Small Families Subsidizing Large Families.

[AVG-JOE]

Given that insurance companies are all about $$$, I'd be willing to bet they don't calculate their family rates based upon only one child. They no doubt take an average (maybe a bit more) and go from there.

At my last job, the only choices were 'employee' and 'family'.

And finally the truth is skirted around.

Instead of taking the time to figure actual costs, the insurance lobby paid congress to allow them to charge small families, who decided to restrict the number of children they had for whatever reason, the same as large families, increasing their profits in doing so.

Since virtually all of the insurance plans sold through employers are like this and since employer provided insurance pretty much IS the marketplace here in America, I say with confidence, so much for the concept of 'competition' in the current insurance market.

How do you propose they figure "actual costs"?

I honestly don't know... I kind of favor a single payer system that is run based on rules instead of profits.

It works for Social Security - 1.2% efficiency is pretty impressive to this average Joe.

That means that for every dollar you pay in FICA taxes (premiums) only 1.2 pennies is used for overhead and administration. Private, for profit insurance needs to spend 22 to 25 pennies of your premium dollar for overhead, but then again, the Social Security Administration doesn't have all those pesky million-dollar executives to satisfy that for-profit insurance does.

 

[AVG-JOE]

The government doesn't think that way. They will just form a parenting department to compete against parents for their children. THe children can then choose who they get the best deal from and go there. It will be quality care for all children at a reduced cost.

What the HELL do you base THAT assertion on?!?

 

[AVG-JOE]

The whole health insurance deal is frustrating. Adding politicans to the equation isn't going to help.

And million-dollar insurance executives running the bureaucracy has proved to be VERY efficient and effective!

 

[AVG-JOE]

Either way, it's a dumb idea that would be too expensive to administer.

Don't insurance companies already waste a ridiculous percentage of their profits on paperwork? I've read somewhere that they spend more on administrative costs than actual healthcare.

It is not the paperwork that costs... it is the executive salaries and bonuses, coupled with the share holder profits. This is where the extra 20 cents per dollar are going.

 

[Ravi]

No it isn't.

The Congressional Budget Office:

CBO’s projections indicate that future Social Security beneficiaries will receive larger benefits in retirement—and will have paid higher payroll taxes—than current beneficiaries do, even after adjustments have been made for inflation and even if the scheduled payments are reduced because the trust funds are exhausted.
​

Oh, and CBO projects that the trust funds will last until 2049.

Social Security zombies - Paul Krugman Blog - NYTimes.com

These projections assume congress does nothing between now and 2049.

Since 1984, all newly hired Federal Employees including congresscritters are on Social Security instead of the Civil Service Plan. This means that as soon as we get rid of the incumbents that were hired prior to 1984, and there are a LOT, especially in leadership positions, Congress will have a personal vested interest in shoring up the trust funds and the program.

The point? Dump an incumbent and assure your retirement.

I realize that and it would be easy enough to fix...stop capping SS by salary, let people that work in the country that aren't citizens pay in...the list goes on and on.

 

[Care4all]

small families subsidize larger families, and adults with no children subsidize the small families....with their property taxes for their children's schools and CHIPS insurance for their kids and probably for their insurance as well....where the cost of all children is spread out among ALL insurance policies.

Also, the healthy does subsidize the unhealthy...both those that are unhealthy due to genetic reasons or those who live a high risk lifestyle.

That is HOW insurance works....and WHY the additional 20 to 40 million americans FORCED in to having insurance, is a God Send, a GIFT HORSE for them....it spreads the risk greatly....
*unfortunately, there are no provisions in these bills that will force the insurance companies to pass along these savings.

 

[Anguille]

small families subsidize larger families, and adults with no children subsidize the small families....with their property taxes for their children's schools and CHIPS insurance for their kids and probably for their insurance as well....where the cost of all children is spread out among ALL insurance policies.

Also, the healthy does subsidize the unhealthy...both those that are unhealthy due to genetic reasons or those who live a high risk lifestyle.

That is HOW insurance works....and WHY the additional 20 to 40 million americans FORCED in to having insurance, is a God Send, a GIFT HORSE for them....it spreads the risk greatly....
*unfortunately, there are no provisions in these bills that will force the insurance companies to pass along these savings.

All true. I might add that all of us are subsidizing the for profit insurance companies.

 

[Care4all]

small families subsidize larger families, and adults with no children subsidize the small families....with their property taxes for their children's schools and CHIPS insurance for their kids and probably for their insurance as well....where the cost of all children is spread out among ALL insurance policies.

Also, the healthy does subsidize the unhealthy...both those that are unhealthy due to genetic reasons or those who live a high risk lifestyle.

That is HOW insurance works....and WHY the additional 20 to 40 million americans FORCED in to having insurance, is a God Send, a GIFT HORSE for them....it spreads the risk greatly....
*unfortunately, there are no provisions in these bills that will force the insurance companies to pass along these savings.

All true. I might add that all of us are subsidizing the for profit insurance companies.

yep!

 

[Navy1960]

You do realize of course that these Insurance companies that everyone likes to cast as the villan are the same ones that are going to reap the benefits of any law "Forces" people to purchase healthcare Insurance, if it ever passes constitutional muster which is highly unlikely. I hope that people who support the current version of so called healthcare reform are not unde the mistaken impression that the Govt. actually runs their own Insurance program. Perhaps the biggest falacy in this bill are these mandates, because they pre-suppose that otherwise healthy individuals will be mandates into purcahsing Insurance to act as an offset for those comming into the system with pre-existing condition. However, the tax penalty for not purchasing the Insurance is so low, that in many cases it is a lot more simple for a young person to just pay the tax, which they won't anyway because, they won't meet the income requirements to actually pay taxes. That leaves an influx of individuals comming into the system with pre-existing condition with little or no offsets. Even the CBO has admitted as far back as 1992 when this idea was floated the first time around, that it will be an uphill challenge. Frankly, I cannot understand how anyone would every consider any of these bills currently offered as being anything close to reform.

 

[Missourian]

What happened to 'spread the wealth'?

It's a fact that smaller families have more disposable income than larger families.

It is your obligation, being a richer small family, to help the less fortunate large family, right?

Yet in this thread, instead of 'spread the wealth' it's a story of PERSONAL RESPONSIBILITY.

I think I've heard that argument before in a different thread.


.
.
..
.
And since we're speaking of fairness when it comes to large families compared to small families, what about tax breaks for having kids.

The premise of this thread is that the more children, the more consumption of services, the more a family should be required to pay.

And yet, a tax BREAK is given for children, while those who decide not to procreate must subsidize those children by paying higher taxes.

Is that fair?

..
.
..
.
.
.
And let's not forget the practice of penalizing high income families with a higher percentage in income tax to subsidize everyone else.

Find some fairness in that.

 

[Care4all]

You do realize of course that these Insurance companies that everyone likes to cast as the villan are the same ones that are going to reap the benefits of any law "Forces" people to purchase healthcare Insurance, if it ever passes constitutional muster which is highly unlikely. I hope that people who support the current version of so called healthcare reform are not unde the mistaken impression that the Govt. actually runs their own Insurance program. Perhaps the biggest falacy in this bill are these mandates, because they pre-suppose that otherwise healthy individuals will be mandates into purcahsing Insurance to act as an offset for those comming into the system with pre-existing condition. However, the tax penalty for not purchasing the Insurance is so low, that in many cases it is a lot more simple for a young person to just pay the tax, which they won't anyway because, they won't meet the income requirements to actually pay taxes. That leaves an influx of individuals comming into the system with pre-existing condition with little or no offsets. Even the CBO has admitted as far back as 1992 when this idea was floated the first time around, that it will be an uphill challenge. Frankly, I cannot understand how anyone would every consider any of these bills currently offered as being anything close to reform.

Navy
those healthy young adults who can not afford it, will be brought in to the system through the affordability credits, through tax subsidies...won't they? So the insurance companies WILL reap the benefits to offset the disabled they have to cover that are not already covered by SSI...no?

the mandatory provision is still a gifthorse for the insurance industry imo....and gives no reason to lower their costs of doing business with hospitals and doctors due to real competition...

care

 

[Navy1960]

Definition.—
(1) In General.—
For purposes of this division, the term “affordable credit eligible individual” means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)—
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).

In the case of family income
(expressed as a percent of FPL)
within the following income tier: The initial premium percentage is— The final premium percentage is— The actuarial value percentage is—
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%
H.R. 3200/Division A/Title II/Subtitle C - Wikisource

States have some discretion in determining which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. To be eligible for Federal funds, states are required to provide Medicaid coverage for most people who get Federally assisted income maintenance payments, as well as for related groups not getting cash payments. Some examples of the mandatory Medicaid eligibility groups include the following:

Basically Care under those criteria, stated in the bill those individuals will end up in Medicaid, thus the unfunded mandates. So much for the affordability credits. You know Care what really strikes me here is this, ALL of this reform could have been done, simply by opening Medicare to individuals below the required age and set it up as catastrophic coverage. Then set up a system if tax credits to allow for the purchase of supplimental policies for those that wished to have general health insurance coverage. In fact you could have even taken monies left over from TARP, and the Stimulus to actually shore up Medicare to shore up the Insurance fund. Imagine a system here someone can purcahse catastrophic coverage, cheaply, much like life insurance. There you have it. I suppose whats really Ironic about this whole thing is this bill doesn't even reform the cost of health insurance premiums it makes them go up. Personally I don't call that reform Care.

 

[AVG-JOE]

Definition.—
(1) In General.—
For purposes of this division, the term “affordable credit eligible individual” means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)—
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).

In the case of family income
(expressed as a percent of FPL)
within the following income tier: The initial premium percentage is— The final premium percentage is— The actuarial value percentage is—
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%
H.R. 3200/Division A/Title II/Subtitle C - Wikisource

States have some discretion in determining which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. To be eligible for Federal funds, states are required to provide Medicaid coverage for most people who get Federally assisted income maintenance payments, as well as for related groups not getting cash payments. Some examples of the mandatory Medicaid eligibility groups include the following:

Basically Care under those criteria, stated in the bill those individuals will end up in Medicaid, thus the unfunded mandates. So much for the affordability credits. You know Care what really strikes me here is this, ALL of this reform could have been done, simply by opening Medicare to individuals below the required age and set it up as catastrophic coverage. Then set up a system if tax credits to allow for the purchase of supplimental policies for those that wished to have general health insurance coverage. In fact you could have even taken monies left over from TARP, and the Stimulus to actually shore up Medicare to shore up the Insurance fund. Imagine a system here someone can purcahse catastrophic coverage, cheaply, much like life insurance. There you have it. I suppose whats really Ironic about this whole thing is this bill doesn't even reform the cost of health insurance premiums it makes them go up. Personally I don't call that reform Care.

Best idea in health coverage reform that I have seen.

Kudos, Navy.

Too bad we're going to get stuck with reform written by the insurance lobby, for the insurance industry...

 

[Polk]

Definition.—
(1) In General.—
For purposes of this division, the term “affordable credit eligible individual” means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)—
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).

In the case of family income
(expressed as a percent of FPL)
within the following income tier: The initial premium percentage is— The final premium percentage is— The actuarial value percentage is—
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%
H.R. 3200/Division A/Title II/Subtitle C - Wikisource

States have some discretion in determining which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. To be eligible for Federal funds, states are required to provide Medicaid coverage for most people who get Federally assisted income maintenance payments, as well as for related groups not getting cash payments. Some examples of the mandatory Medicaid eligibility groups include the following:

Basically Care under those criteria, stated in the bill those individuals will end up in Medicaid, thus the unfunded mandates. So much for the affordability credits. You know Care what really strikes me here is this, ALL of this reform could have been done, simply by opening Medicare to individuals below the required age and set it up as catastrophic coverage. Then set up a system if tax credits to allow for the purchase of supplimental policies for those that wished to have general health insurance coverage. In fact you could have even taken monies left over from TARP, and the Stimulus to actually shore up Medicare to shore up the Insurance fund. Imagine a system here someone can purcahse catastrophic coverage, cheaply, much like life insurance. There you have it. I suppose whats really Ironic about this whole thing is this bill doesn't even reform the cost of health insurance premiums it makes them go up. Personally I don't call that reform Care.

Best idea in health coverage reform that I have seen.

Kudos, Navy.

Too bad we're going to get stuck with reform written by the insurance lobby, for the insurance industry...

Nice idea, but would Republicans would have made a bigger stink over that than they do this bill.

 

[AVG-JOE]

Definition.—
(1) In General.—
For purposes of this division, the term “affordable credit eligible individual” means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)—
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).

In the case of family income
(expressed as a percent of FPL)
within the following income tier: The initial premium percentage is— The final premium percentage is— The actuarial value percentage is—
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%
H.R. 3200/Division A/Title II/Subtitle C - Wikisource

States have some discretion in determining which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. To be eligible for Federal funds, states are required to provide Medicaid coverage for most people who get Federally assisted income maintenance payments, as well as for related groups not getting cash payments. Some examples of the mandatory Medicaid eligibility groups include the following:

Basically Care under those criteria, stated in the bill those individuals will end up in Medicaid, thus the unfunded mandates. So much for the affordability credits. You know Care what really strikes me here is this, ALL of this reform could have been done, simply by opening Medicare to individuals below the required age and set it up as catastrophic coverage. Then set up a system if tax credits to allow for the purchase of supplimental policies for those that wished to have general health insurance coverage. In fact you could have even taken monies left over from TARP, and the Stimulus to actually shore up Medicare to shore up the Insurance fund. Imagine a system here someone can purcahse catastrophic coverage, cheaply, much like life insurance. There you have it. I suppose whats really Ironic about this whole thing is this bill doesn't even reform the cost of health insurance premiums it makes them go up. Personally I don't call that reform Care.

Best idea in health coverage reform that I have seen.

Kudos, Navy.

Too bad we're going to get stuck with reform written by the insurance lobby, for the insurance industry...

Nice idea, but would Republicans would have made a bigger stink over that than they do this bill.

Doesn't matter what the republicans or the dems think of a great idea like opening up Medicare to the general population for a fee.

It would be tantamount to a 'public option' and the insurance lobbyists holding leash on our representatives would not stand by for that kind of competition for the corporations holding their leashes.

 

[Care4all]

Definition.—
(1) In General.—
For purposes of this division, the term “affordable credit eligible individual” means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)—
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).

In the case of family income
(expressed as a percent of FPL)
within the following income tier: The initial premium percentage is— The final premium percentage is— The actuarial value percentage is—
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%
H.R. 3200/Division A/Title II/Subtitle C - Wikisource

States have some discretion in determining which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. To be eligible for Federal funds, states are required to provide Medicaid coverage for most people who get Federally assisted income maintenance payments, as well as for related groups not getting cash payments. Some examples of the mandatory Medicaid eligibility groups include the following:

Basically Care under those criteria, stated in the bill those individuals will end up in Medicaid, thus the unfunded mandates. So much for the affordability credits. You know Care what really strikes me here is this, ALL of this reform could have been done, simply by opening Medicare to individuals below the required age and set it up as catastrophic coverage. Then set up a system if tax credits to allow for the purchase of supplimental policies for those that wished to have general health insurance coverage. In fact you could have even taken monies left over from TARP, and the Stimulus to actually shore up Medicare to shore up the Insurance fund. Imagine a system here someone can purcahse catastrophic coverage, cheaply, much like life insurance. There you have it. I suppose whats really Ironic about this whole thing is this bill doesn't even reform the cost of health insurance premiums it makes them go up. Personally I don't call that reform Care.

I agree, making medicare available for all would have been a much better and less complicated than what has been done.

the idea of it being catastrophic, with supplemental insurance is definitely something i will consider or mull over...

The right wing was completely against such along with all the Democrats in the pockets of the insurance industry and along with the lobbies representing hospitals i believe?

I don't call this healthcare bill reform either, but imo....mainly for what has been taken out of it....with the one measure of it being mandatory being left in it.

care

 

[Emma]

Best idea in health coverage reform that I have seen.

Kudos, Navy.

Too bad we're going to get stuck with reform written by the insurance lobby, for the insurance industry...

Nice idea, but would Republicans would have made a bigger stink over that than they do this bill.

Doesn't matter what the republicans or the dems think of a great idea like opening up Medicare to the general population for a fee.

It would be tantamount to a 'public option' and the insurance lobbyists holding leash on our representatives would not stand by for that kind of competition for the corporations holding their leashes.

Humph. Old Rocks and I proposed this months ago:

http://www.usmessageboard.com/1442648-post88.html

 

[Navy1960]

The way I see it is Medicare is already a "public option" so really all this talk about "public option" really is something for the rabid party folks to beat each up over. Let's say for example that people face an illness they cannot afford to pay for, well isn't offering catastrophic coverage rather like life insurance in a way? It's not like your actually giving it away, it's people buying it, in order to stave off the burden of a a medical illness that will cause them to lose everything. As for those that wish to purchase healthcare that pays for Doctors visits, medicine, etc. etc. then as supplimental insurance sold on the open market and with the additional number of people purchasing it, you have a win win in my mind. I fail to see why a person can buy life Insurance thats low cost in any state they choose but healthcare insurance they cannot. You may as well add that to the list too, okay don't like calling it a "public option" then call the catastrophic part of it, Medicare Part F, G, whatever. The point is, your actually making a insolvent program work and not taking money from it to create an entire new program to do the same thing which is complety backwards in my mind.

 

[AVG-JOE]

Nice idea, but would Republicans would have made a bigger stink over that than they do this bill.

Doesn't matter what the republicans or the dems think of a great idea like opening up Medicare to the general population for a fee.

It would be tantamount to a 'public option' and the insurance lobbyists holding leash on our representatives would not stand by for that kind of competition for the corporations holding their leashes.

Humph. Old Rocks and I proposed this months ago:

http://www.usmessageboard.com/1442648-post88.html

Kudos to both of you too then, Emma.

It is a good idea that I'm certain has support beyond the 5 of us.

It's just too damn bad that the ears of congress are all gummed up with lobby-dollars.

 

[AVG-JOE]

The way I see it is Medicare is already a "public option" so really all this talk about "public option" really is something for the rabid party folks to beat each up over. Let's say for example that people face an illness they cannot afford to pay for, well isn't offering catastrophic coverage rather like life insurance in a way? It's not like your actually giving it away, it's people buying it, in order to stave off the burden of a a medical illness that will cause them to lose everything. As for those that wish to purchase healthcare that pays for Doctors visits, medicine, etc. etc. then as supplimental insurance sold on the open market and with the additional number of people purchasing it, you have a win win in my mind. I fail to see why a person can buy life Insurance thats low cost in any state they choose but healthcare insurance they cannot. You may as well add that to the list too, okay don't like calling it a "public option" then call the catastrophic part of it, Medicare Part F, G, whatever. The point is, your actually making a insolvent program work and not taking money from it to create an entire new program to do the same thing which is complety backwards in my mind.

I've always felt that we need two types of coverage:

> Maintenance, to spread the cost of routine and minor doctors visits over the course of the years.

&

> Insurance, for when your kid gets leukemia.