CDZ Can we have a serious discussion of how to fix the Affordable Care Act?

[JoeMoma]

It was and is an idiotic attempt to get single payer by blackmail that took a very bad situation and made it much worse as it was designed to do.

And it will probably work. Single payer is probably just down the road. Will it be 10 years or 25 years, IDK! But it's coming.

 

[JoeMoma]

I do not have the answers and I was in the insurance business for a long time.

I do believe getting the federal government completely out of the HC business, would be a good start.

And that only ends up with a single payer system instead.

That's the opposite of getting the government completely out of the HC business. Unless you think a single payer system would not be government run.

 

[Mac1958]

The fixes will require some significant changes, including more government spending. I can't imagine anything stopping Single Payer at this point.

We could have done the smart thing and just expanded the current Medicare/Medicare Supplement/Medicare Advantage system to all, an excellent blend of public resources and private competition, but our "leaders" have their heads squarely up their butts and have failed us yet again.

What a shock.
.

 

[gipper]

The fixes will require some significant changes, including more government spending. I can't imagine anything stopping Single Payer at this point.

We could have done the smart thing and just expanded the current Medicare/Medicare Supplement/Medicare Advantage system to all, an excellent blend of public resources and private competition, but our "leaders" have their heads squarely up their butts and have failed us yet again.

What a shock.
.

That's right. Politicians are liars and terribly corrupt. Yet, some Americans think they can fix things.

Can't fix stupid.

 

[KokomoJojo]

Why the hell didnt they just take the few million people who had no insurance and put them on Medicaid and leave every one else the hell alone? Assuming you believe the goernment should be providing health insurance at alll, that is..

there is no big corporate money in it, simple as that.

 

[NCC1701]

Exactly......all military veterans should be able to go to any doctor they want and have the fee picked up...that should be the deal...their families too..........

But, that isn't what the left wants..........they want control of the healthcare system for the power of it..........

retired pretty much get that, so do disabled as I understand it. But I would not hand it out to people like me who did a 4 year stateside stint and drove a desk. I was just a regular working guy as are much of active duty now.

Think about the perverse incentive, I think there are 2 year deals now, a person with 4 kids and a spouse does 2 years as a yeoman and then gets free medical care for the rest of their life?

 

[NCC1701]

Americans are too sick and demand too much, we have a large and growing minority population who don't pay their way. We have underemployed young who don't make a lot. Forget fixing anything as long as this holds.

 

[NCC1701]

What do you think could be done, reasonably to reform the ACA?

• Offer coverage and premiums commensurate with the various groups of people who may need coverage:
  • Offer gender based insurance policies --> All insurers must offer policies tailored to men and to women. Prices reflect the commensurate risk/cost associated with gender.
  • Offer health condition based insurance policies --> All insurers must offer policies based around a handful of health status levels.
  • Offer age based insurance policies --> All insurers must offer policies segmented by age.
  • The combination of gender, age, and health status level should define the "group" policy type consumers may purchase.
  • I'm not sure what the implemented groups should be, but it's clear that consumers don't like being tossed into a group whereof the related premiums reflect the average actuarial risk and cost of covering the whole group, even though that's exactly the sort of coverage folks had (those who had it) before ACA.

- we just learned that insuring the condition-based and age based costs too much for them, that is why the democrats needed the young to risk pool with them

- age based? we have medicare already

 

[320 Years of History]

What do you think could be done, reasonably to reform the ACA?

• Offer coverage and premiums commensurate with the various groups of people who may need coverage:
  • Offer gender based insurance policies --> All insurers must offer policies tailored to men and to women. Prices reflect the commensurate risk/cost associated with gender.
  • Offer health condition based insurance policies --> All insurers must offer policies based around a handful of health status levels.
  • Offer age based insurance policies --> All insurers must offer policies segmented by age.
  • The combination of gender, age, and health status level should define the "group" policy type consumers may purchase.
  • I'm not sure what the implemented groups should be, but it's clear that consumers don't like being tossed into a group whereof the related premiums reflect the average actuarial risk and cost of covering the whole group, even though that's exactly the sort of coverage folks had (those who had it) before ACA.

- we just learned that insuring the condition-based and age based costs too much for them, that is why the democrats needed the young to risk pool with them

- age based? we have medicare already

??? I'm sorry. It's been a while since I was in this thread.

• Costs too much for whom?

 

[JimBowie1958]

The fixes will require some significant changes, including more government spending. I can't imagine anything stopping Single Payer at this point.

We could have done the smart thing and just expanded the current Medicare/Medicare Supplement/Medicare Advantage system to all, an excellent blend of public resources and private competition, but our "leaders" have their heads squarely up their butts and have failed us yet again.

What a shock.
.

Some say that the ACA was set up to fail to pave the way for single payer.

I think one of the best aspects of the ACA is that it was designed to use the markets to lower the cost of insurance.

IT also put a buffer between the government paying for our health care and the argument that since it was paying for health care the government had a right to dictate our life style, diet and other health habits to us.

Imagine the whole country on a Michelle Obama diet plan. YIKES! But with government paid health care, the government would have a stake in forcing us to eat in a way that they considered healthy and force other choices on us also.

While the ACA is a failure, I think it can be rescued and improved. Medicare does not have enough safe guards from fraud and theft, it should be replaced by an improved ACA, IMO.

 

[JimBowie1958]

??? I'm sorry. It's been a while since I was in this thread.

• Been a while for whom?

Wow, thats a keeper.

 

[320 Years of History]

??? I'm sorry. It's been a while since I was in this thread.

• Been a while for whom?

Wow, thats a keeper.

TY for pointing out the absurdity of that post in time for me to correct it.

 

[320 Years of History]

??? I'm sorry. It's been a while since I was in this thread.

• Been a while for whom?

Wow, thats a keeper.

TY for pointing out the absurdity of that post in time for me to correct it.

I'd like to note that in accordance with my remonstrations of others, I "own" my incoherence rather than trying to defend it.

 

[JimBowie1958]

I'd like to note that in accordance with my remonstrations of others, I "own" my incoherence rather than trying to defend it.

Yes, you are a fairly honest man with a few blind spots I will not bring up.....in this thread.

 

[NCC1701]

What do you think could be done, reasonably to reform the ACA?

• Offer coverage and premiums commensurate with the various groups of people who may need coverage:
  • Offer gender based insurance policies --> All insurers must offer policies tailored to men and to women. Prices reflect the commensurate risk/cost associated with gender.
  • Offer health condition based insurance policies --> All insurers must offer policies based around a handful of health status levels.
  • Offer age based insurance policies --> All insurers must offer policies segmented by age.
  • The combination of gender, age, and health status level should define the "group" policy type consumers may purchase.
  • I'm not sure what the implemented groups should be, but it's clear that consumers don't like being tossed into a group whereof the related premiums reflect the average actuarial risk and cost of covering the whole group, even though that's exactly the sort of coverage folks had (those who had it) before ACA.

- we just learned that insuring the condition-based and age based costs too much for them, that is why the democrats needed the young to risk pool with them

- age based? we have medicare already

??? I'm sorry. It's been a while since I was in this thread.

• Costs too much for whom?

if all the people who have medical conditions risk pool, their premiums would be enormous, that is why Obamacare failed since the young and healthy did not join in enough to fund the sick

 

[william the wie]

What do you think could be done, reasonably to reform the ACA?

• Offer coverage and premiums commensurate with the various groups of people who may need coverage:
  • Offer gender based insurance policies --> All insurers must offer policies tailored to men and to women. Prices reflect the commensurate risk/cost associated with gender.
  • Offer health condition based insurance policies --> All insurers must offer policies based around a handful of health status levels.
  • Offer age based insurance policies --> All insurers must offer policies segmented by age.
  • The combination of gender, age, and health status level should define the "group" policy type consumers may purchase.
  • I'm not sure what the implemented groups should be, but it's clear that consumers don't like being tossed into a group whereof the related premiums reflect the average actuarial risk and cost of covering the whole group, even though that's exactly the sort of coverage folks had (those who had it) before ACA.

- we just learned that insuring the condition-based and age based costs too much for them, that is why the democrats needed the young to risk pool with them

- age based? we have medicare already

??? I'm sorry. It's been a while since I was in this thread.

• Costs too much for whom?

if all the people who have medical conditions risk pool, their premiums would be enormous, that is why Obamacare failed since the young and healthy did not join in enough to fund the sick

What do you think could be done, reasonably to reform the ACA?

• Offer coverage and premiums commensurate with the various groups of people who may need coverage:
  • Offer gender based insurance policies --> All insurers must offer policies tailored to men and to women. Prices reflect the commensurate risk/cost associated with gender.
  • Offer health condition based insurance policies --> All insurers must offer policies based around a handful of health status levels.
  • Offer age based insurance policies --> All insurers must offer policies segmented by age.
  • The combination of gender, age, and health status level should define the "group" policy type consumers may purchase.
  • I'm not sure what the implemented groups should be, but it's clear that consumers don't like being tossed into a group whereof the related premiums reflect the average actuarial risk and cost of covering the whole group, even though that's exactly the sort of coverage folks had (those who had it) before ACA.

- we just learned that insuring the condition-based and age based costs too much for them, that is why the democrats needed the young to risk pool with them

- age based? we have medicare already

??? I'm sorry. It's been a while since I was in this thread.

• Costs too much for whom?

if all the people who have medical conditions risk pool, their premiums would be enormous, that is why Obamacare failed since the young and healthy did not join in enough to fund the sick

More people are expected to pay penalty than sign up this go round because what is on offer is something nearly as good as VA care.

 

[JimBowie1958]

More people are expected to pay penalty than sign up this go round because what is on offer is something nearly as good as VA care.

Is the fine for not having an insurance plan bigger than the cost of the lowest cost plan?

If the fine is not significantly larger, then the whole thing is designed to fail because too many of the the younger folks would rather pay the fine than get something that they think that they dont need.

 

[ScienceRocks]

Adopt single payer/universal healthcare like the rest of the industrial world. Time to get with it!

 

[william the wie]

More people are expected to pay penalty than sign up this go round because what is on offer is something nearly as good as VA care.

Is the fine for not having an insurance plan bigger than the cost of the lowest cost plan?

If the fine is not significantly larger, then the whole thing is designed to fail because too many of the the younger folks would rather pay the fine than get something that they think that they dont need.

The costs go up faster than the fine and you are right it was designed to fail. However it has other cutesy features:

12 months coverage for 9 months of premiums.

all sorts of life events that most people need a CPA or lawyer to explain their changes in tax liability.

An actual tax on insurance companies that run more efficient and profitable plans.

The above list is far from exhaustive but even insurance companies can't figure out how to make money on the exchanges unless they are medicaid specialists.

 

[auditor0007]

Just to establish that the ACA is not doing great, I give a list of links that one can read to see the nature of the problems.

Sky rocketing insurance premiums so far, not reducing
Obamacare Insurance Premiums Set to Skyrocket Yet Again

It appears that enrollments are shrinking.
It’s official: Obamacare debuts with more canceled plans than enrollments

Aetna appears to be withdrawing from the ACA exchanges
Aetna pulling back from ObamaCare in blow to health law

And the Co-ops are steadily declining as well.
The Ruins: Two More Obamacare Co-Ops Collapse, Only One-Third Remain (For Now)

But what are the successes?

Millions of people now have insurance that never did. A great amount of stress on the public hospitals for free (uninsured care) has been lifted.

From Wikipedia:

Annual or lifetime coverage caps on essential benefits were banned.[73][74] Prohibits insurers from dropping policyholders when they get sick.[75]

A partial community rating requires insurers to offer the same premium to all applicants of the same age and location without regard to gender or most pre-existing conditions (excluding tobacco use).[76][77][78] Premiums for older applicants can be no more than three times those for the youngest.[79]

Preventive care, vaccinations and medical screenings cannot be subject to co-payments, co-insurance or deductibles.[80][81][82] Specific examples of covered services include: mammograms and colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STI counseling, HIV screening and counseling, contraceptive methods, breastfeeding support/supplies and domestic violence screening and counseling.[83]

The law established four tiers of coverage: bronze, silver, gold and platinum. All categories offer the essential health benefits. The categories vary in their division of premiums and out-of-pocket costs: bronze plans have the lowest monthly premiums and highest out-of-pocket costs, while platinum plans are the reverse.[60][84] The percentages of health care costs that plans are expected to cover through premiums (as opposed to out-of-pocket costs) are, on average: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum).[85]

Insurers are required to implement an appeals process for coverage determination and claims on all new plans.[75]

Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued to policyholders if this is violated​

These are some serious benefits to the American people that the health insurance industry fought for decades. This is good stuff, but what is discouraging people from signing up?

Seems to me that, since the GOP abstained from helping to construct the ACA, the leftwing radicals got to monopolize the product.

One size fits all plans that force men to take pregnancy coverage, the exclusion of Catastrophic care plans with very high deductibles that can be combined with health savings accounts to cover most if not all of the deductibles and other costs were ignored and not included.

What do you think could be done, reasonably to reform the ACA?

The only problem with the ACA is that it covers everyone who wants insurance, therefore the rates had to go up from the time when insurance companies only provided private policies to really healthy people, and I do mean really healthy. Insurance companies would deny you for anything that even seemed remotely like a risk, like say diabetes. The only possible thing that can be done to lower premiums is to force more young healthy people to buy insurance. In order to do that, the penalty needs to be increased for going without.

Here is the little dirty secret that nobody is telling you; employer health insurance is more expensive than most plans in the ACA. Don't believe me? Research it. Most people just don't realize this little fact because their employers pay the bulk of their premiums, so they think they are getting their insurance for $150 per month instead of $500 per month. A family plan may cost a company as much as $16,000 per year. Average Single Premium per Enrolled Employee For Employer-Based Health Insurance

The only real downside to the ACA rates is that younger people don't pay enough, and the older ones get super dinged. It's reasonable to expect a young healthy person to pay less than a 62 year old, but with the ACA, the 25 year old pays $125 per month, and the 62 year old could pay as much as $1000 or more per month. Under an employer plan, the cost is spread evenly among all employees. This is where the ACA needs some work.