It's nice to see someone put out well thought out objections (not the standard "this is the worst legislation EVER!!1!!1!").
However, on the actual mechanics of what's going to happen, I think you've got the wrong picture. The point of exchanges is to generate competition and it looks like they're going to be able to do that. New insurers are entering the individual market in many states and there's going to be robust competition on a number of plan options in most places. That's not going to be true everywhere at first, but it looks like 90% of individual market consumers are going to be buying in more competitive markets next year. That's part of why the premiums in the exchanges next year are looking the way they are (i.e. lower than expected).
According to what? I understand that the new exchanges are
supposed to increase competition but really all they are is a store. Essentially, it gives you some insight as to the various insurance available BUT that only is going to increase the visibility NOT the number of insurers. You make the claim that will happen but I see nothing that backs that claim up. Then there still is the employer provided insurance. That kills ALL competition for the reasons that I outlined earlier and is a plague on the insurance market.
Moreover, this is competition on price and quality (including things like the provider network included, etc), not on the ability to cull undesirable customers and shed risk. Prices now have meaning, since the market will be organized (i.e. you can make apples-to-apples comparisons between competing bronze plans, or between competing silver plans, etc) and you know what you're getting. Transparency and the ready availability of information important to the decision-making process is going to make things better for consumers, and at the same time it's going to make insurers accountable in a way they haven't been before when they could hide behind a byzantine market structure (see the example out of Oregon in my first post).
That is one reason why I stated the exchanges were a GOOD idea. That does not mean that completion is necessarily going to be better though. The exchanges can be voluntary as well and virtually all insurers would use them as almost all car sales companies congregate – the customers go to those places and that is where the business lies. That might be good for the consumer BUT I already gave you that and it is not good when rapped in the 2000 other pages of legislation.
More importantly, the employer-based insurance situation is going to evolve over the next decade. The employer mandate isn't there to encourage employers to start offering coverage: ~94% of employers with 50 or more employees already offer coverage. The primary objective is to prevent the erosion of employer-based coverage once the incentives of the individual market change next year.
But that was my entire point: that is a HORRIBLE thing. I WANT that to erode. Employer provided care is a disease in the whole system. It should have been phased out and made entirely illegal.
But small employers are going to be able to use SHOP exchanges beginning next year. In some states next year (and in all states starting in 2015) that's going to allow an employee choice option, meaning employers can specify a contribution and let their employees go shop for coverage on their own, instead of having the employer choose a company plan for everyone. Effectively employer-sponsored coverage will then begin to act more like the individual market, with employees choosing the right plans for their families directly from the marketplace. Starting in 2017, large employers with more than 100 employees can begin entering the exchanges and doing this, as well (this is a state prerogative).
IF that occurs, that would be a good thing. I am skeptical that it will happen though. Employers choose plans because they are getting something out of it – essentially kickbacks and a company that looks out for the employer rather than the individual. If it does happen, then I will have to admit, that would be another positive in the plan.
That means even if the percentage of folks with employer-based insurance remains the same, the market and incentives at work are going to shift dramatically over the next decade as more and more people are empowered to make their own choices and do their own shopping.
That's the market for insurance. In the market for actual care, there will be changes to incentives too, since cost-sharing is an important piece of the insurance puzzle. The idea that people aren't going to be charged isn't correct, exchange plans do have a fair amount of cost-sharing. The only things exempt from cost-sharing are evidence-based preventive services. Other things will be subject to deductibles and coinsurance, etc. The exchanges are going to have plenty of plans with enough cost-sharing to qualify for coupling with an HSA if shoppers want that. So the notion that people are about to be getting everything free isn't correct.
I never made that assertion BUT they are going to begin to receive some things for free and they are going to be subsidized as well. If you think that things are going to stop there though, I think you are being naive about how politicians work. There are going to be pushes and promises made continually with small childrenÂ’s faces on commercials about forcing one thing or the other to be subsidized. Another reason that I donÂ’t want the government determining what must be provided and whether or not that coverage should be 100 percent. They are going to start to get involved in places that politicians simply do not belong.
This did only cover a few of my points though. Employer provided care is STILL going to be the norm, the taxing power increase to unprecedented levels is still affirmed along with the ability to demand that you buy 10 apples a year from a specific source, they are still defining coverage limits and political bias is going to play into that, and you are still going to increase usage without any real increase in capability.
Your counter revolves around the HC markets increasing competition. That is not the only problem with Obamacare and I don’t see any real evidence that there is going to be any real increase in competition through the market. Visibility is going to increase and I agree that it is a good thing BUT I don’t think it is enough or sufficient to counter the big negatives as I see them; particularly the new powers that politicians are gaining over you and the definition of a ‘qualified’ insurance plan. Coincidently, that is one of the counterbalances to gaining competition, the need for the government to approve your plan and the requirements that you are going to have to meet to be an approved plan.
