Vinson issues stay of his own ruling

[Polk]

Look at that, even if HHS determines a rate increase is unreasonable and unjustified, they cannot do a thing about it.

I'm genuinely impressed. You've discovered for yourself one of the key aspects of the ACA: it's not about federal authority. It's state-driven. The rate review provisions are simply one example of that; states choose (with federal support, if they want it) how and whether to revamp their state premium oversight laws and infrastructure. Those that have or acquire the authority to halt unjustified premium increases over the next three years can do so; otherwise the state will have to rely on the real deterrent, the threat of exclusion from the exchange, which every state's exchange will be empowered to employ if necessary. But if a state's exchange doesn't want to use that particular tool, then it won't get used. Those decisions are left to the state.

Reform will look different in different states because states will be doing things differently from each other. Beyond sketching out broad contours, HHS isn't the one deciding what reform will look like in your state, your state's leadership is.

So kudos. There are still a great many folks who haven't figured out that health reform is federated, not centralized.

I have no real problem with the PPACA as such, other than we cannot afford it. My problem has always been with the attempt to force people to buy a product from a private company. Even Obama had a problem with that before he realized he is a lying politician at heart.

By the way, since every single state has to meet the federal guidelines, and they cannot opt out for a less extensive reform. That actually makes it centralized, not federated, but nice try.

How can you claim "Obama had a problem" with it? He did oppose the individual mandate during the primary, but his argument was that he felt it wasn't necessary, not so deep-rooted ideological objection. I'd also challenge the notion that the bill is unaffordable. The reality is that without aggressive movements on medical cost containment, our existing obligations, without ACA, are unaffordable. The bill represents a first step toward cost containment. If you're really worried about the fiscal health of the nation, you'd be looking at working together to fund programs which prove to be effective at reducing cost, while eliminating those that do not. This process will require multiple rounds of policy experimentation if it's going to work.

 

[Greenbeard]

I have no real problem with the PPACA as such, other than we cannot afford it. My problem has always been with the attempt to force people to buy a product from a private company.

Really? Because it looked like in your post you were sneering about the absurdity of leaving the oversight of insurance premiums to the states themselves. Those "stupid regulations" that don't give the feds the power you think they need, instead reserving it to the states.

In fact, if I recall correctly, you bitch and moan about just about everything.

 

[code1211]

What benefits? The higher insurance premiums? The loss of choices in the market? The blatant favoritism and politics being played in awarding exemptions to unions and insurance companies that supported the new law? Are those the benefits you are talking about?

What utter nonsense. The law won't result in higher insurance premiums beyond what they would have been without the law (since insurances have to justify rate increases now). As for loss of choices, that "loss" has been from the removal of policies that don't protect against anything.

All of the waivers granted, all of them, were to prevent unaffordable rate increases demanded by the new law for the employees of companies and members of organizations.

What planet have you been on for the last year?

 

[The T]

The Real Story:

Judge Vinson to Obama: Speed up the Appeal or Stop Implementing Obamacare

 

[Quantum Windbag]

What utter nonsense. The law won't result in higher insurance premiums beyond what they would have been without the law (since insurances have to justify rate increases now). As for loss of choices, that "loss" has been from the removal of policies that don't protect against anything.

I am so glad you mentioned the requirement to "justify" rate increases, it gives me a chance to show just how ignorant you are.`



Implementing Health Reform: The Premium Review Regulation – Health Affairs Blog

You can have unreasonable and justified increases? Can we try that again?

The proposed regulation attempts to sort out this puzzle. It begins by establishing a threshold level above which premium increases must be justified preliminarily. For 2011 this threshold will be 10 percent; for 2012 and later it will be either 10 percent or a state-specific threshold (which could be higher or lower) determined by the costs of health care and insurance in a particular state. Any issuer that proposes a rate increase in excess of this threshold must submit a preliminary justification for the rate increase before it goes into effect to HHS and to the applicable state. HHS will post this information on its website. If the applicable state has a rate review program determined by HHS to be “effective,” the state will review the rate request and report to HHS, which will accept its decision. If the state does not have an approved program, the insurer must submit further information to HHS and HHS will review the proposed rate increase determining whether it is “unreasonable,” defined as excessive, unjustified, or unfairly discriminatory. If HHS decides that a proposed rate increase is unreasonable, it will post this determination on its website. The insurer may then withdraw its proposed increase, propose a lower increase (which must also be reviewed if it is above the threshold), or implement the proposed “unreasonable” increase. Whether or not an insurer can implement an increase determined to be unreasonable by a state will, of course, depend on state law.

Look at that, even if HHS determines a rate increase is unreasonable and unjustified, they cannot do a thing about it. You are so right, once people understand how all of this works they are just going to love it. I might as well settle in and accept that I am just a grumpy old man totally opposed to change.

Thank you for giving me a chance to prove just how stupid the regulations you think will save the world are.

I'd need to go back and look at the specific text, but I was referring to the "medical loss" ratio.

An arbitrary ration that is causing insurers to choose between reclassifying administrative expenses as medical expenses, or simply paying every claim they receive without checking them for fraud. Another fine example of just how good the law is.

I want to thank you again, that had slipped my mind.

 

[Quantum Windbag]

I'm genuinely impressed. You've discovered for yourself one of the key aspects of the ACA: it's not about federal authority. It's state-driven. The rate review provisions are simply one example of that; states choose (with federal support, if they want it) how and whether to revamp their state premium oversight laws and infrastructure. Those that have or acquire the authority to halt unjustified premium increases over the next three years can do so; otherwise the state will have to rely on the real deterrent, the threat of exclusion from the exchange, which every state's exchange will be empowered to employ if necessary. But if a state's exchange doesn't want to use that particular tool, then it won't get used. Those decisions are left to the state.

Reform will look different in different states because states will be doing things differently from each other. Beyond sketching out broad contours, HHS isn't the one deciding what reform will look like in your state, your state's leadership is.

So kudos. There are still a great many folks who haven't figured out that health reform is federated, not centralized.

I have no real problem with the PPACA as such, other than we cannot afford it. My problem has always been with the attempt to force people to buy a product from a private company. Even Obama had a problem with that before he realized he is a lying politician at heart.

By the way, since every single state has to meet the federal guidelines, and they cannot opt out for a less extensive reform. That actually makes it centralized, not federated, but nice try.

How can you claim "Obama had a problem" with it? He did oppose the individual mandate during the primary, but his argument was that he felt it wasn't necessary, not so deep-rooted ideological objection. I'd also challenge the notion that the bill is unaffordable. The reality is that without aggressive movements on medical cost containment, our existing obligations, without ACA, are unaffordable. The bill represents a first step toward cost containment. If you're really worried about the fiscal health of the nation, you'd be looking at working together to fund programs which prove to be effective at reducing cost, while eliminating those that do not. This process will require multiple rounds of policy experimentation if it's going to work.

The fact that he sees exactly the same problems with the mandate that Republicans do? Nice of you to argue that he did not really mean what he said about it though.



By the way, the mandate is not about containing anything, it is about spreading the costs to more people. The PPACA does absolutely nothing to contains costs, so any argument that it does is based on a false premise. It does not address anything that anyone raised as methods of containing the costs of health care.

If you cared about the fiscal health of this nation you would join me in combating this law because it is useless, and only raises the cost of doing business.

How does requiring insurers to pay for office visits reduce costs? How does requiring them to cover everyone, no matter how sick, for the same price, reduce cost? Can you point to a single provision in the PPACA that actually reduces costs? If not, stop lying about what it does. If so, I will admit I am wrong.

 

[Quantum Windbag]

I have no real problem with the PPACA as such, other than we cannot afford it. My problem has always been with the attempt to force people to buy a product from a private company.

Really? Because it looked like in your post you were sneering about the absurdity of leaving the oversight of insurance premiums to the states themselves. Those "stupid regulations" that don't give the feds the power you think they need, instead reserving it to the states.

In fact, if I recall correctly, you bitch and moan about just about everything.

How the fuck do you take me pointing out that the claim that PPACA does not keep premiums down to mean that I oppose letting the states monitor insurance? Are you as deluded and stupid as rdean?

I bitch and moan about the fact that we cannot afford it, and point out the absurdity of any claims that it reduces costs. I bitch and moan about you claiming that this law is perfectly reasonable,w ill work exactly as planned, and your incredible stupidity in thinking that this was open and transparent in the way it was passed. I bitch and moan about almost everything you post because I despise shills of any type, and you are obviously a shill for the PPACA and the insurance industry.

I also bitch and moan because you continually misrepresent my position, just like you did here.

 

[Quantum Windbag]

I forgot one.

I also bitched and moaned about your presumption that you could read the moind of a federal judge.

 

[The T]

I have no real problem with the PPACA as such, other than we cannot afford it. My problem has always been with the attempt to force people to buy a product from a private company.

Really? Because it looked like in your post you were sneering about the absurdity of leaving the oversight of insurance premiums to the states themselves. Those "stupid regulations" that don't give the feds the power you think they need, instead reserving it to the states.

In fact, if I recall correctly, you bitch and moan about just about everything.

How the fuck do you take me pointing out that the claim that PPACA does not keep premiums down to mean that I oppose letting the states monitor insurance? Are you as deluded and stupid as rdean?

I bitch and moan about the fact that we cannot afford it, and point out the absurdity of any claims that it reduces costs. I bitch and moan about you claiming that this law is perfectly reasonable,w ill work exactly as planned, and your incredible stupidity in thinking that this was open and transparent in the way it was passed. I bitch and moan about almost everything you post because I despise shills of any type, and you are obviously a shill for the PPACA and the insurance industry.

I also bitch and moan because you continually misrepresent my position, just like you did here.

GreenBoy is a paid shill...what do you expect?

 

[BolshevikHunter]

~BH

 

[Greenbeard]

How the fuck do you take me pointing out that the claim that PPACA does not keep premiums down to mean that I oppose letting the states monitor insurance?

"Look at that, even if HHS determines a rate increase is unreasonable and unjustified, they cannot do a thing about it. [Pissy sarcasm snipped] Thank you for giving me a chance to prove just how stupid the regulations you think will save the world are."

Implication: "smart" (presumably you mean effective) premium oversight would empower HHS to "do a thing about it."

I happen to disagree; state insurance regulators really are well-positioned to scrutinize their own markets. That's why even many of the federal guidelines for state insurance markets are being drafted by NAIC before they pass through HHS. Just because states are better-positioned than HHS to handle this, that doesn't mean they'll all do a better job than HHS would; some states simply have ineffective leadership. But that's how it goes. That doesn't mean that effective premium oversight has to be done by HHS, despite your implication to the contrary.

I bitch and moan about the fact that we cannot afford it, and point out the absurdity of any claims that it reduces costs.

There is no way to slow cost growth in the long run without harming health unless we begin a transition to a higher-value health system. Enter the ACA.

I bitch and moan about you claiming that this law is perfectly reasonable,w ill work exactly as planned, and your incredible stupidity in thinking that this was open and transparent in the way it was passed.

I don't think you've read my posts very well. It won't work "exactly as planned," whatever that means. Much of its value lies in its willingness to experiment with tens of pilots that may improve quality and/or lower costs; presumably we'll learn from the pilots that fail as well as those that succeed in meeting those goals. And despite its breadth, the law leaves certain crucial areas untouched.

But I happen to be a big fan of the IOM's concept of a learning health care system. And I'm pleased as punch that federal policymakers worked to support the concept as much as they did with the ACA. And I was thrilled that reforms putting patient-centeredness, quality improvement, and patient safety at the forefront made it through Congress. I'm not going to apologize for that simply because you're unable to see how those are worthy achievements and you're unable to make the connection to costs.

I bitch and moan about almost everything you post because I despise shills of any type, and you are obviously a shill for the PPACA and the insurance industry.

I prefer pursuing value enhancement over limiting access and potentially harming health. The ACA is the vehicle we have for the former now--and the bulwark against proposals that rely on the latter--so yes, I support the ACA. I realize that infuriates you and that's regretable.

 

[Polk]

What benefits? The higher insurance premiums? The loss of choices in the market? The blatant favoritism and politics being played in awarding exemptions to unions and insurance companies that supported the new law? Are those the benefits you are talking about?

What utter nonsense. The law won't result in higher insurance premiums beyond what they would have been without the law (since insurances have to justify rate increases now). As for loss of choices, that "loss" has been from the removal of policies that don't protect against anything.

All of the waivers granted, all of them, were to prevent unaffordable rate increases demanded by the new law for the employees of companies and members of organizations.

What planet have you been on for the last year?

Except that the law doesn't demand rate increases, so you're simply making things up. Waivers issued were for "mini med", which are effectively like not having insurance in the first place.

 

[The T]

What utter nonsense. The law won't result in higher insurance premiums beyond what they would have been without the law (since insurances have to justify rate increases now). As for loss of choices, that "loss" has been from the removal of policies that don't protect against anything.

All of the waivers granted, all of them, were to prevent unaffordable rate increases demanded by the new law for the employees of companies and members of organizations.

What planet have you been on for the last year?

Except that the law doesn't demand rate increases, so you're simply making things up. Waivers issued were for "mini med", which are effectively like not having insurance in the first place.

But if the LAW is so great? WHY the need for 700+ Waivers?

Answer is easy. The LAW is dead...and has been and the present Florida Ruling will be upheld in the SCOTUS. The Statists know this.

 

[Polk]

I am so glad you mentioned the requirement to "justify" rate increases, it gives me a chance to show just how ignorant you are.`



Implementing Health Reform: The Premium Review Regulation – Health Affairs Blog

You can have unreasonable and justified increases? Can we try that again?

Look at that, even if HHS determines a rate increase is unreasonable and unjustified, they cannot do a thing about it. You are so right, once people understand how all of this works they are just going to love it. I might as well settle in and accept that I am just a grumpy old man totally opposed to change.

Thank you for giving me a chance to prove just how stupid the regulations you think will save the world are.

I'd need to go back and look at the specific text, but I was referring to the "medical loss" ratio.

An arbitrary ration that is causing insurers to choose between reclassifying administrative expenses as medical expenses, or simply paying every claim they receive without checking them for fraud. Another fine example of just how good the law is.

I want to thank you again, that had slipped my mind.

Spare me the sob story for insurers. They won't reclassify administrative expenses as medical ones (unless they want to get busted for fraud) and they'll still be perfectly able to check claims to make sure they are not fraudulent. Even after full enactment, the administrative cost portion allowed for private insurances will be five times that of Medicare.

 

[The T]

I'd need to go back and look at the specific text, but I was referring to the "medical loss" ratio.

An arbitrary ration that is causing insurers to choose between reclassifying administrative expenses as medical expenses, or simply paying every claim they receive without checking them for fraud. Another fine example of just how good the law is.

I want to thank you again, that had slipped my mind.

Spare me the sob story for insurers. They won't reclassify administrative expenses as medical ones (unless they want to get busted for fraud) and they'll still be perfectly able to check claims to make sure they are not fraudulent. Even after full enactment, the administrative cost portion allowed for private insurances will be five times that of Medicare.

So it's OK for Gubmint to tell them (a Private entity) what they must do...right?

 

[Polk]

I have no real problem with the PPACA as such, other than we cannot afford it. My problem has always been with the attempt to force people to buy a product from a private company. Even Obama had a problem with that before he realized he is a lying politician at heart.

By the way, since every single state has to meet the federal guidelines, and they cannot opt out for a less extensive reform. That actually makes it centralized, not federated, but nice try.

How can you claim "Obama had a problem" with it? He did oppose the individual mandate during the primary, but his argument was that he felt it wasn't necessary, not so deep-rooted ideological objection. I'd also challenge the notion that the bill is unaffordable. The reality is that without aggressive movements on medical cost containment, our existing obligations, without ACA, are unaffordable. The bill represents a first step toward cost containment. If you're really worried about the fiscal health of the nation, you'd be looking at working together to fund programs which prove to be effective at reducing cost, while eliminating those that do not. This process will require multiple rounds of policy experimentation if it's going to work.

The fact that he sees exactly the same problems with the mandate that Republicans do? Nice of you to argue that he did not really mean what he said about it though.



By the way, the mandate is not about containing anything, it is about spreading the costs to more people. The PPACA does absolutely nothing to contains costs, so any argument that it does is based on a false premise. It does not address anything that anyone raised as methods of containing the costs of health care.

If you cared about the fiscal health of this nation you would join me in combating this law because it is useless, and only raises the cost of doing business.

How does requiring insurers to pay for office visits reduce costs? How does requiring them to cover everyone, no matter how sick, for the same price, reduce cost? Can you point to a single provision in the PPACA that actually reduces costs? If not, stop lying about what it does. If so, I will admit I am wrong.

The clip is not making the same argument Republicans make. Republicans claim the mandate is an absolute affront to liberty. He's arguing the issue of some technical details of implementation.

I did not state the mandate is about containing cost. And yes, the bill contains tons of cost containment measures, including funding for research into best practices, the aforementioned medical loss ratio requirements, requiring insurance policies cover preventive care (cheaper to make sure someone doesn't get diabetes than to pay to treat it), and funding for the digitalization of medical records.

Furthermore, yes, I will argue that the mandate reduces costs in the long-run. If people have insurance, they'll be able to get treatment when they first fall ill, instead of waiting around until the suffering is unbearable, then flopping in to the ER.

 

[Polk]

All of the waivers granted, all of them, were to prevent unaffordable rate increases demanded by the new law for the employees of companies and members of organizations.

What planet have you been on for the last year?

Except that the law doesn't demand rate increases, so you're simply making things up. Waivers issued were for "mini med", which are effectively like not having insurance in the first place.

But if the LAW is so great? WHY the need for 700+ Waivers?

Answer is easy. The LAW is dead...and has been and the present Florida Ruling will be upheld in the SCOTUS. The Statists know this.

There isn't a practical need for the waivers. It's a political consideration that people will be pissed if they lose their "mini med" policy, even though it wouldn't cover much of anything if they got sick.

I'm glad you are a psychic though and can predict how the Supreme Court will rule.

 

[Quantum Windbag]

"Look at that, even if HHS determines a rate increase is unreasonable and unjustified, they cannot do a thing about it. [Pissy sarcasm snipped] Thank you for giving me a chance to prove just how stupid the regulations you think will save the world are."

That pissy sarcasm was in response to this post.

What utter nonsense. The law won't result in higher insurance premiums beyond what they would have been without the law (since insurances have to justify rate increases now). As for loss of choices, that "loss" has been from the removal of policies that don't protect against anything.

Maybe if you didn't go around snipping things you would have better reading comprehension.

Implication: "smart" (presumably you mean effective) premium oversight would empower HHS to "do a thing about it."

Actual implication, Polk is completely wrong when he says the regulations will prevent insurance hikes. Again, check on you reading comprehension.

By the way, even in states that actually have the power to restrict premium hikes that are unreasonable, and where unreasonable is clearly defined, the insurers always manage to get the hikes they ask for because they do not make unreasonable rate increase requests. In the few cases that have been adjudicated because the state tried to impose restrictions, the courts have always ruled in favor of the insurers rate increases being justified.

The reason for that is actually quite simple, they ask for increases based on the previous years cost, solid statistical analysis, and a desire to minimize the impact of guessing wrong. Did you know that most state insurance boards are only empowered to act if the insurance rate increase is too low? There is a lot of historical evidence of insurers undercharging policies in order to get more customers. Just something to think about.

I happen to disagree; state insurance regulators really are well-positioned to scrutinize their own markets. That's why even many of the federal guidelines for state insurance markets are being drafted by NAIC before they pass through HHS. Just because states are better-positioned than HHS to handle this, that doesn't mean they'll all do a better job than HHS would; some states simply have ineffective leadership. But that's how it goes. That doesn't mean that effective premium oversight has to be done by HHS, despite your implication to the contrary.

You disagree with your misinterpretation of my position?

So fucking what?

There is no way to slow cost growth in the long run without harming health unless we begin a transition to a higher-value health system. Enter the ACA.

No way? None at all? So, our only choice is complete financial meltdown because health care cost keep rising, or complete financial meltdown because they rise faster with the PPACA.

Guess which one I choose.

I don't think you've read my posts very well. It won't work "exactly as planned," whatever that means. Much of its value lies in its willingness to experiment with tens of pilots that may improve quality and/or lower costs; presumably we'll learn from the pilots that fail as well as those that succeed in meeting those goals. And despite its breadth, the law leaves certain crucial areas untouched.

Why do we need to spend money to test something that has been demonstrated to work in different places? How do you improve quality by adding another layer of bureaucracy? How do you reduce cost by keeping the burden of health care on employers instead of on individuals?

But I happen to be a big fan of the IOM's concept of a learning health care system. And I'm pleased as punch that federal policymakers worked to support the concept as much as they did with the ACA. And I was thrilled that reforms putting patient-centeredness, quality improvement, and patient safety at the forefront made it through Congress. I'm not going to apologize for that simply because you're unable to see how those are worthy achievements and you're unable to make the connection to costs.

You happen to be a big fan of trying to build a bureaucracy that learns? Did you pay any attention in your history classes? Systems do not learn, people do.

I prefer pursuing value enhancement over limiting access and potentially harming health. The ACA is the vehicle we have for the former now--and the bulwark against proposals that rely on the latter--so yes, I support the ACA. I realize that infuriates you and that's regretable.

What infuriates me is you think your position infuriates me. Come to think of it, that just amuses me. I actually pity you because you think this is the only option.

 

[Polk]

An arbitrary ration that is causing insurers to choose between reclassifying administrative expenses as medical expenses, or simply paying every claim they receive without checking them for fraud. Another fine example of just how good the law is.

I want to thank you again, that had slipped my mind.

Spare me the sob story for insurers. They won't reclassify administrative expenses as medical ones (unless they want to get busted for fraud) and they'll still be perfectly able to check claims to make sure they are not fraudulent. Even after full enactment, the administrative cost portion allowed for private insurances will be five times that of Medicare.

So it's OK for Gubmint to tell them (a Private entity) what they must do...right?

In certain cases, absolutely. And guess what? The vast majority of Americans agree with that principle. Try proposing allowing companies to dump toxic chemicals in the water supply and see how fast that moves.

 

[Quantum Windbag]

I'd need to go back and look at the specific text, but I was referring to the "medical loss" ratio.

An arbitrary ration that is causing insurers to choose between reclassifying administrative expenses as medical expenses, or simply paying every claim they receive without checking them for fraud. Another fine example of just how good the law is.

I want to thank you again, that had slipped my mind.

Spare me the sob story for insurers. They won't reclassify administrative expenses as medical ones (unless they want to get busted for fraud) and they'll still be perfectly able to check claims to make sure they are not fraudulent. Even after full enactment, the administrative cost portion allowed for private insurances will be five times that of Medicare.

Maybe you should try living in the real world.

Wonk Room » WellPoint Reclassifies Costs As ‘Medical Care’ To Meet Reform’s Medical Loss Ratio Requirement