Obamacare

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The assumption is that a transparent, competitive marketplace is going to do better than the opaque broken "markets" we have now. The cost problem isn't entirely on the insurer side and the ACA devotes a lot of attention to starting to reform the care delivery side and way services are paid for, but obviously fixing insurance markets is a major goal.

That Oregon example does demonstrate something important: a degree of standardization allows prices to actually become meaningful to the consumer. That, in turn, allows the choices consumers make to send meaningful signals back to the sellers. So the new actuarial tiers of coverage--bronze, silver, gold, and platinum--will allow people to make apples-to-apples comparisons between plan options and, as we're seeing in Oregon, they won't allow insurers to hide behind an opaque and incomprehensible market structure.

There's a good, succinct introduction to what the ACA is trying to fix about insurance markets and how it's going to do that in this article: Health Insurance Exchanges.

Whys didn't they just vote to allow insurers to compete across state lines instead of passing this 2000 page mess that is Obamacare? Wouldn't have cost a dime.

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Whys didn't they just vote to allow insurers to compete across state lines instead of passing this 2000 page mess that is Obamacare? Wouldn't have cost a dime.

Too simple. People would understand it. Too cheap. People wouldn't have to send their money into the oblivion of wasted tax money. Too transparent. No place to hide laws within the law.

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Whys didn't they just vote to allow insurers to compete across state lines instead of passing this 2000 page mess that is Obamacare? Wouldn't have cost a dime.

First of all, as has already been discussed, if you don't have markets that act like markets, none of that matters. If it's not transparent, structured so that prices are meaningful and intelligible to shoppers and so that shoppers can send signals to sellers, and consumer-friendly (i.e. offering some set of consumer protections) then you're not going to have market forces acting and it doesn't matter what kind of cosmetics you plaster over it.

Second, the across-state-lines proposals that have been put forth in recent years (yes, by the GOP) are simply thinly veiled deregulation and, in the most optimistic description of them, create incoherent markets. Insurance markets are dysfunctional now; I can't even imagine one in which every seller participating in it is operating under a different set of rules (probably unbeknownst to the consumer).

Third, there are serious practical challenges to what you're proposing. States can do this now on their own. For instance, Georgia passed a law allowing out-of-state insurers to sell in its markets a few years ago. What happened? No one came: No out-of-state insurers offer plans in Georgia

A new law that allows Georgians to buy health insurance plans approved by other states was envisioned as free-market solution that would lower prices and increase choices.

So far, the law has failed to produce results: Not a single insurer is offering a policy under the new law.

“Nobody has even asked to be approved to sell across state lines,” Georgia Insurance Commissioner Ralph Hudgens said. “We’re dumbfounded. We are absolutely dumbfounded.”

There was a very good brief out of a few months ago exploring this issue: Selling Insurance Across State Lines. They looked at six states (including Georgia) that are implementing or actively exploring the feasibility of what you suggest and found "Officials in all six states reported that no health insurers have entered the market or expressed an interest in entering the market in response to the passage of across state lines or interstate compact legislation." They give some good reasons these approaches falter, the most important of which is that they're based on an oversimplified picture of how things actually work.

Officials and insurers in all six states reported that their across state lines legislation was largely unsuccessful because of the localized nature of how health care is delivered, rather than the state’s regulatory requirements. As Wyoming officials noted, their residents generally do not want to leave the state to see an in-network provider. Indeed, to compete with domestic insurers, out-of-state insurers must build a network of local providers and negotiate competitive reimbursement rates. Out-of-state insurers thus face a chicken-and-egg dilemma: they must build a sufficient membership to negotiate competitive rates with providers, but, to garner that membership, they must show customers they have an adequate network of providers and charge a premium that is comparable to their competitors.

All that said, if the point is to get more and new insurers into state markets, the ACA has mechanisms for that. Insurers can contract to sell multi-state plans, so they're no longer limited to selling only in a single state. Every new marketplace is required to have at least two of those multi-state plans in it. The ACA is also offering start-up funds for new nonprofit, member-run co-op insurance companies in several states. It gives states the option to create marketplaces that span multiple states, or to enter into compacts that allow their insurers to enter each other's markets.

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You're really hopeful aren't you?

I chose to be hopeful, yet plan for the worst. Just like with Social Secuirity.... I'm hopeful that something will be there, yet I'm making my retirement plans as if it is not going to exist.

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Whys didn't they just vote to allow insurers to compete across state lines instead of passing this 2000 page mess that is Obamacare? Wouldn't have cost a dime.

Also they needed the bill so they could put in all kinds of stuff and force it through.

I do believe College Student Loans were taken from Banks and now only available from the FedGov. That was one of the major non-Health Care pieces of the legislatioin that was shoe horned in. But then you see this in all kinds of bill packages. Not just Dem bills. And not just the ACA.

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I chose to be hopeful, yet plan for the worst.

That's the same motto I have when I go to Las Vegas. All the cash I bring I plan to lose and hope to win. I never win.

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That's the same motto I have when I go to Las Vegas. All the cash I bring I plan to lose and hope to win. I never win.

A life lesson applicable to everyone and to a lot more subject?? I think so!!

******************************

There is no "Free Lunch" from the Government people. Someone has to pay for everything, even if it is only the Rich. You can bet they are not going to do so without concequences to everyone else...

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Posted (edited)

The point is, members of Congress and their staffs are already treated differently by the law: it treats them more harshly. If they were trying to change that--which, despite Politico's unsubstantiated gossip, they don't seem to be doing--what they would be doing is changing the law to make it treat members of Congress the same way it treats everyone else. Asking what they should be, or want to be, or could be "exempt" from makes no sense.

If Congress was attempting to get that part of the ACA disabled, so that things remain the same as they are... Then isn't that actually doing what the OP suggests. They are actually removing part of the ACA to help themselves?

That it is not fair as written and that it might cause hardships is the fault of those who wrote/passed the law, right? That they want to fix it is understandable, yet that does not change the fact that Congress would want to change it. So the charge is likely true, even though it appears justified. The wording of the charge may be up for discussion, but unless the Congress goes with the ACA as written, they are editing their own law to help themselves.

Edited by DieChecker
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Posted (edited)

First of all, as has already been discussed, if you don't have markets that act like markets, none of that matters. If it's not transparent, structured so that prices are meaningful and intelligible to shoppers and so that shoppers can send signals to sellers, and consumer-friendly (i.e. offering some set of consumer protections) then you're not going to have market forces acting and it doesn't matter what kind of cosmetics you plaster over it.

Healthcare doesn't act like a market because it isn't treated like one now and never has been. As far as transparent and structured you sound like the old union leaders who screamed the same crap when they broke up Ma Bell. With one fel;ll swoop and nothing but a very slanted and narrow opinion you completely dismiss free market economy from the table and insist on more government control is is the main cause of out of control prices already (see medicare/medicaid). Healthcare doesn't need more government and its billions in fraud, it needs more free market.

regardless, they could've tried and it wouldn't have cost a dime. If it hadn't changed anything in three years try something else. It was dismissed because it didn't answer the basic requirement of the democrats, taking over 20% of the economy and all of our lives.

Edited by Merc14
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Whys didn't they just vote to allow insurers to compete across state lines

they did

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the basic requirement of the democrats, taking over 20% of the economy and all of our lives.

In the end, that's what it's all about. When that doesn't work they'll say they need to do more, control more.

Liberals never believe what they are doing doesn't work. They only believe they haven't been able to do enough of it.

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As many of you know 0bama care pushed me right outta the system. Our insurance company has raised prices 3 times since the law was past. Well dont cha know I just got a call from my wife, who's company is about to have a emergency meeting cause prices are going up again. This time the actual words sky rocket were used. Now no one in my family will have health care at all. I litteraly have to choose between health care and food, and or paying my morgage. And Im lower middle class. I can clearly see why dems are trying to run from this, and I dont make anywhere near what they do.

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As many of you know 0bama care pushed me right outta the system. Our insurance company has raised prices 3 times since the law was past. Well dont cha know I just got a call from my wife, who's company is about to have a emergency meeting cause prices are going up again. This time the actual words sky rocket were used. Now no one in my family will have health care at all. I litteraly have to choose between health care and food, and or paying my morgage. And Im lower middle class. I can clearly see why dems are trying to run from this, and I dont make anywhere near what they do.

I'm so sorry to hear that. I know it's getting tough all over for everyone. My parents insurance rates have been "sky rocketing" as well. I hope everything works out! The latest in this fiasco called Obamacare:

WASHINGTON (AP) -- Cancer patients could face high costs for medications under President Barack Obama's health care law, industry analysts and advocates warn.

Where you live could make a huge difference in what you'll pay.

To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.

Such "specialty drugs" can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month's supply, says the Leukemia & Lymphoma Society.

New York is taking a different approach, setting flat dollar copayments for medications. The highest is $70, and it would apply to specialty drugs as well.

Critics fear most states will follow California's lead, and that could defeat the purpose of Obama's overhaul, because some of the sickest patients may be unable to afford their prescriptions.

"It's important that the benefit design not discriminate against people with chronic illness, and high copays do that," said Dan Mendelson, president of Avalere Health, a data analysis firm catering to the health care industry and government.

Avalere's research shows that 1 in 4 cancer patients walks away from the pharmacy counter empty-handed when facing a copay of $500 or more for a newly prescribed drug.

"You have to worry about a world where if you happen to contract cancer or multiple sclerosis, you are stuck with a really big bill," Mendelson said. "It's going to be very important for states to take a long, hard look at their benefit design."

Although the money for covering uninsured Americans is coming from Washington, the heath care law gives states broad leeway to tailor benefits, and the local approach can also allow disparities to emerge.

A spokesman for Covered California said state officials are trying to balance between two conflicting priorities: comprehensive coverage and affordable premiums.

"We are trying to keep the insurance affordable across the board," said Dana Howard, the group's spokesman. "This is just part of trying to manage the overall risk of the pool." Covered California is one of the new state marketplaces where people who don't get coverage on the job will be able to shop for private insurance starting this fall. Coverage takes effect Jan. 1.

Insurers are forecasting double-digit premium increases for individual policies, as people with health problems flock to buy coverage previously denied them. The Obama administration says the industry warnings are overblown, and that for many consumers, premium increases will be offset by tax credits to help buy insurance. And officials say it's important to realize that the law sets overall limits on patients' liability, even if those seem high to some people. Still, a full picture of costs and benefits isn't likely to come into focus until the fall.

Howard said California officials are aware of the concerns about drug costs and are trying to make medications more affordable.

Meanwhile, he said consumers will be protected because the law limits total out-of-pocket costs — the deductibles and copayments that policy holders are responsible for, apart from monthly premiums. In California, the annual out-of-pocket limit for an individual is $6,400, although it can be as low as $2,250 for low-income people. Once that limit is reached, insurance pays 100 percent.

That's still a lot of money, and such reassurances haven't dispelled the concerns.

"The intent of the Affordable Care Act is to make sure that all Americans have access to quality, affordable health care," said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. He adds that there is a danger that the insurance marketplaces "will discriminate against the patients with the highest medical need. That would completely undermine the spirit of the ACA."

The group has been joined by Rep. Doris Matsui, D-Calif., in urging state officials to reconsider the policy. The high copays "could prevent many patients from receiving the lifesaving treatments they need because of prohibitively high cost," Matsui wrote to the state.

The problem with costly drugs is similar to another money issue with the health care law — a provision that could price millions of smokers out of coverage. Insurers are allowed to charge tobacco users buying an individual policy up to 50 percent higher premiums. For a 55-year-old smoker, the penalty could reach nearly $4,250 a year, on top of the standard premium. California is trying to override that problem by passing its own law. There's also pending state legislation to address some issues with prescription costs, but its prospects are unclear.

Meanwhile, leukemia patient Lisa Lusk worries about what will happen to her. A nursing assistant who lives near Fresno, Lusk is hoping to return to work in the next few months. When that happens, she expects to lose emergency coverage she's now getting through the state. And the medication Lusk takes to manage her chronic form of the disease costs more than $5,000 a month.

"I'm scared that when I get a job my copay may be more than $1,500 a month," said Lusk. "I'll just be working to pay for my medications."

Taken from http://news.yahoo.com/huge-drug-cost-disparities-seen-071203974.html

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they did

Who, when and where?

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So in the end, it's gonna be cheaper to pay the penalty than it is to get the insurance. Another money racket is born.

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So in the end, it's gonna be cheaper to pay the penalty than it is to get the insurance. Another money racket is born.

For now, but that penalty is schedule to go up and eventually costs more than insurance.

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For now, but that penalty is schedule to go up and eventually costs more than insurance.

Which will lead to more and more people on some government sponsored health care. As soon as penalties come in and people can't afford the penalty they sure wont be able to afford insurance and the penalties will act as a catapult to total control.

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Our insurance company has raised prices 3 times since the law was past.

what makes you think they wouldn't have done this anyway?

So in the end, it's gonna be cheaper to pay the penalty than it is to get the insurance.

no it's not. Whoever tells you this is wrong.

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Which will lead to more and more people on some government sponsored health care.

The affordable care act is not government sponsored health care. We usually call that Medicare. It's very popular.

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Posted (edited)

The affordable care act is not government sponsored health care. We usually call that Medicare. It's very popular.

I understand you cannot buy or be on a program called obamacare and that it is a law and not a product of any kind. Notice I said some other government sponsored health care. Such programs will be born from this legislation out of necessity and by design.

Edited by F3SS

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Posted (edited)

I understand you cannot buy or be on a program called obamacare and that it is a law and not a product of any kind. Notice I said some other government sponsored health care. Such programs will be born from this legislation out of necessity and by design.

He can't understand anything beyond what he is told. He has no idea that there are ramifications from things such as "no refusal for a prior condition". How does an Insurance company operate if they have to accept a patient with cancer, who has never paid a dime in and cover all his bills? The simple answer is they can't and they won't so they leave the business or price themselves out of the business. NJ can't perceive this very basic tenet of insurance and will never be able to. The big awakening will be when he is told he is to old to warrant the cost of his cure. As Obama said,

[media=]http://youtu.be/U-dQfb8WQvo[/media]

Edited by Merc14
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no it's not. Whoever tells you this is wrong.

If I had to get health insurance today, and on my own, it would be more than $200/month. All that money getting sucked out of the economy is going to have consiquences.

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what makes you think they wouldn't have done this anyway?

Well Ive had the same insurance for over 15 years, and have never seen increases like this. Not even close. Combine that with the fact that several sources warned us that this is exactly what would happen and, well, if it looks like a duck...........

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no it's not. Whoever tells you this is wrong.

How the hell do you figure they are wrong? Ive already done the numbers on my end with my accountant and the penalty is a fraction of the cost of my current health insurance. You and star seriously need to stop drinking this coolaid. Its making it so you cant even understand basic math.

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With one fel;ll swoop and nothing but a very slanted and narrow opinion you completely dismiss free market economy from the table and insist on more government control is is the main cause of out of control prices already (see medicare/medicaid).

What does "free market" mean in this context? A system in which insurers get to pick the rules they want to play by and consumers have to be content with whatever scraps they can find?

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