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Merc14

Is Obamacare on death's door?

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Gromdor
1 hour ago, DieChecker said:

RE: The first link. Where does it say "higher deductibles, narrower networks, and smaller affordability tax credits."? I read half of it, and that's not what I got out of it at all.

Here's the Summary at beginning of the PDF.

So, the idea is to tinker with the enrollment dates, the special enrollment items ,and the things that allow one to qualify for the various plans. This will make it MORE affordable for the HEALTHY people to bring them into the markets and make the Exchanges viable. This logically WILL result in possible higher deductibles, and less credits for the minority of customers who are MOST SERIOUSLY ILL, but that can't be helped at this point. Without those younger, healthier people joining, the markets are going to fail anyway.

Well, it's true that if you let the poor and disabled die off, the overall health of the populace would improve.  Thus making it cheaper to insure.  But are we seriously going to go that route? 

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Harte
13 hours ago, Frank Merton said:

That you aren't willing to take the time to read links you don't like, and then spend what was obviously a good long time preparing wordy polemics, tells me you are not connected properly and are interested only in convincing others, which of course you do not do -- indeed, you have the opposite effect.

"Not connected"?

You are the one going on about how this hurts the uninsured poor, when this country has had free health care for the poor for fifty years now.

Harte

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Harte
41 minutes ago, Gromdor said:

Well, it's true that if you let the poor and disabled die off, the overall health of the populace would improve.  Thus making it cheaper to insure.  But are we seriously going to go that route? 

Here's the relevant sentence: "Without those younger, healthier people joining, the markets are going to fail anyway."

It's like Social Security and Medicare reform. Maybe it's not palatable, but it's a hell of a lot tastier than the result of doing nothing.

Harte

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Startraveler
4 hours ago, DieChecker said:

RE: The first link. Where does it say "higher deductibles, narrower networks, and smaller affordability tax credits."? I read half of it, and that's not what I got out of it at all.

Network adequacy = standards for the minimum size of a provider network. Lowering those standards means further narrowing networks.

Actuarial value = the amount an insurer pays vs what you pay out of pocket. Lowering actuarial values means increasing the amount you pay out of pocket (usually that's out into deductibles but sure it could also just be put into higher copays and coinsurance for you).

And lowering the actuarial value of silver plans will reduce the value of the tax credits, making all plans more expensive for most people.

So yes, that's all in there.

 

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DieChecker
19 hours ago, Gromdor said:

Well, it's true that if you let the poor and disabled die off, the overall health of the populace would improve.  Thus making it cheaper to insure.  But are we seriously going to go that route? 

They will still be better off then if they had nothing. The other choice is that the Exchanges fail altogether and those Pre-existing Condition people loose their insurance anyway.

 

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DieChecker
16 hours ago, Startraveler said:

Network adequacy = standards for the minimum size of a provider network. Lowering those standards means further narrowing networks.

It seems to me that Lowering standards would invite More health networks to join. Perhaps ones that aren't 5 star, to be sure, but who might offer plans much cheaper then the super-uber-mega Corporations.

Quote

Actuarial value = the amount an insurer pays vs what you pay out of pocket. Lowering actuarial values means increasing the amount you pay out of pocket (usually that's out into deductibles but sure it could also just be put into higher copays and coinsurance for you).

I see. What I read was that they are proposing a increase in the variance of the actuarial values for the various plans. To allow for More Insurers to have Greater leeway. That will attract more Insurers and possibly lower rates, due to competition. Your assumption of rates OOP increasing is just that, an assumption.

Quote

And lowering the actuarial value of silver plans will reduce the value of the tax credits, making all plans more expensive for most people.

So yes, that's all in there

I'd argue that making those at the lowest end pay more... since most of them will pay nothing after the credits, will spread the pain more evenly and thus allow those at the higher end to actually pay LESS.

 

You are seeing clouds out over the Pacific coming toward California and thinking... "OMG, there's going to be many hours of flooding!". When others look and see, "YES! There will be months of irrigation water, no water rationing, and we can water our lawns this year.

Edited by DieChecker
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Startraveler
On 2/19/2017 at 6:07 AM, DieChecker said:

It seems to me that Lowering standards would invite More health networks to join. Perhaps ones that aren't 5 star, to be sure, but who might offer plans much cheaper then the super-uber-mega Corporations.

I see. What I read was that they are proposing a increase in the variance of the actuarial values for the various plans. To allow for More Insurers to have Greater leeway. That will attract more Insurers and possibly lower rates, due to competition. Your assumption of rates OOP increasing is just that, an assumption.

I'd argue that making those at the lowest end pay more... since most of them will pay nothing after the credits, will spread the pain more evenly and thus allow those at the higher end to actually pay LESS.

You are seeing clouds out over the Pacific coming toward California and thinking... "OMG, there's going to be many hours of flooding!". When others look and see, "YES! There will be months of irrigation water, no water rationing, and we can water our lawns this year.

Networks are the doctors and hospitals that insurers contract with to provide services--the ones that show up when you search the provider directory for your insurance plan. Narrowing the network means contracting with fewer doctors and hospitals, meaning more of them will be out-of-network. The purpose of network adequacy standards is to ensure that insurers contract with enough doctors and hospitals that a person enrolled in the insurer's product can access all the services that their plan supposedly covers. Lowering those standards means allowing insurers to leave even more doctors and hospitals out of network and potentially restricting access to care for consumers.

As for the actuarial value piece, I don't know what you think "leeway" means here. The leeway is that insurers can now offer plans with lower actuarial values than they could before. By definition that means greater out-of-pocket spending for the consumer. That's not an assumption, that the definition of actuarial value.

These are meant to be attractive to insurers. And they may be! For exactly the same reason that they're unattractive to consumers. They double down on everything that you folks have been complaining about for years.

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DieChecker
6 hours ago, Startraveler said:

Networks are the doctors and hospitals that insurers contract with to provide services--the ones that show up when you search the provider directory for your insurance plan. Narrowing the network means contracting with fewer doctors and hospitals, meaning more of them will be out-of-network. The purpose of network adequacy standards is to ensure that insurers contract with enough doctors and hospitals that a person enrolled in the insurer's product can access all the services that their plan supposedly covers. Lowering those standards means allowing insurers to leave even more doctors and hospitals out of network and potentially restricting access to care for consumers.

You mean that lowering those standards COULD lead to insurers leaving out even more doctors... However that is not a certainty. It could also result in more doctors and hospitals being eligible for those enrolled. You're presuming a negative when a negative isn't the automatic conclusion.

Quote

As for the actuarial value piece, I don't know what you think "leeway" means here. The leeway is that insurers can now offer plans with lower actuarial values than they could before. By definition that means greater out-of-pocket spending for the consumer. That's not an assumption, that the definition of actuarial value.

These are meant to be attractive to insurers. And they may be! For exactly the same reason that they're unattractive to consumers. They double down on everything that you folks have been complaining about for years.

That is not the point however. This could easily lead to more companies joining the Exchanges, and providing competition. Wasn't a big selling point of the Exchanges that they would spur competition and drive down prices on the Exchanges? If more companies join the Exchanges, the price compared to another plan might indeed go up, but over time it might go down, due to competition. Or was the selling point of competition a myth to begin with??

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Startraveler
8 hours ago, DieChecker said:

You mean that lowering those standards COULD lead to insurers leaving out even more doctors... However that is not a certainty. It could also result in more doctors and hospitals being eligible for those enrolled. You're presuming a negative when a negative isn't the automatic conclusion.

That is not the point however. This could easily lead to more companies joining the Exchanges, and providing competition. Wasn't a big selling point of the Exchanges that they would spur competition and drive down prices on the Exchanges? If more companies join the Exchanges, the price compared to another plan might indeed go up, but over time it might go down, due to competition. Or was the selling point of competition a myth to begin with??

I support the concept of the exchanges, I've been clear on that point.

What I'm saying to you is that Trump's "solutions" are to allow narrower networks (plans with fewer doctors and hospitals in-network) and skimpier plans than are sold now--i.e., plans with higher out-of-pocket spending, such as higher deductibles.

I had thought network size and the size of deductibles were considered by critics to be the problems that need to be fixed. Apparently that's not the case! So what is the problem? What are people supposed to be trying to fix?

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Merc14

Neither Trump nor congress has put forth any long range plan to date, that is all still being negotiated, a difficult thing to do when the democrats have done everything possible to bar Trump's cabinet from forming, so please stop with referring to Trump's plan for replacing Obamacare as if it is a done deal.    :rolleyes:

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Startraveler

These changes aren't a plan, they are actual regulations that have already been published in the Federal Register. People have a few more days to weigh in with public comments, those will be reviewed, and then these changes will go into effect.

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Merc14

That is understood but  these regulations do not represent what will follow Obamacare. 

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DieChecker
20 hours ago, Startraveler said:

I support the concept of the exchanges, I've been clear on that point.

What I'm saying to you is that Trump's "solutions" are to allow narrower networks (plans with fewer doctors and hospitals in-network) and skimpier plans than are sold now--i.e., plans with higher out-of-pocket spending, such as higher deductibles.

I had thought network size and the size of deductibles were considered by critics to be the problems that need to be fixed. Apparently that's not the case! So what is the problem? What are people supposed to be trying to fix?

But, "narrowing the networks" is not what I read out of that. I saw loosening the standards. To me that would attract more doctors and hospitals, as the area to operate (pun intended) is larger. And "skimpier plans" doesn't mean for everyone, or a small percentage. The main body of people who might then get into the Exchanges would save money. And the variability on out-of-pocket spending could attract more companies to the Exchanges, and thus lower premiums even more.

If the gain due to competition outpaces the lose due to standards change, isn't that worth it? Especially if it means a State Exchange will stay open, rather then be forced to close?

If you're only going to see the cloudy days... the possible down side to everything, then everything is going to suck.

Is a bird in the hand worth two in the bush? Because right now we've not even looked in the bush.

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DieChecker
20 hours ago, Startraveler said:

These changes aren't a plan, they are actual regulations that have already been published in the Federal Register. People have a few more days to weigh in with public comments, those will be reviewed, and then these changes will go into effect.

I did find this....

Quote

H. Congressional Review Act

This proposed rule is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 801, et seq.), which specifies that before a rule can take effect, the Federal agency promulgating the rule shall submit to each House of the Congress and to the Comptroller General a report containing a copy of the rule along with other specified information, and has been transmitted to Congress and the Comptroller for review.

So Congress could do something about it if they wanted to.

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Startraveler
35 minutes ago, DieChecker said:

But, "narrowing the networks" is not what I read out of that. I saw loosening the standards. To me that would attract more doctors and hospitals, as the area to operate (pun intended) is larger. And "skimpier plans" doesn't mean for everyone, or a small percentage. The main body of people who might then get into the Exchanges would save money. And the variability on out-of-pocket spending could attract more companies to the Exchanges, and thus lower premiums even more.

The standards in question limit how narrow a network can get. Loosening them means allowing networks to get narrower. Which means fewer participating doctors and hospitals, not more.

And changing the rules to allow plans to get skimpier will affect nearly everyone. The value of the affordability tax credits is determined by the price of the second cheapest silver plan in a market. If sub-silver (i.e. skimpier) plans are now going to be classified as silver, it doesn't matter if you choose to buy the skimpier plans, the re-classification of them as silver plans means the value of everyone's tax credit falls. Which means every other plan gets relatively more expensive.

It looks to me like you're attempting to willfully misunderstand what's happening here and why. 

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DieChecker
11 hours ago, Startraveler said:

The standards in question limit how narrow a network can get. Loosening them means allowing networks to get narrower. Which means fewer participating doctors and hospitals, not more.

But, does it allow the to get wider? Or only narrower? Answer honestly please.

Quote

And changing the rules to allow plans to get skimpier will affect nearly everyone. The value of the affordability tax credits is determined by the price of the second cheapest silver plan in a market. If sub-silver (i.e. skimpier) plans are now going to be classified as silver, it doesn't matter if you choose to buy the skimpier plans, the re-classification of them as silver plans means the value of everyone's tax credit falls. Which means every other plan gets relatively more expensive.

It looks to me like you're attempting to willfully misunderstand what's happening here and why. 

I didn't see "skimpier", I saw potentially more expensive. The coverage shouldn't change drastically, that I saw.

The problem with that argument is that these Silver plans will still be silver, and No Way near what is offered in Bronze. This is not a reclassification, it is an expansion.

It really seems like you are trying to only see the negatives, and dismissing everything else. I agree there is a point in examining such changes that warrent such scrutiny, but you have to weigh the Pros and Cons, not just the Cons.

Can you point me to an article that sums up what you are saying? Because I've just been googling this and didn't read anything that says this is Nearly as bad as you are trying to make it out to me. If it was really bad, I'd expect the liberal media, and celebrities, and Democrat politicians, to be all over it.

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DieChecker

So reading up some, it seems the "standards" refer to the standards of how many doctors service a plan. This does not automatically mean that plans will drop doctors, but it does mean that providers that offer less doctors will be able to offer plans on the Exchanges. If a person wants to have a lot of doctors on their plan, they simply will have to pick the one that does that. It might cost a little more, but if they are OK with going with some other doctor, then they could get a cheaper plan.

True, customers are already complaining about the limitations on services/doctors, but if we're to believe the news, these are people that didn't even have insurance before. And allowing these changes could be what allows the existing Exchanges to actually remain open.

https://www.aol.com/article/news/2017/02/15/the-trump-administration-just-proposed-massive-changes-to-obamac/21714655/

Quote

Additionally, the rules would lower the "de minimis range used for determining the level of coverage." Essentially, the ACA established minimum standards for coverage (here's a full breakdown from CMS) in order to be certified on the bronze, silver, and gold plan levels. The new rule would allow insurers to cover slightly fewer areas of health and still be counted at a certain medal level.

The rule also does project that this move will increase out-of-pocket costs for Americans in the short-run, but said that it should lower premiums to offset this in the long-run.

"The proposed change in AV could reduce the value of coverage for consumers, which could lead to more consumers facing increases in out-of-pocket expenses, thus increasing their exposure to financial risks associated with high medical costs," reads the rule. "However, in the longer run, providing issuers with additional flexibility could help stabilize premiums, increase issuer participation and ultimately provide some offsetting benefit to consumers."

Same article published here... and here...

Edited by DieChecker

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