ER visits went UP under Romneycare

all i know is when i worked for express scripts we had bcbs of mass and we had to bend over backwords for those people and alot of them were very RUDE even if the mistake was theirs!! just saying
 
all i know is when i worked for express scripts we had bcbs of mass and we had to bend over backwords for those people and alot of them were very RUDE even if the mistake was theirs!! just saying

I had BCBS of Mass for a while. The biggest problem was that BCBS wanted us to use Express Scripts exclusively for ANY type of recurring prescription, like my Cosopt and Xalatan eyedrops. The problem with that being - my 30 day eyedrop prescription generally lasts me 45-60 days because I only take it in one eye, and only once or twice a day. So getting new drops every 30 days is a waste of money for me. Yet they repeatedly tried to demand that I switch from my pharmacy to Express Scripts for the prescriptions.
 
The health care crises we are facing is HOPELESS until we rethink the social contract.

Seriously, there is NO solution (not socialist or capitalist) until we have a seachange in thinking about what obligations and rights citizens have in regard to society as a whole.

Rights have NOTHING to do with health care.



That's illogical - the more sophisticated medicine and health care gets, the more likely diseases are to be prevented and the attendant costs.

Ya think?

Well, there's no other way to say this other than:

You're completely wrong.

The distribution of health care costs is strongly age dependent, a phenomenon that takes on increasing relevance as the baby boom generation ages. After the first year of life, health care costs are lowest for children, rise slowly throughout adult life, and increase exponentially after age 50 (Meerding et al. 1998). Bradford and Max (1996) determined that annual costs for the elderly are approximately four to five times those of people in their early teens. Personal health expenditure also rises sharply with age within the Medicare population. The oldest group (85+) consumes three times as much health care per person as those 65–74, and twice as much as those 75–84 (Fuchs 1998). Nursing home and short-stay hospital use also increases with age, especially for older adults (Liang et al. 1996).

source

This distribution in medical costs over age group has absoulutely nothing to do with what I said. :rolleyes:
 
What a load of hair-splitting crap. :lol: The HR department's decision-making process will be economically compelled by the new law which makes it disadvantageous for some companies to continue to offer their current plans. Clearly, obama left the impression to employees that they would be allowed to keep their plans if they wanted, which for many, will be simply false, BECAUSE OF THE NEW LAW.

Were you under the impression that your doctor would be forbidden from retiring because, if he did, you wouldn't be able to keep him?

:D You're going from erroneous to ridiculous. Of course I neither said nor implied any such thing.

Clearly you seem to think Obama was suggesting the law would forbid HR departments from changing health plans, which makes about as much sense.

I didn't say that, and I already corrected that same (probably disinguous) objection above once - how many times do you obamabots need to be told something??

The reality is that Obama was translating a specific policy in rhetoric: namely, he was referring to the fact that the law would (as every incarnation of it did) contain a grandfather clause to prevent regulatory changes from affecting existing plans as long as individuals or groups retained them.

That's simply false - the law gives employers the option of opting out of employee coverage, paying an annual per employee penalty, and then those employees are dumped into the so called exchanges. This is in clear contradiction to obama's promise that employees who like their current coverage could keep it. You need to read up.
 
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:D You're going from erroneous to ridiculous. Of course I neither said nor implied any such thing.

And yet you're clearly advocating an understanding of "if you have your plan and you like it,…or you have a doctor and you like your doctor...you don't have to change plans" that's devoid of common sense. Namely one in which administrators of group plans are unable to change plans for that group. That's just as silly as assuming "if you like your doctor you can keep him" means elderly doctors will be prevented from retiring.

That's simply false - the law gives employers the option of opting out of employee coverage, paying an annual per employee penalty, and then those employees are dumped into the so called exchanges.

No, the law doesn't give employers the option of declining to offer coverage. They've always had that option and will continue to have it. That has nothing to do with the ACA. The difference is that now 1) employers with more than 50 employees have an additional disincentive to stop offering coverage, and 2) SHOP exchanges offer the prospect of bringing some predictability to employer premium contributions and giving individuals greater freedom to put their employer's contribution toward a plan of their choosing.

But back to your point in the OP: Can you describe the workforce provisions of Chapter 58 of the Acts of 2006 in Massachusetts? What was the strategy there for addressing primary care shortages? Maybe you can do a little compare and contrast with the ACA for us.
 
:D You're going from erroneous to ridiculous. Of course I neither said nor implied any such thing.

And yet you're clearly advocating an understanding of "if you have your plan and you like it,…or you have a doctor and you like your doctor...you don't have to change plans" that's devoid of common sense. Namely one in which administrators of group plans are unable to change plans for that group.

You're hopelessly confused - both obama's statements and what I said was that UNDER THE NEW LAW, he said that if you like your current coverage, you could keep it. That's FALSE - if the company opts out of covering you, you'll be dumped into an exchange and there's no telling what you'll end up with. That has NOTHING to do with employers in the past merely changing insurers.

That's simply false - the law gives employers the option of opting out of employee coverage, paying an annual per employee penalty, and then those employees are dumped into the so called exchanges.

No, the law doesn't give employers the option of declining to offer coverage. They've always had that option and will continue to have it.

Here, you're just doing a diversion. Never before did employers HAVE THE INCENTIVE to drop employee coverage that they now have under obamacare. Since I doubt whether anyone can be confused on the subject as you appear to be, my guess is you're just trying to spread disinformation.
 
You're hopelessly confused - both obama's statements and what I said was that UNDER THE NEW LAW, he said that if you like your current coverage, you could keep it.

The purpose of posting an actual quote from mid-2009 is to dispel the myths you're continuing to push. So I'll post it again:

“When I say if you have your plan and you like it,…or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform,” the President said.​

That doesn't mean your company can't opt out of covering you, as it's always had that option and it always will. Your company ≠ the government.

Never before did employers HAVE THE INCENTIVE to drop employee coverage that they now have under obamacare.

For the first time in history, there is a per-employee fine for declining to offer health insurance (provided an employee receives subsidized exchange coverage), whereas before there was no penalty for dropping coverage. You consider this penalty a new incentive to drop coverage? Fascinating.

Hey, by the way, given that the premise of your thread is that the ACA and RomneyCare are the same thing regarding their implications for ERs: Can you describe the workforce provisions of Chapter 58 of the Acts of 2006 in Massachusetts? What was the strategy there for addressing primary care shortages? Maybe you can do a little compare and contrast with the ACA for us.
 
This is indeed very interesting. Did you know that between 2004 and 2008 that emergency room visits increased by 9%? And since 2006 when Romneycare went into effect, they increased 4%. So that tells us that they actually were increasing at a higher rate prior to Romneycare going into effect.

Emergency Room Visits Increase in Massachusetts - By Avik Roy - Critical Condition - National Review Online

Another interesting fact; while emergency room visits increased by 4.1% between 2006 and 2008, low severity visits fell by 1.8%. In other words, the emergency room visits that increased the number of visits were due to high severity injuries or illnesses for which people tend to go to the ER regardless of whether they have insurance or not. The fact that ER visits for low severity problems fell by 1.8% tells us that since more people now have insurance, they are not going to the ER for a simple cold of flu. The ones that were going to the ER had major emergencies that actually needed immediate attention. The cause of the increase in these severe injuries or illnesses is not known.

Visits to ER rise despite health law - Boston.com

You raise interesting points, but neither of those articles conclusively prove that RomneyCare is the reason for the leveling off of emergency room increases. It's all speculation pretty much.

I can agree with that, the same as the OP's statement that ER visits went up 4% can't necessarily be proven to be due to Romneycare.
 
This is indeed very interesting. Did you know that between 2004 and 2008 that emergency room visits increased by 9%? And since 2006 when Romneycare went into effect, they increased 4%. So that tells us that they actually were increasing at a higher rate prior to Romneycare going into effect.

Emergency Room Visits Increase in Massachusetts - By Avik Roy - Critical Condition - National Review Online

Another interesting fact; while emergency room visits increased by 4.1% between 2006 and 2008, low severity visits fell by 1.8%. In other words, the emergency room visits that increased the number of visits were due to high severity injuries or illnesses for which people tend to go to the ER regardless of whether they have insurance or not. The fact that ER visits for low severity problems fell by 1.8% tells us that since more people now have insurance, they are not going to the ER for a simple cold of flu. The ones that were going to the ER had major emergencies that actually needed immediate attention. The cause of the increase in these severe injuries or illnesses is not known.

Visits to ER rise despite health law - Boston.com

You raise interesting points, but neither of those articles conclusively prove that RomneyCare is the reason for the leveling off of emergency room increases. It's all speculation pretty much.

I can agree with that, the same as the OP's statement that ER visits went up 4% can't necessarily be proven to be due to Romneycare.

I don't have to prove that. Romney and his libs said ER visits would go down, because people were going there who had no insurance. HE MADE THE ASSERTION. He was wrong.
 
You're hopelessly confused - both obama's statements and what I said was that UNDER THE NEW LAW, he said that if you like your current coverage, you could keep it.

The purpose of posting an actual quote from mid-2009 is to dispel the myths you're continuing to push. So I'll post it again:

“When I say if you have your plan and you like it,…or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform,” the President said.​

That doesn't mean your company can't opt out of covering you, as it's always had that option and it always will. Your company ≠ the government.

OK - I'll play your silly ass game of repetition. :D How it is with obamacare certainly IS NOT how it's always been. Obama's statement is a knowing deception, because never before obamacare did the companies have a big specific INCENTIVE to drop employees, other things being equal. Depending on how individual states work out the so-called exchanges, people could end up with a lot worse coverage, by a chain of events that wouldn't have happened before obmacare. OK, now repeat your shit again. :rolleyes:
 
The health care crises we are facing is HOPELESS until we rethink the social contract.

Seriously, there is NO solution (not socialist or capitalist) until we have a seachange in thinking about what obligations and rights citizens have in regard to society as a whole.

Rights have NOTHING to do with health care.



That's illogical - the more sophisticated medicine and health care gets, the more likely diseases are to be prevented and the attendant costs.

Ya think?

Well, there's no other way to say this other than:

You're completely wrong.

The distribution of health care costs is strongly age dependent, a phenomenon that takes on increasing relevance as the baby boom generation ages. After the first year of life, health care costs are lowest for children, rise slowly throughout adult life, and increase exponentially after age 50 (Meerding et al. 1998). Bradford and Max (1996) determined that annual costs for the elderly are approximately four to five times those of people in their early teens. Personal health expenditure also rises sharply with age within the Medicare population. The oldest group (85+) consumes three times as much health care per person as those 65–74, and twice as much as those 75–84 (Fuchs 1998). Nursing home and short-stay hospital use also increases with age, especially for older adults (Liang et al. 1996).

source

I agree with this.

The cost of health care has been a big item in each of the past two NH presidential primaries and the one thing I gleaned from each of those debates is that the cost of health care is really not a problem in this country but the cost of treating chronic health care issues is.

And those chronic issues are overwhelming associated with the aged.

So the problem is not about simply treating diseases, it's about the fact that we wear out as we grow old.
 
Obama's statement is a knowing deception, because never before obamacare did the companies have a big specific INCENTIVE to drop employees, other things being equal.

Of course they did. They have always had incentives to offer coverage, and disincentives to offer coverage. The specific decision on whether to offer coverage (and whether to continue offering coverage) has always been made by weighing those two against each other. A great deal of analysis has been done of how the balance between those opposing incentives is impacted by the ACA.

Now, I could start by taking the premise of your thread: that the Massachusetts reforms are identical in this regard to the ACA and thus provide a reliable indicator of things to come. If I did that, I would undoubtedly point out that not only did employer dumping not occur, but employer-sponsored health insurance increased substantially after Massachusetts implemented its reform law. In 2005, 45% of firms with 50 or fewer employees offered Section 125 plans and 80% of firms with more than 50 employees did. In 2009 those numbers were up to 56% of firms with 50 or fewer employees and 97% of firms with 51 or more employees. Overall, the rate of employers offering health insurance in Massachusetts rose to 76% in 2009, up from 70% in 2005 (before the state reforms were enacted).

So even by the premise of your thread (look to Massachusetts to see the shape of things to come!), you're full of shit.

Now we can consider the various economic analysis that have also considered the effects of the ACA on employer coverage.

RAND:

RAND found that the ACA will increase employer offer rates (that is, the probability that businesses will offer coverage) to workers. After the new policies have taken full effect, employer offer rates will increase from
  • 57 percent under the status quo to 80 percent for firms with 50 or fewer workers
  • 90 percent to 98 percent for firms with 51 to 100 workers
  • 93 percent to 98 percent for firms with more than 100 workers.

What explains these increases? Firms will increase their offer rates in response to employee preferences, which will change in response to the individual mandate. Specifically, workers will have greater demand for insurance, since there is a penalty associated with being uninsured. In many cases, workers will prefer employer-sponsored coverage to other insurance policies because of the generous tax treatment (health insurance purchased through an employer is generally paid for with pretax dollars, rather than after-tax dollars). Offer rates will increase substantially even among firms with 50 or fewer workers, which are exempt from penalties associated with not offering coverage, because of the greater value employees will have for this benefit.


Urban:

Overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform. Small- and medium-firm ESI coverage would be almost unchanged, and large-firm ESI coverage would increase by just over 2 percentage points. Large-firm ESI policies cover more people than small- and medium-firm policies combined. [...]

Our reasons include the following:
  • Nondiscrimination rules require that firms that offer health benefits offer them to all workers, and firms employ a mix of workers at different income levels. Firms would have an incentive to drop ESI only if the savings on low-income workers outweigh the costs of compensating all workers for the lost benefits.
  • As shown in Table 5, the large majority (79 percent) of workers with their own ESI coverage have incomes above 250 percent of the FPL.The share is higher (81 percent) in large firms. Firms would not have an incentive to drop coverage for these workers and would need to compensate them with higher wages if they did.
  • Only 35 percent of ESI policyholders with incomes under 250 percent of the FPL select family coverage according to our estimates (Table 5). In 2014, a single policy would cost the employer around $5,100—far less than $11,941. This greatly reduces the savings firms would obtain from dropping ESI.
  • The tax advantage of ESI is unchanged under the ACA. Holtz-Eakin and Smith only consider federal income taxes, but employer premium contributions are excluded from payroll taxes and state income taxes (if applicable) as well. Many workers’ contributions to premiums are excluded from these taxes under Section 125 plans. When all relevant taxes are taken into account, firms that dropped ESI coverage would have to compensate the higher- income workers even more.
  • Higher-income workers tend to be older than lower-income workers. In large firms, half of workers with incomes more than 250 percent of the FPL are between the ages of 45 and 64 (Table 5). In compensation for the loss of benefits to higher-income workers, an employer dropping coverage would need to raise wages enough to allow the worker to buy unsubsidized, age-rated coverage in the exchange. Equivalent age-rated coverage in the nongroup market would very likely be more expensive than average premium costs under ESI. Again, this implies a higher cost of compensating workers for lost ESI benefits.
  • The individual mandate raises demand for all types of coverage, including ESI coverage. There will be new demand for ESI coverage among currently uninsured workers who already have offers and those who do not. This acts as a counter-incentive to firms dropping coverage.
  • The empirical findings of Gruber and Lettau (2004) suggest that the preferences of high-wage workers in a firm carry more weight than the preferences of low-wage workers. If applicable, this would temper incentives for an employer to drop ESI.17
  • It may not be sufficient for a firm to boost the wages of workers who lose ESI coverage. Pay equity considerations could require that all workers, even those who did not participate in the employer’s plan, receive wage increases. This would add to the cost of dropping coverage.
  • In Massachusetts, which passed a landmark set of reforms in 2006 similar to those in the ASA, the rate of employer-sponsored coverage increased about 3 percent from fall 2006 to fall 2009, a period covering both the implementation of the state reforms and a 4.5 percentage point rise in the state unemployment rate.18 The Massachusetts experience suggests that the combination of individual and employer mandates can increase ESI coverage, even when subsidized alternatives to ESI are introduced.

For each of these reasons, most of which HIPSM accounts for, we believe the risk of widespread dropping of employer- sponsored coverage due to the ACA is far lower than some have suggested, particularly among large firms.Any economic incentives to drop employer- sponsored health insurance due to the ACA would not even begin to take effect until sometime after 2014, when the exchanges are up, running, and perceived as a viable alternative to ESI.

CBO and JCT:

On balance, the number of people obtaining coverage through their employer would be about 3 million lower in 2019 under the legislation, CBO and JCT estimate. The net change in employment-based coverage under the proposal would be the result of several flows, which can be illustrated using the estimates for 2019:

  • Between 6 million and 7 million people would be covered by an employment-based plan under the proposal who would not be covered by one under current law (largely because the mandate for individuals to be insured would increase workers’ demand for coverage through their employers).
  • Between 8 million and 9 million other people who would be covered by an employment-based plan under current law would not have an offer of such coverage under the proposal. Firms that would choose not to offer coverage as a result of the proposal would tend to be smaller employers and employers that predominantly employ lower- wage workers—people who would be eligible for subsidies through the exchanges—although some workers who would not have employment-based coverage because of the proposal would not be eligible for such subsidies. Whether those changes in coverage would represent the dropping of existing coverage or a lack of new offers of coverage is difficult to determine.
  • Between 1 million and 2 million people who would be covered by their employer’s plan (or a plan offered to a family member) under current law would instead obtain coverage in the exchanges. Under the legislation, workers with an offer of employment-based coverage would generally be ineligible for exchange subsidies, but that “firewall” would be enforced imperfectly and an explicit exception to it would be made for workers whose offer was deemed unaffordable.

The CMS Actuary:

Employer-sponsored health insurance has traditionally been the largest source of coverage in the U.S., and we anticipate that it would continue to be so under the PPACA. By 2019, an estimated 13 million workers and family members would become newly covered as a result of additional employers offering health coverage, a greater proportion of workers enrolling in employer plans, and an extension of dependent coverage up to age 26. However, a number of workers who currently have employer coverage would likely become enrolled in the expanded Medicaid program or receive subsidized coverage through the Exchanges. For example, some smaller employers would be inclined to terminate their existing coverage, and companies with low average salaries would find it to their--and their employees'--advantage to end their plans, thereby allowing their workers to qualify for heavily subsidized coverage through the Exchanges. Somewhat similarly, many part-time workers could obtain coverage more inexpensively through the Exchanges or by enrolling in the expanded Medicaid program. Finally, as mentioned previously, the per-worker penalties assessed on nonparticipating employers are relatively low compared to prevailing health insurance costs. As a result, the penalties would not be a substantial deterrent to dropping or forgoing coverage. We estimate that such actions would collectively reduce the number of people with employer-sponsored health coverage by about 14 million, or slightly more than the number newly covered through existing and new employer plans under the PPACA. As indicated in table 2, the total number of persons with employer coverage in 2019 is estimated to be 1 million lower under the reform legislation than under the prior law.

Depending on how individual states work out the so-called exchanges, people could end up with a lot worse coverage, by a chain of events that wouldn't have happened before obmacare.

Odd, the conservative complaint about exchange coverage generally isn't that they anticipate it being low-grade cut-rate insurance, but rather exactly the opposite.
 

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