Average Obamacare Enroll - Age 50+ Game Set.

[theeedude]

More taxpayer payments on the hook.
Premiums will go up as far as allowed and then they will ask for a government handout.

They don't have to ask, it's the law. So when Koch are running ads telling the young people to not sign up, they are advertising ballooning the deficit.

 

[werepossum]

There are no health questions at my company's open enrollment, and same price for all employees, regardless of pre-existing conditions.

Obamacare individual mandate is creating a large pool for the exchange plans, so that people in the individual market get same risk pooling (or as you call it, "socialism") benefits as those working for large companies.

As Sactoking points out, you are confusing what your employer charges you with what your employer pays.

i'm so glad we FINALLY have a thread to discuss Obamacare.

LOL +1

Can anyone provide a reasonable explanation of why a young male in his 20's would pay $200/month instead of paying the small fine. Many don't have coverage now...is there something different that will now cause them to sign up, especially in the numbers that are needed to make the ACA work as intended?

A healthy young male in his 20s can quickly become an unhealthy young male in his 20s with a LOT of medical bills or pressing a medical condition that is not life-threatening but still needs to be addressed. A bad fall mountain biking that results in a compound fracture is probably not going to make one decide to purchase health insurance before seeking medical aid. A better question might be if said young male is willing to sacrifice his smartphone to afford it, as young men may well want it but not enough to sacrifice life style.

As Eskimospy and I think Shira before point out, strength of motivation varies. Healthy young people may well be planning on purchasing insurance, but are just not as motivated to try fighting through the web site as are older people who have multiple doctors and prescriptions. A year from now the average age may well skew down from today. If not, look for penalties to become much more draconian as the federal government has a pretty big hammer and sees us all as nails.

 

[theeedude]

No, but they should be funneled into a different system that has a facet of care rationing and end of life counseling.

You should forward this idea of yours to the GOP, have them run on that as Obamacare replacement

 

[theeedude]

As Sactoking points out, you are confusing what your employer charges you with what your employer pays.

Nope. I don't think you are getting it. There is no health history questionnaire, the insurer has no info about my per-existing conditions and can't do medical underwriting.
It's called a large pool. Insurance only cares that the pool covers its own costs plus overhead, not that each individual does. That's what employees with health care have had for ages, and Obamacare brings that to the individual market. Individual mandate, means very large and diverse pool.

 

[poofyhairguy]

You should forward this idea of yours to the GOP, have them run on that as Obamacare replacement

My idea would never fly as policy in a country where the largest per capita voting population is old people and the largest population in general is about-to-be-old-people baby boomers. They all would bankrupt America to be able to continue to see "their doctor."

Turns out we don't need policy. Unintended consequences are leading the system in the direction of my idea, as Medicare reimbursement cuts means less doctors are taking Medicare, which means longer wait times for procedures and care (aka rationing). Once the Medicare puts together some death panels////financial advisory panels to balance the budget on this thing I will get what I want anyway.

 

[compuwiz1]

Based on experience of every other universal health care country, we'll either have an individual mandate system or a single payer system, or some hybrid. The American people will decide one way or the other.

Based on current reality and the way Obamacare was shoved down our throats, by the democrats, it seems it doesn't work that way anymore. How could it when over 70% of Americans are opposed to this ridiculous train wreck?

 

[sactoking]

Nope. I don't think you are getting it. There is no health history questionnaire, the insurer has no info about my per-existing conditions and can't do medical underwriting.
It's called a large pool. Insurance only cares that the pool covers its own costs plus overhead, not that each individual does. That's what employees with health care have had for ages, and Obamacare brings that to the individual market. Individual mandate, means very large and diverse pool.

That's not true. There are no health history questionnaires because group insurance prohibits pre-existing conditions with the presence of creditable coverage. If you've ever changed jobs you should have received a certificate of creditable coverage from your old employer's insurer. When you sign up with your new employer you're required to disclose if you've been continuously insured for the past year or whatever (I forget the actual timeframe). If you've had creditable coverage then you new employer's insurer cannot take pre-ex into account; they rate you based on age, marital status, etc. (all info your employer already has and can provide without a questionnaire). If you haven't had creditable coverage your employer isn't upcharged on the premium but your pre-ex can be excluded for a year.

It's not a risk pool thing at all, since each employer is rated as their own risk pool. Businesses in industries dominated by the aged and elderly (e.g. those where mental, not physical, acuity is paramount) often complain about their group insurance rates being too high; it's a result of their business being a bad risk.

The only states this doesn't apply to (that I know of) are states with pure community rating, like New York. In those states there is a true market-wide risk pool, and that's why their markets were so effed up; young adults didn't like paying the same pure rate as seniors, souring the risk pool and driving premiums even higher.

 

[theeedude]

That's not true. There are no health history questionnaires because group insurance prohibits pre-existing conditions with the presence of creditable coverage. If you've ever changed jobs you should have received a certificate of creditable coverage from your old employer's insurer. When you sign up with your new employer you're required to disclose if you've been continuously insured for the past year or whatever (I forget the actual timeframe). If you've had creditable coverage then you new employer's insurer cannot take pre-ex into account; they rate you based on age, marital status, etc. (all info your employer already has and can provide without a questionnaire). If you haven't had creditable coverage your employer isn't upcharged on the premium but your pre-ex can be excluded for a year.

It's not a risk pool thing at all, since each employer is rated as their own risk pool. Businesses in industries dominated by the aged and elderly (e.g. those where mental, not physical, acuity is paramount) often complain about their group insurance rates being too high; it's a result of their business being a bad risk.

The only states this doesn't apply to (that I know of) are states with pure community rating, like New York. In those states there is a true market-wide risk pool, and that's why their markets were so effed up; young adults didn't like paying the same pure rate as seniors, souring the risk pool and driving premiums even higher.

I changed jobs and never had to prove continuous coverage at previous job to my current employer. Agree that business is it's own pool, but within that pool everyone is quoted same rate, regardless of their health. Individual coverage is a pool of 1, so if that one individual is likely to get sick, his insurance can easily be unaffordable. Obamacare seeks to make it a large and diverse pool. That way some healthy people may pay more, but everyone will be able to afford coverage (some with subsidies).
Pre Obamacare: Healthy - Cheap Coverage, Sick - Screwed
Obamacare: Healthy - Affordable (not necessarily cheap) Coverage, Sick - Affordable Coverage

 

[sactoking]

You're conflating individual and group market rules.

 

[rudder]

Last I checked, at my work, everyone pays same for insurance, regardless of how risky they are and how much they use. I guess all private companies that provide this type of health insurance are socialists.

No, this is a result of a company negotiating with an Insurance provider. The insurance provider decides whether to accept this risk. The company providing insurance decides whether they can afford it.

I am sure companies would like to make obese, smoking employees pay more.... but they would likely get sued by the Feds.

 

[theeedude]

You're conflating individual and group market rules.

For the purposes of this discussion, (healthy subsidizing sick), I am not, since my work pool does not screen or set rates by individual health status.

 

[theeedude]

No, this is a result of a company negotiating with an Insurance provider. The insurance provider decides whether to accept this risk. The company providing insurance decides whether they can afford it.

I am sure companies would like to make obese, smoking employees pay more.... but they would likely get sued by the Feds.

Correct. And now same rules apply to individual coverage (except for smoking).
Discriminate by preexisting condition, get sued by the Feds.

 

[Darwin333]

No, but they should be funneled into a different system that has a facet of care rationing and end of life counseling.

And who exactly decides exactly how much they are "worth" as far as medical bills go? Some super scary "death panel"? The so called free market which does not exist in any shape, form or fashion in the medical industry? Politicians who know dickall about medicine and are only concerned about getting reelected (hint: old people vote)?

 

[werepossum]

Nope. I don't think you are getting it. There is no health history questionnaire, the insurer has no info about my per-existing conditions and can't do medical underwriting.
It's called a large pool. Insurance only cares that the pool covers its own costs plus overhead, not that each individual does. That's what employees with health care have had for ages, and Obamacare brings that to the individual market. Individual mandate, means very large and diverse pool.

Again, you just don't see it is happening. An employer's health insurance rates vary according to statistical morbidity. As a part owner and director, I see this happening. As company demographics change, company costs change. As individual employees' morbidity deviates from the statistical mean, company costs change. Most employers' plans don't allow exclusion of pre-existing conditions, but rates are absolutely set by group morbidity. There is no other way, otherwise either the carrier goes broke or the company gets shafted.

This must also happen with Obamacare to avoid the system going broke; it will merely happen with less volatility (presumably) since the pool is larger.

 

[Matt1970]

Based on experience of every other universal health care country, we'll either have an individual mandate system or a single payer system, or some hybrid. The American people will decide one way or the other.

Oh if we could only let the people decide what they want.....

 

[Londo_Jowo]

Something tells me that senseamp's employer is self insured and he doesn't see the real cost of insurance. The company for whom I work is self insured and our premiums pay for the insurance company to administer the plans. The PPO and Medical Plus (HSA) premiums are a flat rate and have three levels (Employee, Employee + 1, and Employee + Family). I pay far less for a much better plan than most of my neighbors, the only ones that have premums that are comparable also work for self employed companies.

 

[Hayabusa Rider]

Based on experience of every other universal health care country, we'll either have an individual mandate system or a single payer system, or some hybrid. The American people will decide one way or the other.

Based on the experience of how politicians do things we'll wish we hadn't. The American people won't decide a damn thing. The parties will, and we lost control over them a long time ago.

 

[werepossum]

And who exactly decides exactly how much they are "worth" as far as medical bills go? Some super scary "death panel"? The so called free market which does not exist in any shape, form or fashion in the medical industry? Politicians who know dickall about medicine and are only concerned about getting reelected (hint: old people vote)?

To be fair, Obama tried to include mandatory physician end-of-life counseling, the point being that many of the very expensive end-of-life costs which typically extend life mere days or weeks (and quality of life not at all) are not the result of patient decisions, but simply because in the absence of clear-cut direction physicians must use heroic measures, and patients in extremis are not usually able or competent to make (and transmit) those decisions. He received a political firestorm.

 

[Hayabusa Rider]

To be fair, Obama tried to include mandatory physician end-of-life counseling, the point being that many of the very expensive end-of-life costs which typically extend life mere days or weeks (and quality of life not at all) are not the result of patient decisions, but simply because in the absence of clear-cut direction physicians must use heroic measures, and patients in extremis are not usually able or competent to make (and transmit) those decisions. He received a political firestorm.

That's really too bad. People should have options in place. It could be done like with organ donations and drivers licenses. You pick if you want extreme measures at the end of life. That kind of thing makes sense.

 

[TerryMathews]

To be fair, Obama tried to include mandatory physician end-of-life counseling, the point being that many of the very expensive end-of-life costs which typically extend life mere days or weeks (and quality of life not at all) are not the result of patient decisions, but simply because in the absence of clear-cut direction physicians must use heroic measures, and patients in extremis are not usually able or competent to make (and transmit) those decisions. He received a political firestorm.

The problem with the proposal was they wanted a blank check, so to speak. I think people in general would support eliminating the craziest treatments on a cost/benefit basis if it were your doctor making the decision.

People with a brain between their ears are afraid of letting the government ration treatment, and rightfully so. Look at that little girl that Sebillius refused to let have an adult-sized transplant. Had a judge not intervened, she would likely have died before a suitable pediatric organ became available.

The worst part is, I believe they got their rationing panels backdoor anyway, and most people didn't catch it. http://en.m.wikipedia.org/wiki/Independent_Payment_Advisory_Board As I understand that, they can de facto eliminate certain procedures by setting reimbursement levels to an amount where no facility will perform said procedure.

 

[OverVolt]

All insurance is a pyramid scheme by your definition where the more fortunate subsidize the less fortunate. That is how insurance works. The young and healthy of today are likely the future's old and sick, so it balances out.

No... insurance is based on statistics.

Maternity care for males isn't statistics. As you get older your insurance rates increase as you are more likely to get sick. Thats statistics.

The fact that the insurers are concerned about the enrollment age is telling, as it shouldn't matter if they were quoting an accurate price to begin with. Apparently they really were overcharging the young to pay for the rich. Thats not statistics.

 

[theeedude]

Again, you just don't see it is happening. An employer's health insurance rates vary according to statistical morbidity. As a part owner and director, I see this happening. As company demographics change, company costs change. As individual employees' morbidity deviates from the statistical mean, company costs change. Most employers' plans don't allow exclusion of pre-existing conditions, but rates are absolutely set by group morbidity. There is no other way, otherwise either the carrier goes broke or the company gets shafted.

This must also happen with Obamacare to avoid the system going broke; it will merely happen with less volatility (presumably) since the pool is larger.

Yeah, hence the individual mandate. I am not sure what you are arguing for or against.

 

[theeedude]

No... insurance is based on statistics.

Maternity care for males isn't statistics. As you get older your insurance rates increase as you are more likely to get sick. Thats statistics.

The fact that the insurers are concerned about the enrollment age is telling, as it shouldn't matter if they were quoting an accurate price to begin with. Apparently they really were overcharging the young to pay for the rich. Thats not statistics.

Should insurance not cover ovarian and testicular cancer too, since those are gender specific? I am not sure what you are arguing for. Price discrimination based on gender?

 

[werepossum]

That's really too bad. People should have options in place. It could be done like with organ donations and drivers licenses. You pick if you want extreme measures at the end of life. That kind of thing makes sense.

Agreed. It's something people should discuss with their doctor and loved ones.

The problem with the proposal was they wanted a blank check, so to speak. I think people in general would support eliminating the craziest treatments on a cost/benefit basis if it were your doctor making the decision.

People with a brain between their ears are afraid of letting the government ration treatment, and rightfully so. Look at that little girl that Sebillius refused to let have an adult-sized transplant. Had a judge not intervened, she would likely have died before a suitable pediatric organ became available.

The worst part is, I believe they got their rationing panels backdoor anyway, and most people didn't catch it. http://en.m.wikipedia.org/wiki/Independent_Payment_Advisory_Board As I understand that, they can de facto eliminate certain procedures by setting reimbursement levels to an amount where no facility will perform said procedure.

This is inevitable with the federal government controlling health care.

Yeah, hence the individual mandate. I am not sure what you are arguing for or against.

I wasn't actually arguing for or against anything, just correcting your misconception.

I have no problem with the individual mandate; I think it's a necessary evil which is better than the alternatives. I do think it's laughable as a way to reduce health care costs, but as a matter of principle, if everyone is entitled to health care regardless of ability to pay then everyone needs to pay in if they are able.

 

[OverVolt]

Should insurance not cover ovarian and testicular cancer too, since those are gender specific? I am not sure what you are arguing for. Price discrimination based on gender?

Part of your coverage as a male is maternity care. Are you going to get pregnant as a male? Are you going to get testicular cancer as a woman?

Its not price discrimination based on gender its how you write an insurance policy.

AFAIK the ACA doesn't care about smoking either. So all the non-smokers are subsidizing the smokers. There is alot of subsidizing going on. If they are going to call it insurance they have to price it on risk.