Prop 106 Arizona healthcare choice wins!

[Navy1960]

The problem is that the uninsured individual never pays his/her medical bills. They file for bankruptcy and the hospital writes off the loss. It happens all the time. I think it should be simple. If people don't want to purchase health insurance, then let them opt out with the stipulation that they must have the means to pay in order to receive treatment.

This would satisfy those who believe they shouldn't be forced to buy something they don't want, and it would protect those who do pay from also having to subsidize those who choose not to.

No, it still means you have to forced to buy something you don't want, a policy, a bond, or show some means you will let someone else put a claim on.

People without insurance get health care. It's not perfect, but it doesn't warrant massive disruption of a health insurance system that works fine for 85% of Americans for a handful of outliers.

It doesn't work fine for 85% of Americans, unless you believe that a total cost of over $650,000 per person over their lifetime is working fine. The cost is killing businesses in the US and making it much more difficult to compete with companies in countries throughout the world where they don't have this expense.

If we told every person 18 and over that they need to start making payments on their $650,000 medical bill immediately, you would see how well our system is working. Medical costs are hidden from most Americans because very few pay them directly. They are spread through insurance that is paid by employers and taxes paid to the government. If every American had to be responsible for their own healthcare, you would see drastic changes, because the cost is beyond absurd.

You see we are not that far apart then, the high cost of insurance and the high cost of care itself are a big factor in why healthcare is unaffordable for many in this nation. In fact the complete lack of competition in the health insurace industry sets up a system that allows for these high costs. If you as an individual can purchase a sofa from China then you should be allowed to purchase health insurance from anywhere other than the state you iive in. The fact is that costs were not addressed in this bill and will remain high, nor was the overall quality of care. Do those that support the current model seriously think all those that will be on state medicaid are now somehow better off than they were before, when medicaid is perhaps in terms of quality and acceptence the worst form of health insurnce you can have? The fact is that most Americans desire the cost of healthcare insurance to go down and the converage to remain the same or rise. In this new healthcare bill that is far from the case, so the only thing that has been accomplshed here is adding more people to an already over tasked system of state health insurance that suffers from poor quality care, and lack of providers. I will say that the addition of those with pre-existing condition is a good thing and could have been easily accomplished without the addtion of 2 Trillion dollars in addtional debt with no results other than to drive down the quality of care in this nation.

 

[Greenbeard]

In fact I will also say this, you will have a hard time finding many who would disagree that covering those with pre-existing condition is a bad thing, and if just those provisions had been part of the healthcare bill it would have passed with little if any fanfare and with wide bi-partisan support.

It's not all that difficult to find bi-partisan support for bad policy if neither party is in the mood to act responsibility. That doesn't change the fact that it's still bad policy. If you put in place a guaranteed issue rule with rating restrictions to stop insurers from discriminating on the basis of things like gender or medical history, you throw the door open to adverse selection. People can opt out of buying insurance, knowing full-well that they can opt in without penalty when they need insurance. Witness the uproar six weeks ago over the implementation of the immediate guaranteed issue rule for a very limited market--child-only policies--even though the law still allows for rating restrictions, open enrollment periods, penalties for opting out and then buying coverage again later, and several other mechanisms for deterring adverse selection.

In fact the complete lack of competition in the health insurace industry sets up a system that allows for these high costs. If you as an individual can purchase a sofa from China then you should be allowed to purchase health insurance from anywhere other than the state you iive in.

Unless you intend to actually travel to that other state to get care when you need it, I'm not seeing what mechanism you foresee significantly bringing down costs for you. The fact is that if you live in a high-cost area with high-cost provider facilities (say a place like Boston), you're going to face high costs. Doesn't matter if your insurer is based in Idaho or South Dakota or Guatemala. To the extent that deregulation of the insurance market will reduce costs, it will do so by denying people care (either through total exclusion from insurance pools or through refusal to cover their medical needs).

That isn't to say that additional competition is a bad thing; certainly the exchange model is based on correcting some of the existing inefficiencies in the individual market, in part by increasing transparency, reducing insurers' administrative burdens, and structuring the market to ensure competition is based on quality improvement and cost reduction. But there are limits to how much a better insurance marketplace can accomplish (though certainly they're necessary). Ultimately you have to think about providers and the cost of the care itself, not the cost of your insurance premiums.

One of the forms of interstate insurance purchasing promoted by the reform law involves states entering into compacts (voluntarily and according to mutually agreed-upon terms) that allow insurers based in one compact-participating state to sell insurance in all of the other participating states. A few months ago, HHS solicited input on health insurance exchanges to help as it puts together the regulatory framework for the exchanges. Yesterday, all of the comments submitted by interested states, groups, and individuals were posted online (there are a little less than 900). I was interested to see this in the comments submitted by the National Conference of State Legislatures:

State Compacts

Several states are interested in looking at joining neighboring states through state compacts. Many states believe that state compacts could increase their ability to compete for providers and therefore provide their citizens with more choice. The compact provision in the ACA is a new concept. There are no real models to evaluate. I urge you to dedicate some staff to the development of guidelines for states that may be interested in this option.​

Not only is it interesting to know that several states are very seriously considering entering into these compacts, but the primary reason offered is that this would increase competition on the provider side. Obviously there are some geographical constraints on how effective that kind of thing would be but an area like New England, for example, would probably benefit greatly from something like this.

The fact is that costs were not addressed in this bill and will remain high, nor was the overall quality of care.

I would argue exactly the opposite: that the quality improvement aspects and aims of this law (and don't be fooled, there are lots) are more significant in the long run than the coverage expansions. In fact, I tend to think that quality improvement is the main thrust of the law.

 

[Navy1960]

Let's see , as we have been down this road before, your assertions on several topics while noted, are somewhat off the mark. First let's take interstate compacts, one which I am in favor of by the way, at this moment in time you have more states in litigation against this healthcare bill than you do those seeking to enter into compacts under it. So that might pose a problem when it comes to the over all bill itself . The real issue of the bill though is not compacts, or reforms on those with pre-existing conditions. It is the movement of vast numbers of people into state Medicaid. Now you cite several sources that are somewhat vague when it comes to quaility and costs , however I will give you a real look at the current situation.

NEW YORK (CNNMoney.com) -- States will have to dig deeper into their already empty coffers next year in order to pay for rising Medicaid costs.

Next fiscal year states will spend 7.4% more on the health care coverage -- which is already one of their biggest expenses -- according to a report released Thursday by the Kaiser Family Foundation.

The severe economic downturn has sent people flocking to state Medicaid programs, which provide health care coverage for the disadvantaged. Next year, enrollment is expected to rise by 6.1%.

later in the article

A record 20 states implemented benefits restrictions in fiscal 2010 and 14 states plan to make additional changes in the coming fiscal year. The changes include eliminating dental benefits or limiting services such as therapy and personal care.
Soaring Medicaid costs could bust state budgets - Sep. 30, 2010

The Issue: Low-Income Patients Have Difficulty Obtaining Health Care
The Medicaid program, designed to help low-income citizens obtain health care through a match of federal and state dollars, suffers from gross under-funding and excessive paperwork. This forces physicians to either limit access for Medicaid patients or have their practice go bankrupt and close.

Medicaid payments don’t cover the costs of service.
Medicaid pays about one-third the rate of private insurers, and for most medical practices, the payments do not cover the cost of the service provided. Over the last 12 years, the number of people eligible for the state’s Medicaid program has doubled to more than 955,000 but funding has not been provided for this.

https://www.everettclinic.com/About...ent_Health_Issues/Medicaid Crisis.ashx?p=1019


When you propose to move 1 in 7 Americans to Medicaid and then turn around through a series of mandates , think your going to raise the quality of care, your sadly mistaken. In fact in areas like Dallas, Phoenix, Atlanta, and many other states your seeing many providers begin to drop Medicaid and in some cases Medicare, limiting the number providers available.

As for your example of a person, purchasing healthcare across state lines, if someone is in Boston and wishes to purchase a health insurance plan from Arizona and less cost to them, then you have lowered the cost to the consumer. What you have not done is lowered the cost in which the provder charges. That too can be addressed through regulation. As for pools, again something I am very much in favor of and would have liked to have seen it deregulated to the point where individuals and families could form their own co-ops and purchase health insurance in the open market place and not through an exchange that is managed by the Federal Govt. that says what kind of policies I may purchase. However all that being said, I do think that the core issues of lowering costs, and opening up healthcare access many agree on, it's how we accomplish that is were many tend to part ways and I tend to believe that the current edition of the healthcare bill does not accomplish that.

 

[Toronado3800]

Navy, I am not quite the sneaky big government socialist you are I suppose.

Are you using that general welfare clause to make hospitals treat the poor? Pretty liberal reading there I suppose.

Ideally I would not use the power of the army to force hospitals to treat folks who do not pay upfront or enter into a compact.

It is time to either stop the freeloaders and force them to pay into a private or public insurance their whole lives or time to stop forcing hospitals and doctors to see you without payment. Either way, pick your poison. The math is messed up, Anthem has lost tens of thousands of dollars on my wife and I over the last decade. Baby births, knee surgery, nothing catastrophic even.

 

[Greenbeard]

First let's take interstate compacts, one which I am in favor of by the way, at this moment in time you have more states in litigation against this healthcare bill than you do those seeking to enter into compacts under it.

Those aren't mutually exclusive positions. We just saw 48 states apply for and receive grants to start designing their health insurance exchanges a few weeks ago. Plenty of those states are involved in the lawsuits. And while I haven't looked to see if NCSL has a list of which states are exploring the compacts, I wouldn't be at all surprised if that list includes states suing the federal government.

The real issue of the bill though is not compacts, or reforms on those with pre-existing conditions. It is the movement of vast numbers of people into state Medicaid.

You bring up valid points about provide reimbursements (though those are getting a temporary bump for primary care under ACA) and the hit that benefit packages take during recessions. I won't pretend outcomes are better for Medicaid recipients than people in private coverage; in terms of procedure, if you browse NCQA's State of Health Care Quality 2010 you'll see that on some HEDIS measures Medicaid plans outperform private plans, and in many they do not.

But the relevant question isn't whether it's better to have Medicaid than private coverage; it's whether it's better to have Medicaid or go uninsured. Austin Frakt had a series on this question over at The Incidental Economist a few weeks ago and his conclusions after reviewing the relevant literature concur with the common wisdom:

My take-away from the Medicaid-IV literature review is: there is no credible evidence that Medicaid results in worse or equivalent health outcomes as being uninsured. That is Medicaid improves health. It certainly doesn’t improve health as much as private insurance, but the credible evidence to date–that using sound techniques that can control for the self-selection into the program–strongly suggests Medicaid is better for health than no insurance at all.

There are observational studies that purport to reveal otherwise, that Medicaid coverage is worse or no better than being uninsured. One cannot draw such conclusions from such studies if they do not control for the unobservable factors that drive Medicaid enrollment. Causal inference requires appropriate techniques. Even a regression with lots of controls, even propensity score analysis, is insufficient in this area of study.

Finally, none of this means Medicaid is a program without flaws. It is badly in need of reform. It should be federalized or otherwise protected from state-level fiscal woes. Physicians and hospitals treating Medicaid patients should be reimbursed at rates closer to those of Medicare or private insurance. (That might mean lowering the latter, not only increasing the former.) So long as they’re evidence-based, I’m not opposed to adjustments in the design of Medicaid to increase the value of care delivered to the population that relies on it.

However, what we should not do is fool ourselves into thinking Medicaid is not capable of improving health. Based on high-quality evidence to date, it is and it has.​

It's going to be challenging for state Medicaid programs to absorb the newly eligible but most of those new eligibles are going to end up better off than they were before the expansions.

Now you cite several sources that are somewhat vague when it comes to quaility and costs , however I will give you a real look at the current situation.

Do you want to talk more about that?

As for your example of a person, purchasing healthcare across state lines, if someone is in Boston and wishes to purchase a health insurance plan from Arizona and less cost to them, then you have lowered the cost to the consumer.

You're missing my point. If the Arizona insurance policy is cheaper, it's likely cheaper because costs in its primary service area are cheaper. If you--imagining you're a person in a high-cost area like Boston--buy a policy from them, it's certainly not going to be at the same price its customers in Arizona pay (assuming they're free to practice price discrimination). Unless, as I said, you intend to travel to Arizona for your care. Your logic here seems to be predicated on the assumption that when it comes to cost, it's not you (i.e. your area), it's your insurer. But if you're able to buy insurance from other states, you might find that in fact it's not your insurer, it's you (again, your area).

It's worth thinking about the difference in the cost of living between various places (not just the cost of health care but everything else, including wages). If you actually compare group premiums to what people make, the picture is a bit different than it would look in terms of absolute dollars. For example, in terms of "Employer premiums as percent of median household income for under-65 population" in 2008, Massachusetts (15.6%) actually came in lower than Arizona (18.9%).

The standard conservative interstate purchasing proposal is designed as a tool of deregulation (i.e. shedding risk and consumer protections), nothing more and nothing less.

What you have not done is lowered the cost in which the provder charges. That too can be addressed through regulation.

And should be, I agree.

 

[jimbetty123]

An Arizona Health Insurance Reform Amendment, also known as Proposition 106, or HCR 2014, will be on the November 2, 2010 ballot in Arizona as a legislatively-referred constitutional amendment. State legislators in both the Arizona State Senate and Arizona House of Representatives voted to put the measure before the state's voters. The proposed amendment to the Arizona Constitution was sponsored by state representative Nancy Barto.
Proposition 106 would amend the Arizona Constitution by barring any rules or regulations that would force state residents to participate in a health-care system. The proposed amendment would also ensure that individuals would have the right to pay for private health insurance.

 

[Common Sense]

An Arizona Health Insurance Reform Amendment, also known as Proposition 106, or HCR 2014, will be on the November 2, 2010 ballot in Arizona as a legislatively-referred constitutional amendment. State legislators in both the Arizona State Senate and Arizona House of Representatives voted to put the measure before the state's voters. The proposed amendment to the Arizona Constitution was sponsored by state representative Nancy Barto.
Proposition 106 would amend the Arizona Constitution by barring any rules or regulations that would force state residents to participate in a health-care system. The proposed amendment would also ensure that individuals would have the right to pay for private health insurance.

question:
why exactly would you not want to purchase health insurance?
we drive cars and have car insurance, we have homes and thus have homeowners insurance, we live and we have life insurance. all of these are protections against the unknown. i am baffled that any one individual would actually reject "affordable" health insurance. but we can be mandated to have homeowners insurance (by some mortgage companies) but not health insurance? i agree that part of the reason costs have risen is due to people not paying their medical bills and hospitals having to write those costs off. but what about making health care providers become either non-profits or not-for-profits? thus forcing them take the millions and millions of dollars that they profit from every year and reinvest these dollars back in the system? would this not lower the patient cost?

i also like the idea of if you want to opt out of buying insurance you should have to sign a waiver, but i go a step farther and look at the auto insurance industry. if you dont want to carry auto insurance you can provide (dont quote me, but i believe) a $10,000 proof of financial responsibility to the DMV and opt out of carrying health insurance. if this was adpated over to the health insurance market i do believe that the limit would need to be much much higher say $50,000. but this could be a viable solution to those who want to opt out of the mandatory coverage provision.