Obama Slaps States That Don't Comply With Obamacare

[gallantwarrior]

What are the perks that the exchanges provide that will be unavailable on the free market

More transparency on health plan performance on quality indicators and enrollee satisfaction, access to national/out-of-state insurance plans, a variety of consumer assistance functions, public reporting on a number of things (including factors underlying premium increases), eligibility determinations for financial assistance and a calculator to determine what your actual costs are going to be, etc.

If you want a more complete picture of what an exchange is for and what it can do, read through this: Update: Health Insurance Exchanges – Health Reform GPS: Navigating the Implementation Process

One of the great challenges in buying health insurance has been a highly fragmented market. Individuals and group purchasers lack a reliable means for seeing their choices in one place and in a manner that allows them to compare what the plans cover, which providers are in various plans’ practice networks, how cost-sharing might differ, and how numerous competing plans might compare on key measures of quality performance. Nor has there been an active, consumer-oriented system for assuring that insurance plans that are offered in the individual and small group markets provide comparable coverage, cover the benefits that are considered essential to any health insurance plan, have accessible provider networks, and are accountable for specific measures of health care quality. State insurance departments play a different role in most states, overseeing health insurers’ solvency and marketing and business practices. But typically insurance departments do not, as part of their work, organize the health insurance market to make it accountable and user-friendly to individual and group consumers.

Health insurance exchanges are designed to help individuals and small employer groups be better positioned to purchase high quality health insurance by creating “organized markets”[1] that simplify the job of selecting and enrolling in coverage and securing performance information about available products. Health insurance exchanges have been a key element of numerous health reform proposals; indeed, the concept of an exchange lies at the core of systems that turn on the competitive selection of health insurance products in the individual and group markets.[2] Massachusetts’ Commonwealth Health Insurance Connector Authority, established as part of the state’s 2006 health reform legislation, is probably the best known example of a health insurance exchange.[3] The Medicare Part D prescription drug benefit also utilizes an exchange concept as the means by which beneficiaries select their prescription drug plans. At the same time, there are several issues that can derail the development and functionality of exchanges, including adverse selection, a low number of participants, over-complexity, transparency and disclosure, and competition, among other things.[4]

A health insurance exchange might carry out numerous functions: helping individual and group purchasers calculate and compare (e.g., individuals versus families; older versus younger individuals; small versus larger employer groups); providing information about the plans and negotiating prices; helping purchasers gain access to available subsidies; and assuring that premium payments to plans are adjusted to reflect the level of health risk among enrollees (a practice known as risk adjustment) in order to assure payment fairness depending on the specifics of their products. For example, health plans may differ on the level of pharmacy benefits covered or may offer provider networks that are broader or narrower. Health plans’ provider networks may also perform differently on key measures of health care quality. Depending on these variations, plans may attract sicker versus healthier populations.[5]

why are federal subsidies required if these exchanges are intended to be self-sustaining?

Self-sustaining in this context means each exchange's operational costs are not paid for out of federal appropriations. That means keeping the lights on, manning the phones, running the website, etc.

The federal subsidies are for the actual purchase of health insurance by low-to-middle income people buying coverage through the exchange.

If the goal of this entire plan is to make healthcare affordable, why are government subsidies needed at all. If the program has to be subsidized, then it is not affordable.

 

[bigrebnc1775]

Here's my opt out plan
Quite work that pays by check
Work only for cash.
Fuck this government. I urge others if they can to do the same thing.

Many are already doing that. All over the country there are individuals engaging in little acts of rebellion on a daily basis.

That's excellent news.

 

[Murf76]

Obama Slaps States That Don't Comply With Obamacare​

By: Sandy Fitzgerald and Martin Gould
01 Dec 2012


Residents of states that refuse to set up health insurance exchanges under Obamacare are set to be hit with higher premiums under new rules announced by the Health and Human Services Department.

Insurance companies will be charged 3.5 percent of any premiums they sell through the federal exchanges, the department announced Friday. And insurers are likely to pass that surcharge on to clients, leaading to higher premiums.

The only states to be affected are those that refuse to set up their own exchanges because of opposition to the Patient Protection and Affordable Care Act. They are almost certain to be those under Republican control. In those states, HHS will set up the exchanges. …


(Excerpt)

Read more:
Obama Slaps States That Refuse to Comply With Obamacare

The feds weren't planning on paying for these exchanges past the first year anyway, which means they were sticking the States with the cost of maintaining them. Of course, when that didn't work, they're looking at more deficit spending on their end, hence the new charges.

The governors are RIGHT to refuse these exchanges. Not only do they result in additional expenses to already cash-strapped states, the federal government controls them in every way that counts. Further, there are some pretty good loopholes that states can take advantage of by virtue of the poor wording cited often in Obamacare, chiefly "state-run exchanges".

 

[Katzndogz]

Obama Slaps States That Don't Comply With Obamacare​

By: Sandy Fitzgerald and Martin Gould
01 Dec 2012


Residents of states that refuse to set up health insurance exchanges under Obamacare are set to be hit with higher premiums under new rules announced by the Health and Human Services Department.

Insurance companies will be charged 3.5 percent of any premiums they sell through the federal exchanges, the department announced Friday. And insurers are likely to pass that surcharge on to clients, leaading to higher premiums.

The only states to be affected are those that refuse to set up their own exchanges because of opposition to the Patient Protection and Affordable Care Act. They are almost certain to be those under Republican control. In those states, HHS will set up the exchanges. …


(Excerpt)

Read more:
Obama Slaps States That Refuse to Comply With Obamacare

What would happen if these states just ignore Obamacare altogether? You know, just like Obama ignores illegal immigration laws and passes Executive Orders that are in opposition to them?

Would he send in the troops like Lincoln?

The law states that if individual states ignore obamacare and do not set up the exchanges, the obligation is on the federal government to come in and set up their own exchanges. Not send in troops to force government to set up exchanges. Just overwhelm the government with more states refusing to set up exchanges.

 

[Katzndogz]

Here's my opt out plan
Quite work that pays by check
Work only for cash.
Fuck this government. I urge others if they can to do the same thing.

Many are already doing that. All over the country there are individuals engaging in little acts of rebellion on a daily basis.

That's excellent news.

Consider it. More than 50% of the voting public voted against obama. Whether they voted for Romney, someone else or didn't vote at all. If every individual engaged in some small act of rebellion every day, all the time the regime couldn't stand that kind of onslaught. It doesn't have to be political, it can be social.

 

[Greenbeard]

If the goal of this entire plan is to make healthcare affordable, why are government subsidies needed at all. If the program has to be subsidized, then it is not affordable.

...because the subsidies make it possible for these families to buy the insurance. The provisions for the longer-term bending of the cost curve will be happening in parallel but that's a long term project, it's not going to happen overnight.

The governors are RIGHT to refuse these exchanges. Not only do they result in additional expenses to already cash-strapped states, the federal government controls them in every way that counts.

That's Michael Cannon's rhetoric, not reality. States can design who's responsible for the exchange, what it looks like, and how it works. The markets can look a lot of different ways and do a lot of different things. Last year Deloitte laid out different models that will appeal to different states:

The ACA prescribes basic functions that all exchanges must be able to perform but gives the states some design flexibility. A host of factors are expected to impact the eventual design and functionality of the operating model of a given state exchange. The two main factors are:

• Market Environment – Some states manage markets through regulation, while others employ a free-market approach.
• Exchange Capabilities – Some states will take a de minimis approach, while others will opt to build robust operational capabilities as they bring these exchanges online.

We anticipate that four health insurance exchange operating models will emerge, each with distinct characteristics: Information Aggregator, Retail-oriented Exchange, Guided Exchange, Market Curator (Figure 1).

1. Information Aggregator – Takes a laissez-faire approach, where the state facilitates the transaction, and little more.
2. Retail-Oriented Exchange – Seeks to develop a competitive marketplace focused on providing a robust shopping experience for the consumer.
3. Guided Exchange – Reduces confusion for new consumers by offering a reduced number of more standardized products and a simplified shopping experience.
4. Market Curator – Manages competition on a robust platform, where the state curates who can be on the exchange and, to a lesser extent, which products can be offered.

The model that emerges for any given state will factor heavily into a health plan’s decision to participate in the market, as well as influence development of its go-to-market strategy in “entry” states.

California's exchange is not going to look like Mississippi's, which in turn may not look much like the federal fallback. The states themselves are responsible for making the basic design decisions that determine what the marketplace looks like in their state. Unless they prefer not to play that role and defer to what the federal option looks like.

You're buying Cannon's shtick that a state's exchange will look the same regardless of whether or not the state steps up to design and administer it (i.e. that a state design must mirror some federal model). That isn't the case. If it were, there wouldn't be much point in having 51 state-level exchanges instead of just going with a single national exchange (as the House Democrats wanted to do). The goal here is to let states tailor their designs to 51 unique environments.

 

[Murf76]

If the goal of this entire plan is to make healthcare affordable, why are government subsidies needed at all. If the program has to be subsidized, then it is not affordable.

...because the subsidies make it possible for these families to buy the insurance. The provisions for the longer-term bending of the cost curve will be happening in parallel but that's a long term project, it's not going to happen overnight.

The governors are RIGHT to refuse these exchanges. Not only do they result in additional expenses to already cash-strapped states, the federal government controls them in every way that counts.

That's Michael Cannon's rhetoric, not reality. States can design who's responsible for the exchange, what it looks like, and how it works. The markets can look a lot of different ways and do a lot of different things. Last year Deloitte laid out different models that will appeal to different states:

The ACA prescribes basic functions that all exchanges must be able to perform but gives the states some design flexibility. A host of factors are expected to impact the eventual design and functionality of the operating model of a given state exchange. The two main factors are:

• Market Environment – Some states manage markets through regulation, while others employ a free-market approach.
• Exchange Capabilities – Some states will take a de minimis approach, while others will opt to build robust operational capabilities as they bring these exchanges online.

We anticipate that four health insurance exchange operating models will emerge, each with distinct characteristics: Information Aggregator, Retail-oriented Exchange, Guided Exchange, Market Curator (Figure 1).

1. Information Aggregator – Takes a laissez-faire approach, where the state facilitates the transaction, and little more.
2. Retail-Oriented Exchange – Seeks to develop a competitive marketplace focused on providing a robust shopping experience for the consumer.
3. Guided Exchange – Reduces confusion for new consumers by offering a reduced number of more standardized products and a simplified shopping experience.
4. Market Curator – Manages competition on a robust platform, where the state curates who can be on the exchange and, to a lesser extent, which products can be offered.

The model that emerges for any given state will factor heavily into a health plan’s decision to participate in the market, as well as influence development of its go-to-market strategy in “entry” states.

California's exchange is not going to look like Mississippi's, which in turn may not look much like the federal fallback. The states themselves are responsible for making the basic design decisions that determine what the marketplace looks like in their state. Unless they prefer not to play that role and defer to what the federal option looks like.

You're buying Cannon's shtick that a state's exchange will look the same regardless of whether or not the state steps up to design and administer it (i.e. that a state design must mirror some federal model). That isn't the case. If it were, there wouldn't be much point in having 51 state-level exchanges instead of just going with a single national exchange (as the House Democrats wanted to do). The goal here is to let states tailor their designs to 51 unique environments.

It doesn't make a goddamned difference what they "look" like. What matters is that each and every one of them are required to follow the federally-prescribed mandates from HHS. So... the States are exactly correct to tell Obama and Sebelius to POUND SAND. And that goes double for the Medicaid expansions. States don't have printing presses. What's more, most are actually required to not only produce a budget but to balance it, something this current administration can't be bothered with doing.

There are plenty of good loopholes to take advantage of as well. So, wish in one hand and spit in the other leftists. If it were up to me, the States would challenge not only Obamacare but every other two-bit initiative the federal government tries to put on them. We'd take our schools back and tell the feds to go stuff their money and the strings they attach to it.

The more people who feel the pain of this latest federal power grab, the better. Already, people are having their hours cut back on their jobs or losing their employer-paid health benefits in lieu of the fine. Good. Pain is cathartic. It helps people notice the stink of tyranny.

 

[Greenbeard]

It doesn't make a goddamned difference what they "look" like.

Of course it does. There's a huge amount of variation in how exchanges can be designed, based on the preferences and needs of a given state or region. Bill Frist put it well:

State exchanges are the solution. They represent the federalist ideal of states as "laboratories for democracy." We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics. While much planning has yet to be done, we are already seeing a huge range in state models. I love the diversity and the innovation.

Want a more conservative, small-business focused exchange that bans abortion coverage in all its plans? Try Utah and its state exchange, originally founded under Gov. Jon Huntsman. Think that President Obama missed a huge opportunity to steer the nation towards a single payer system? Try Vermont, which plans to ultimately transform its state exchange into a single payer system, Green Mountain Care, that will offer coverage to all state residents. With soaring health care costs one of, if not the most, dangerous threats to America's greatness, a new round of national health care experimentation is exactly what we need.

The idea that all must be the same is a fiction concocted by Cannon to help sell his snake oil.

 

[mudwhistle]

It doesn't make a goddamned difference what they "look" like.

Of course it does. There's a huge amount of variation in how exchanges can be designed, based on the preferences and needs of a given state or region. Bill Frist put it well:

State exchanges are the solution. They represent the federalist ideal of states as "laboratories for democracy." We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics. While much planning has yet to be done, we are already seeing a huge range in state models. I love the diversity and the innovation.

Want a more conservative, small-business focused exchange that bans abortion coverage in all its plans? Try Utah and its state exchange, originally founded under Gov. Jon Huntsman. Think that President Obama missed a huge opportunity to steer the nation towards a single payer system? Try Vermont, which plans to ultimately transform its state exchange into a single payer system, Green Mountain Care, that will offer coverage to all state residents. With soaring health care costs one of, if not the most, dangerous threats to America's greatness, a new round of national health care experimentation is exactly what we need.

The idea that all must be the same is a fiction concocted by Cannon to help sell his snake oil.

Sounds good.

Sounding reasonable about the issue isn't the same as being right about the issue.

 

[Murf76]

It doesn't make a goddamned difference what they "look" like.

Of course it does. There's a huge amount of variation in how exchanges can be designed, based on the preferences and needs of a given state or region. Bill Frist put it well:

State exchanges are the solution. They represent the federalist ideal of states as "laboratories for democracy." We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics. While much planning has yet to be done, we are already seeing a huge range in state models. I love the diversity and the innovation.

Want a more conservative, small-business focused exchange that bans abortion coverage in all its plans? Try Utah and its state exchange, originally founded under Gov. Jon Huntsman. Think that President Obama missed a huge opportunity to steer the nation towards a single payer system? Try Vermont, which plans to ultimately transform its state exchange into a single payer system, Green Mountain Care, that will offer coverage to all state residents. With soaring health care costs one of, if not the most, dangerous threats to America's greatness, a new round of national health care experimentation is exactly what we need.

The idea that all must be the same is a fiction concocted by Cannon to help sell his snake oil.

Bullshit. Each and every one of these exchanges must conform to whatever "the secretary shall...". That's not the kind of verbiage one uses 700 times in a bill when the intent is that the Several States will make their own rules. You people are lying again. But that's all we expect from the despicable, freedom-hating left anyway.

It's just maddening to you that there are still people who won't cooperate. Tough titties. It doesn't make any fiscal sense whatsoever for these states to set up those exchanges or make those Medicaid expansions.

 

[Greenbeard]

Bullshit.

Brilliant rebuttal.

I can see you've really thought this through!

 

[mudwhistle]

Bullshit.

Brilliant rebuttal.

I can see you've really thought this through!

Well, since you deleted the rest of his rebuttal is shows me you're dishonest but at least you're not an angry liar.

 

[gallantwarrior]

It doesn't make a goddamned difference what they "look" like.

Of course it does. There's a huge amount of variation in how exchanges can be designed, based on the preferences and needs of a given state or region. Bill Frist put it well:

State exchanges are the solution. They represent the federalist ideal of states as "laboratories for democracy." We are seeing 50 states each designing a model that is right for them, empowered to take into account their individual cultures, politics, economies, and demographics. While much planning has yet to be done, we are already seeing a huge range in state models. I love the diversity and the innovation.

Want a more conservative, small-business focused exchange that bans abortion coverage in all its plans? Try Utah and its state exchange, originally founded under Gov. Jon Huntsman. Think that President Obama missed a huge opportunity to steer the nation towards a single payer system? Try Vermont, which plans to ultimately transform its state exchange into a single payer system, Green Mountain Care, that will offer coverage to all state residents. With soaring health care costs one of, if not the most, dangerous threats to America's greatness, a new round of national health care experimentation is exactly what we need.

The idea that all must be the same is a fiction concocted by Cannon to help sell his snake oil.

The Fed already foots the medical bills for an entire demographic in AK. Most of the rest pay our own way.

 

[Murf76]

Bullshit.

Brilliant rebuttal.

I can see you've really thought this through!

You're just pissy because there are still a few people left in this country who see you for the communist, thieving bastards you are. Here's your problem though... there's not actually enough money on the planet to satisfy your greed, so even if you could somehow manage to get all the hold-outs on board, you're still fucked.

 

[Greenbeard]

Bullshit.

Brilliant rebuttal.

I can see you've really thought this through!

Well, since you deleted the rest of his rebuttal is shows me you're dishonest but at least you're not an angry liar.

Tough to deconstruct an argument as complex as:

1) Nuh uh!
2) Verbiage!
3) You're lying!
4) You hate freedom!

You want the feds to run your exchange, knock yourself out. You want the state to tailor an exchange to its preferences and needs, so much the better. No need to try and re-package Cannon's snake oil.

 

[Murf76]

Brilliant rebuttal.

I can see you've really thought this through!

Well, since you deleted the rest of his rebuttal is shows me you're dishonest but at least you're not an angry liar.

Tough to deconstruct an argument as complex as:

1) Nuh uh!
2) Verbiage!
3) You're lying!
4) You hate freedom!

You want the feds to run your exchange, knock yourself out. You want the state to tailor an exchange to its preferences and needs, so much the better. No need to try and re-package Cannon's snake oil.

Once more a leftie amuses us all with his complete disregard of irony.
'But..but..but... that Cannon guy is repackaging snake oil!"

Yeah, that's the ticket there, piss-pants.

The States don't get to disregard Sebelius's mandates and we all know it. The maintenance on them isn't paid in perpetuity by the federal government which demands them, so they WILL be an expense to the states at some point. Further, the Supreme Court has said, in an otherwise disastrous decision that allows Congress to control the behavior of individual citizens, that the States DO NOT have to comply with the Medicaid expansions. And as Medicaid is already the largest expenditure for so many states, it's not good fiscal sense to do so.

Oh... and once more, with feeling.... only fools wouldn't take advantage of the loopholes in Obamacare which, for example, would allow more hiring to take place before small employers are saddled with mandates.

 

[Quantum Windbag]

Well--sure--regardless--the consumer is going to pay for it in the end. No surprise here. Whether Obama fines the states 3.5% on their premiums or YOU pay for it in higher state taxes--and or higher state fees--it's a wash. You're going to pay for it one way or another.

So the question becomes is it better to take the 3.5% or throw the dice--with the chance that it may cost a lot more than 3.5% to set up the state exchange?

Christ almighty. State governments aren't paying anything for federal exchanges. Not 3.5%, not anything.

All the wonderful services exchanges are going to offer have operating costs associated with them. The federal government announced last week how it's going to cover those costs for the exchanges it operates: user fees on insurers who sell plans through those exchanges (which isn't unreasonable, given the benefits insurers get from participating). States that choose to operate their own exchanges will need to come up with their own mechanisms to make them self-sustaining. I suspect most state-based exchanges will also rely on user fees on participating insurers and something tells me their rates will be comparable to the federal rates.

Question: will insurers be required to sell their coverage through these exchanges, or will they be permitted an option to offer their services without participating in the exchange? Second: will people be forced to purchase services only through these exchanges, or will people have the option to buy services from insurers not affiliated with the exchange?

That, theoretically, is up to the states. The catch here is that the only policies that are eligible for premium support from the federal government are those that are part of the exchange.

 

[Quantum Windbag]

So, conservative states refuse to run their own exchanges, passing the burden on to the fed gov't, and then they bitch that they'll be charged more. Well then I guess they should run their own exchanges. What's the problem? I thought they didn't need the fed gov't anyway.

Mocking is not bitching.

 

[mudwhistle]

Brilliant rebuttal.

I can see you've really thought this through!

Well, since you deleted the rest of his rebuttal is shows me you're dishonest but at least you're not an angry liar.

Tough to deconstruct an argument as complex as:

1) Nuh uh!
2) Verbiage!
3) You're lying!
4) You hate freedom!

You want the feds to run your exchange, knock yourself out. You want the state to tailor an exchange to its preferences and needs, so much the better. No need to try and re-package Cannon's snake oil.

If you think the lousy deal all of the domestic terrorist sympathizers in the White House have left the states with is fair then I think Bull shit is appropriate.

 

[Quantum Windbag]

What are the perks that the exchanges provide that will be unavailable on the free market

More transparency on health plan performance on quality indicators and enrollee satisfaction, access to national/out-of-state insurance plans, a variety of consumer assistance functions, public reporting on a number of things (including factors underlying premium increases), eligibility determinations for financial assistance and a calculator to determine what your actual costs are going to be, etc.

If you want a more complete picture of what an exchange is for and what it can do, read through this: Update: Health Insurance Exchanges – Health Reform GPS: Navigating the Implementation Process

why are federal subsidies required if these exchanges are intended to be self-sustaining?

Self-sustaining in this context means each exchange's operational costs are not paid for out of federal appropriations. That means keeping the lights on, manning the phones, running the website, etc.

The federal subsidies are for the actual purchase of health insurance by low-to-middle income people buying coverage through the exchange.

If the goal of this entire plan is to make healthcare affordable, why are government subsidies needed at all. If the program has to be subsidized, then it is not affordable.

You are talking to a Democrat, affordable means other people pay for it.