The GOP may create a health crisis in Hospitals when they repeal the ACA

[flacaltenn]

And now --- I've been tossed out of 3 plans by ACA premium increases and TODAY -- a complete meltdown of the providers and plans in this state. With a majority of doctors and hospital in Tenn not on ANY insurance provider network list. Don't know who's gonna pay them for medical care in 2017. Maybe they'll just golf..

I don't understand how TN got so bad compared to other states. Does it have something to do with the state government?

Our state govt is more efficient, more fiscally sane and competent than your state. Pretty much can make that claim. The roads are fine. Budget is balanced and politicians that do illegal things get outed and go to jail.. One of reasons I moved out of Cali.. What were you trying to say?

Already told you the O-Care implosion has VERY LITTLE to do whether the state set up an exchange or not.

 

[Lewdog]

And now --- I've been tossed out of 3 plans by ACA premium increases and TODAY -- a complete meltdown of the providers and plans in this state. With a majority of doctors and hospital in Tenn not on ANY insurance provider network list. Don't know who's gonna pay them for medical care in 2017. Maybe they'll just golf..

I don't understand how TN got so bad compared to other states. Does it have something to do with the state government?

Our state govt is more efficient, more fiscally sane and competent than your state. Pretty much can make that claim. The roads are fine. Budget is balanced and politicians that do illegal things get outed and go to jail.. One of reasons I moved out of Cali.. What were you trying to say?

Already told you the O-Care implosion has VERY LITTLE to do whether the state set up an exchange or not.

Did your Governor not have anything to do with the stuff his brother got in trouble for with Pilot J?

 

[flacaltenn]

ObamaCare’s Meltdown Has Arrived

More important, ObamaCare’s unraveling shows the danger of a one-size-fits-all federal program. What’s happening in Tennessee is only a nationwide harbinger. Every single neighboring state will have less competition on its ObamaCare exchanges next year. The entire state of Alabama will have only one insurer. Almost all are facing double-digit premium increases: in Mississippi a weighted average of 16%; in Kentucky 25%; in Georgia 33%.

These problems aren’t confined to the Southeast. ObamaCare exchange buyers will have only one option in nearly a third of American counties, according to an August report from the Henry J. Kaiser Family Foundation. That’s a 300% increase in single-option counties from last year. Twenty-five states and the District of Columbia have approved rates leading to average premium increases next year of over 26%.

When O-Care started in Tenn, BCBS came in, underbid all the competition by FAR (premiums 20% below competitors). Built a virtual monopoly in the major metros, lost their asses, and pulled out..

It happens whenever rate increases are paid for by Uncle Santa for a large fraction of the pool.. And then Uncle Santa doesn't quite come thru with the under the table deals for kickbacks and bailouts that were promised and never materialized.

Obamacare 2017: Higher Prices, Fewer Choices

Many consumers have fewer choices in 2017 because several major insurers pulled out of many Affordable Care Act marketplaces. UnitedHealth Group, the nation's largest insurer, is exiting Obamacare in 16 states. Other Obamacare dropouts include Aetna Inc., Humana, and Blue Cross Blue Shield plans in Tennessee and Nebraska.

Two of North Carolina's three insurers have left the state's Obamacare marketplace for 2017, displacing 284,000 people, according to published reports.

Rates for 2017, meanwhile, are all over the map. Minnesotans will see premium increases of 50 percent to 67 percent, on average. In Pennsylvania, the average increase is 32.5 percent. In Michigan, it's 16.7 percent; in California, 13.2 percent.

 

[Lewdog]

ObamaCare’s Meltdown Has Arrived

More important, ObamaCare’s unraveling shows the danger of a one-size-fits-all federal program. What’s happening in Tennessee is only a nationwide harbinger. Every single neighboring state will have less competition on its ObamaCare exchanges next year. The entire state of Alabama will have only one insurer. Almost all are facing double-digit premium increases: in Mississippi a weighted average of 16%; in Kentucky 25%; in Georgia 33%.

These problems aren’t confined to the Southeast. ObamaCare exchange buyers will have only one option in nearly a third of American counties, according to an August report from the Henry J. Kaiser Family Foundation. That’s a 300% increase in single-option counties from last year. Twenty-five states and the District of Columbia have approved rates leading to average premium increases next year of over 26%.

When O-Care started in Tenn, BCBS came in, underbid all the competition by FAR (premiums 20% below competitors). Built a virtual monopoly in the major metros, lost their asses, and pulled out..

It happens whenever rate increases are paid for by Uncle Santa for a large fraction of the pool.. And then Uncle Santa doesn't quite come thru with the under the table deals for kickbacks and bailouts that were promised and never materialized.

Obamacare 2017: Higher Prices, Fewer Choices

Many consumers have fewer choices in 2017 because several major insurers pulled out of many Affordable Care Act marketplaces. UnitedHealth Group, the nation's largest insurer, is exiting Obamacare in 16 states. Other Obamacare dropouts include Aetna Inc., Humana, and Blue Cross Blue Shield plans in Tennessee and Nebraska.

Two of North Carolina's three insurers have left the state's Obamacare marketplace for 2017, displacing 284,000 people, according to published reports.

Rates for 2017, meanwhile, are all over the map. Minnesotans will see premium increases of 50 percent to 67 percent, on average. In Pennsylvania, the average increase is 32.5 percent. In Michigan, it's 16.7 percent; in California, 13.2 percent.

I keep reading what you are posting and don't understand why TN is having so many more problems than other states like KY. I got my paperwork just 2 days ago. I still can chose between Anthem BCBS, Wellcare of Ky, Aetna, Passport, or Humana. The only problem I've found so far is my Pharmacy said they will no longer take people with Aetna because they pay like $.25 per prescription filled. It isn't worth his time.

 

[Slashsnake]

The fix to this situation is rather easy.

Let's pretend Congress says:

1) It's illegal for hospitals and doctor's offices to bill for non-emergency services after the fact. What do I mean by this? For example, if you're going in for a routine checkup, you can pay via cash or credit card prior to receiving the services along with the co-pay. Insurance companies can adjust by not negotiating, but placing a set coverage amount on each service pre-decided by each doctor's office in their network ONCE. There's no reason why someone shouldn't be billed for the cost of surgery before it's performed, unless it's emergency surgery which happens during a spur of the moment emergency situation.

What advantage does #1 give everyone? Well for starters, patients will no longer receive a bill in mail for an amount they have no idea what it'll be until it comes. The bill is already paid and not treated as "credit" that doesn't pull a credit bureau report like it is now. Second, the hospital will receive their funds up front and not have to waste time and effort negotiating with the insurance companies after the fact. You don't see banks just throwing out loans to just anyone, so why should hospitals do it? Third, insurance companies won't have to constantly negotiate with hospitals to minimize payouts as it would be a one-time negotiation to the best of the insurance company's ability to get the payouts lower. People will pay a bit more up front, but insurance rates will go down... In other words, those who frequently visit a doctor will pay a lot more than those who never go which is the way it should be. A person in the 20's that never goes to the doctors shouldn't have to heavily subsidize a 75 year old's frequent doctor visits on their premium.

Those who need emergency spur of the moment surgery or emergency room visits who owe a balance to hospitals at the end of the year should have their tax refund or multiple tax refunds garnished to pay for owed hospital bills, up to the total amount due, whether they file joint or single tax returns, which will then be returned to the hospital in a tax break similar to what a write off is. I'd be happier with this policy than fining those who don't want to pay for insurance and never use it anyways. In one situation people don't want to pay huge amounts of money each month for a premium which is a choice. In the other situation, people owe money to the hospital already while people in the first situation don't owe money to any healthcare provider.

So in other words, I see the "pay after the fact" idea as a rather stupid concept developed by hospitals and insurance companies that should be changed to what I've just proposed. I also find how people who never their health insurance subsidizing those who frequently need to use health insurance a joke within itself.

Let's look at example #1)

Tony is going in for spinal surgery because his back constantly aches and effects his everyday enjoyment. Tony gets referred to a surgeon by his insurance company and makes an appointment to have surgery done. The insurance company pre-negotiated a $3,000 coverage payment with this particular surgeon, so when Tony goes in, he pays his co-pay plus the difference in cost with what the insurance company doesn't cover... So let's say the surgery is $5,000, in which the insurance company covered $3,000, so the remaining cost is $2,000. After collecting Tony's insurance information and the receptionist takes Tony's full payment plus co-pay by his AMEX card, the insurance company immediately kicks in their part of the payment over the computer. Tony then goes in for surgery and walks out without worrying about owing money on a bill and the doctor is paid without being out of the money for an undetermined amount of time. This is the way health insurance should work.

Let's look at example #2)

Erica shows up to the doctors because she has the flu. Erica's insurance company has a contract with her doctor to cover a doctor's visit up to a certain amount of money pre-determined between the doctor and them. Let's say Erica's insurance covers $100 of each "routine" checkup/visit, up to 12 visits a year. The doctor's office can then bill Erica $125 for the visit (their amount for all patients) and then require Erica to pay $25 plus her co-pay up front before she's seen. Erica's Visa is declined; thus, now she cannot see her doctor. Since this is not an emergency situation she is refused service. That is the way health insurance should work. The insurance company then doesn't have to kick in coverage for her during that visit since she's not paying for the services at the time they are performed.

Let's look at example #3)

Adam has a heart attack and needs an ambulance and a visit to the emergency room. The bill for the emergency room plus services is $8,000. The insurance company doesn't have an agreement with that particular ambulance so they cover $0. The hospital and Adam's insurance company have an agreement to pay $6,000 for emergency room visits plus a $250 deductible and $30 co-pay. In this situation the services would be billed afterwards due to the nature of the event. Adam's bill is $2,280 after services in which he receives a bill plus $300 for the ambulance totaling $2,580. Adam pays $80 a month for 5 months bringing the bill down to $1,880. Adam then receives a tax refund of $2,500 the following February. The government would then garnish $1,880 of that $2,500 tax return and now Adam's hospital bill is $0. That is the way insurance should work.

 

[LoneLaugher]

Since well over 80% of Americans STILL get their insurance through employer sponsorships...the supposed O care IMPLOSION is imaginary for the vast majority of people.

Bullshit piled on top of bullshit.

 

[Lewdog]

Since well over 80% of Americans STILL get their insurance through employer sponsorships...the supposed O care IMPLOSION is imaginary for the vast majority of people.

Bullshit piled on top of bullshit.

So are you saying that insurance companies thought they were going to make more from the government in this deal, so they bid on more government coverage, but soon found out they wouldn't make as much as they thought they would? Yet, at the same time they jacked up the insurance premiums on regular folks and blamed it on the fact they took on the government bids that they were going to still be making money off of?

How have stocks in the major medical companies been doing?

 

[Penelope]

Who tore it up?

Professional Groups like engineers, lawyers, veterinarians had a lot of coverage. They were effective pools. ObamaCare OUTLAWED these groups. And then the HHS started writing WAIVERS to their favorite groups like Unions, and AARP who helped to propagandize for the passage of ACA..

MILLIONS of folks in these professional group pools that got tossed out right at the beginning of O-Care..

Were there certain qualifications for being in a pool? Besides working in the same profession?

Yes paid up membership in the Professional Society. Like the Amer. Chem Society, IEEE or the Amer. Veterinary Assoc.

Health Care Exchange | ACS Insurance

is this no longer applicable. This is the ACS. I have not checked the others. I meant age limits, medical questions, such as pre existing conditions, etc?

All that is an alternate portal to applicable ACA exchange. Their not covering ANYBODY thru an ACS group.

Most of those professional society plans were STABLE for 10 or 20 years. Meaning that you were eligible simply by writing the check. Towards the end, maybe about 2000, NEW members were subject to pre-existing conditions, proof of continuous coverage or/and medical vetting. But the huge MAJORITY had been covered without any of that for most of their careers. Which is how insurance SHOULD work. It should cover you from youth thru age and move with you. So the INSURER gets the benefit of the good times and the bad. I covered myself and my family in the SAME group, since my early 30s. Until the Dems and ACA KILLED it..

Well I'm sorry, and I see TN is a bad state for the ACA. Its too bad, but like your said ,its vital for everyone to pay into the system, if they need it or not. I read that Republicans in your state fought it tooth and nail, even to the point of not letting someone help another with the site. I suspect we need something like Medicare for everyone, everyone automatically pays in to it, and government can't touch it. The ACA or something like it will even be more important since there are more and more IC's today. Its a plus when one can have mobile HI and not worry about preexisting conditions. We still have BCBS here in MI, and Hosp. HMO's, that's about it. I really wished they'd work the kinks out of it and help it instead of destroying it. They had best come out with something. A lot of people are depending on the ACA and expanded Medicaid.

 

[Sun Devil 92]

Hospitals: GOP may create 'an unprecedented public health crisis'

But the GOP is the GOP is the GOP. Their constituents are wealthy enough that they don't really care.

Deporting millions of illegals will relieve the pressure on hospital emergency rooms.

Most are not going anywhere.

Where is the stupid rating when you need it ?

 

[Sun Devil 92]

good , lets get back to normal and all buy buy our own insurance JimH !!

it's $12000 a year per person for an individual health care insurance policy for a healthy person in their 50's with a $6000 out of pocket, $2000 deductible....that's what individual rate policies cost here..... if we all had to buy our own, then there would be no ''group rate'' policies through your work, which would make insurance cost prohibitive, for most of us....

Is someone selling you a bridge too ?

 

[EdwardBaiamonte]

Hospitals: GOP may create 'an unprecedented public health crisis'

But the GOP is the GOP is the GOP. Their constituents are wealthy enough that they don't really care.

1) blue states are poor and all voted for Trump!! It was in all the papers
2) GOP plan is capitalism. IF fully implemented it will cut prices by 80% and extend life expectancies by 10-15 years. How would you like to have your parents for an extra 10-15 years?