Sebelius: Some Could See Insurance Premiums Rise

It is not their premium rising! It is them buying better insurance which is more expensive than crappy inadequate insurance.

There is a difference.

Like the OP, they're not exactly fans of the ACA.

Some of this seems to be a consequence of previously uninsurable moving into the market.

They have existing risks, and expectations of continuing costs that are higher than otherwise healthy people.

I don't know how we expect profit making insurance companies to acquire those "liabilties" without off-setting fees.

The truth is that although the ACA is overall a good thing, there is a burden that must be met. Unfortunately it must be met at the same time it produces profits.

It was regarding new minimal standards for coverage to avoid having t o pay the penalty. If you had ridiculous worthless insurance before and now you need to get minimally effective insurance you're going to have to pay for that.

Yes, people who were completely uninsured will also now have to pay for that, but that also isn't "raising premiums".,

No, NEITHER of those have any effect of raising premiums for other people. The majority of people who are currently uninsured *while being able to afford to be insured*... which are the group that now have to get insured... are uninsured because they think they can get away with it. They're generally young and healthy and are gambling they're going to stay that way to save a few bucks... and if they lose their gamble the emergency room still has to take them anyway and if they can't pay the insured end up getting stuck eating the costs the hospital passes off on them. Which is one reason insurance premiums were already higher than they should have been.

Making those people get insured LOWERS, not raises, other people's premiums.

from the "tax" to be levied on those who don't have insurance because the premiums attached to policies for those people will be too high.

Apparently, there will be some sort of catastrophic coverage available at a lower cost, but it probably will be thin coverage at a high price.

Many of the people who will face extremely high premiums will be like me: over 50 and with no employer-sponsored policy.

That means that there will be more really sick people who haven't had real health care for 15 years enrolling in Medicare.

How will that save costs?

Raising the age of eligibility for Medicare won't cure the problem--it will just mean even sicker people entering the system.

Oh, I know, some of those sick 65 year-olds may die before they hit 68!

The overall cost savings from our $8200 per capita health care costs will come from people being able to pay into the system, and some will be forced to pay when they would rather have taken the risk of getting sick and pretending that when they do that they and their family will not show up at the emergency room when they run out of money.

Before ACA insurance companies could get a sick person dropped from their job in a few years. That person would end up -- not working -- and on medicare. The insurance company could take 80% in profit if they managed to drop the right people. Billion-dollar yearly income for some. And, the extra people on medicare with expensive diseases was driving medicare into a hole.

In case you don't see how they can get a person removed from a job: Imagine your son now has MS. (A million a year in costs.) The company keeps him, stands by him, but, after two years of incredible increases the company is told that they wouldn't have a problem if you didn't have Bob, your son on the payroll. So, they give Bob lousy jobs, no increases, and trump up some charges. Bob gets let go and defiantly finds another job. They find a reason to trump up why Bob should go, as does another company. Pretty soon, Bob has been let go of several companies "for cause." Bob is not about to find many more jobs.

Bob goes on disability. Not working, not paying into the system, even though he could. He can't afford to work. He'd loose his disability health care.

After ACA, there is less stress on medicare. Because Bob can work, there's more money coming into the system. Because many others can get health care, they're paying into the system. Having everyone finally covered means a lot more things. Lower judicial settlements, health care is already paid. You can take a kid to the hospital without worry. Doctors are more sure they'll be paid. They can lower the cost of things because there are fewer uninsured that need help for free. Hospitals become profitable in the inner cities. Ambulance services get paid. The list is long and wonderful.

Sorry, I could not say it in much fewer words.

no one wants to hire her and she does project work only. She went without health insurance while caring for the elderly person because she could not work and could not afford health insurance.

However, project work is only available in certain cities where the cost of living is very high--probably because in today's America, cities with work are boom towns.

Boom towns have very high housing costs.

Roberta can't get a policy for less than $1400 because of her age. Even a small apartment in a safe neighborhood costs that much. If she makes less than the maximum to obtain a subsidy for her health care premium under the ACA, she can't afford a safe place to live. If she makes a little more, she loses the subsidy, and still can't afford housing and health insurance.

I'm glad that you will benefit from the ACA, but please keep in mind that not everyone will, and that those who won't benefit are those who are more likely to be older because insurance costs will be based on age, but incomes won't.

Frankly, I'm not too surprised, given that Obama wasn't interested in voters over 50 when he ran the first time. He didn't want their votes because he intended to make life increasingly difficult for them.

And, the good area is more important to the pair than getting the caretaker health insurance, should that not be all affordable, to the degree that they are sure that Obama does not like them because of their age. The idea that 2% of income might just miss allowing the pair to afford that nice area means they'd prefer not having health care for the caretaker at all, risking all fortune for an illness. (I'm assuming the parent must have medicare.)

BTW, I did not say I would benefit from Obamacare. In fact, I will probably be one having to pay more. But, I do benefit from being sure the insurance I do have cannot be dropped for ridiculous reasons. The company insurance I've had has be churned twice since I started. First, I was allowed in because of being a recent hire, after waiting three months of course -- no questions asked. Then came the new insurance company. I had to write a multi-page report of what illnesses I have. Okay. Did that. But, if I forgot anything such as being treated for acne once forty years ago, they could drop me -- the moment we discovered I'd have something bad and costly. Yes, I'm thankful they can't do that now. And, if you want to claim that's how I benefit from Obamacare, then understand, that's how we all benefit from Obamacare.

I also took care of my mother for 15 years. The last five amounted to 10-16 hours a day, seven days a week for the last five years. I had two days where I was too sick to help her. Not much room for having any job.

and you should be mightily ashamed of yourself.

If you are an older woman, a safe neighbor is a necessity. Apparently, you know no one who's willing to admit it, or you've closed your ears.

You're lucky that you could find a job in the area where your mother lives. Some of us have Moms who live in rural areas where there simply is no work.

I did not go after you and your situation. Instead, I congratulated you on your benefit.

I used to like your posts, but this post is too much.

The rest of my thoughts are unprintable here.

Nationwide ACA saves us as a whole, money. It also will save lives. But, it does not save everyone and that is sad. I wish it did. I wish it would cover everyone nicely, but it doesn't and it won't. Maybe someday, we will.

The way I read what your wrote is that you asked a nationwide question, but in subsequent posts went on to talk about an individual situation. I understand the nationwide way it saves money, but there are too many individual situations to understand in this and I cannot answer them all except that in all cases of compromise, some win and some others lose. Again, I wish it wasn't so.

I'm sorry my response angered you. I was just trying to help.

Premium subsidies will be available for those with incomes below 400% of the Federal Poverty Level, which for 2012 was $44,680. Age will have no effect for those who qualify, and the maximum premium for those who do would be around $360. That's quite an improvement over the $1400 you say she would have to pay now, isn't it? But suppose she makes over 400% of the FPL. Then age can affect her premium cost, but age differentials are restricted to a ratio of 3:1, while current age differentials may run over 10:1. Nobody knows exactly what premium costs will be a year from now, but the KFF estimates should be somewhere in the ballpark. Their projection is a premium of $582 for a 50-year-old. For a 64-year-old, that goes up to $848. That's still quite an improvement, and it's going to be for insurance with more comprehensive coverage than the $1400 policy Roberta could buy now. Your claim that the ACA neglects older adults is totally at odds with the facts.

and does not qualify for the subsidy.

Individuals who do not get insurance through their jobs will be asked to purchase insurance through a state exchange. I follow the Kaiser Family Foundation price calculator, which estimates the cost of individual policies on these exchanges. Those prices started high, but have gone higher. The last I looked, someone in their late 50s is going to pay something like $1,400 a month for health insurance if they make even a little over the maximum amount for the subsidy. Subsidized the same policy will cost about $600 less. In areas with high costs of living, which are also places where there is a somewhat decent employment market, $44,680 doesn't go very far if you are single.

The price differential between a subsidized premium and an exchanged based premium gets larger the older you get, so that an older person making just over $44,680 is going to pay a much greater percentage of his or her income for health insurance than someone who is younger.

If the subsidies were phased out by basing them on the percentage of income required to buy a policy on the exchange, the subsidy set up wouldn't hit older adults so hard, and would be more fair. After all, the phase out point for the "tax" that people will be required to pay if they don't have health insurance is set at a point where the ACA expects that purchasing insurance will simply be too expensive. IIRC, it is set at 9% of income and has no relation to the Federal Poverty Level. Insurance costing $1,400 a month is above 9% of $45,000. Apparently, that's considered sufficiently expensive that refusing to purchase it will not subject the proposed insured's to the "tax." Obviously, drafters of the ACA knew that there would be cases like this, otherwise the exemption from the "tax" would not be there, so the drafters and anyone looking at the legislation were willing to let some people fall through the cracks. Roberta and I may be two of them.

Most larger companies are mostly self-insured with a reinsurance requirement. That won't change under ACA.

It is cheaper for them, but it still preserves the incentive to drop expensive employees.

The current system that was largely preserved under ACA is one big reason for pervasive age discrimination in larger US companies.

But, I'm thinking the re-insurer will require it. Without a re-insurer they would have to revert to regular policies ending that problem.

Actually, ACA means older workers will not cost the employer more, even though their health care does cost more. Age discrimination has gone on for decades before health care was even a problem on the horizon. Having a choice between training someone who will be around for 30 years instead of 10 years is a drawing card.

The large co self/reinsurance system gives these companies lower costs than say small companies or individual policies, but it also means that ACA will not change anything about their incentives to drop sick/expensive employees.

Healthcare reform didn't put large companies in the same bucket as everyone else. It left them free to insure employees the way they do now. The fact that large companies got a very different deal than small companies was one of the reason there were small co orgs like NFIB as a party to all those lawsuits.

Here's a website to explain it:
http://www.nahu.org/consumer/GroupInsurance.cfm

The reinsurance (stop-loss) policy protects the self-insuring company from significant losses, but it is not medical insurance and it is not regulated under ACA. The way the medical costs are paid for employees is by the company charging premiums and throwing in whatever contribution it wants to make. Usually these self-insured plans are administered by a regular ins co, so the employees don't even know. There are different rules on mandated benefits, and the pool of employees is very different.

Because the company is directly paying for the costs of medical care, it is indeed very seductively easy for companies to raise profits by selecting for a younger/healthier group of employees. This did not change.

Instead, the net expected cost of insuring older/sicker currently uninsured people added to the pool in 2014 and beyond is going to be all borne by the small co/individual markets, which is why the projections for different states mostly show increases, but widely varying increases.

If it works badly in the case of large companies self insuring, that's sad, even maddening. When costed, that should have been taken into consideration and overall ACA as opposed to the Republican plan of -- nothing -- should cost us as nation, less, in terms of money and lives.

That's one of the problems.

I agree that pooling risk was the way to go - it's just that ACA didn't do it properly. We would very definitely get an economic bonus if it did. There's nothing wrong with your thinking - there's something wrong with the law.

A lot of the extra costs of insuring people who are sicker/older are shifted to the exchange individual/small group market. So that helps some that were higher cost groups. This is defiinitely true.

But on net, this entire group will pay higher costs, which is why the warnings of premium increases keep coming. Because more people will be added to this market who have higher costs, average premiums have to go up. For any particular individual or company, they may go up or down.

If ACA had put large employers in the same bucket, these cost increases would have been less overall, and also it would have used the de facto incentive in large companies to get rid of older workers, which they do now. If they weren't paying for just that group of employees, their incentive would be to get the best employees they could get - it would not change their overall medical costs.

I am certain that one of the reasons larger companies are pushing so hard for H1Bs (many will tell their own employees now that they ONLY hire H1Bs, even though that is illegal) is that they can pull from a younger group that will have lower health costs.

Also, a lot of people won't even qualify for the subsidies under the IRS regs. They won't be fined for not having insurance, but they won't get the subsidy either.

If some group must pay more, that does not mean that the overall cost to the country is more. It has been reviewed extensively by the CBO and declared that overall it will cost the country LESS.

The premium increases went on long before ACA. Under the new law they can charge what they want for a while, collect the money, collect the interest off the excess money they collected, and then return the money without the interest later. Not nice, but still worlds better than cutting people's insurance, letting them die, and pocketing all the money.

This is a law born of compromises and is not ideal. It does not solve a host of problems. Yes, individual premium will go up.

Unless you have a cogent argument against the CBO, overall ACA does save money for US as a nation.

Not in any way. CBO of course includes the very substantial tax increases when scoring the bill, as it should.

But in terms of the medical cost side of it, ACA doesn't save money.
http://www.californiahealthline.org/articles/2013/2/6/cbo-updates-spending-projections-for-aca-medicare-medicaid.aspx

Alternating between working for money and working for love makes things much more difficult when the caregiver and the person who sometimes needs care live well apart due to the lack of jobs in the cared for person's area.

People who were young and healthy could notice an increase, however, they also have insurance that can no longer dump them when they get sick, and it will be affordable regardless.

was a blunder ....

Although the quasi-rightist OP rejected ACA due to his own predilection for right wing economic policies, I oppose ACA because it maintained this awful insurance stranglehold on health care prices, promoting them to their own greatest profit, and to hell with the rest of us ...

It should not be allowed ... the supposed "free market" has no place drawing a profit from the economic pain of those who need health care ...

They are running a skim game ... like a freekin casino underboss ....

We'd have put hundreds of thousands of people out of work in a day. The coders, trained as coders, coding for insurance companies against hospitals, and coders from hospitals fighting insurance companies.

I'm not so sure we could have done it that fast.

We needed a slower approach. ... as I see it.

if they put the insurance companies out of business. Many DUers seem to be unaware that the vast majority of the people who contribute to providing Medicare are employees of private insurance companies, primarily BCBS affiliates. From the time it was created, Medicare has contracted out claims examination and benefit determination to private companies, for the reason that it's more economical to do it that way rather than hiring government employees to do the job. Somebody has to do those jobs. Medicare loses tens of billions annually to fraud. That could easily rise to hundreds of billions a year for Medicre and the single-payer program while all those new government employees were being hired and trained, so it's not going to happen. If the United States ever does go to something like single-payer, it will be contracting out services as Medicare (and Tricare) does now. We might end up with a hybrid system similar to that of France rather than something similar to the Canadian system.

And, contracted or not, the overall cost will be less.

Fraud tends to remain at about 2%. You can work like the dickens to reduce that percentage, but it might remain while you continue to work like the dickens.

If a company primarily hires young, healthy males, their premiums may rise to offset the costs of anti-discrimination laws in the ACA that prevent higher premiums for females and limit increased premiums for older workers.

To me, this is fair and is part of what insurance should be all about - spreading risk and cost throughout the population. But it will still be a painful increase for many smaller to medium sized companies.

And the country is crawling with consultants who are advising business owners to drop coverage or shift people to part time in order to avoid paying health premiums.

I strongly support the ACA, but the country is going to go through a big adjustment period.

We don't needed insurance ... we need health care, from doctors, nurses and hospital staff ....

Insurance skims their profits by working down actual health care, increasing premiums and pocketing the difference ...

It's Three Card Monte, played out in a global scale ....

We are being had ....

would have to buy me an expensive dinner first. Then I might feel obligated.

But seriously, I agree with you. Everything that insurance does could be done much cheaper and fairer by the government. I am hoping that our society eventually figures that out. It will be a gradual process if it ever happens.

my coverage decreasing, every single year. It's supposed to get HIGHER?

I have private insurance through my company and my premiums, co-pays and deductibles are increasing and I keep getting bills because they cover less and less for tests that I have had done. What the f**k am I paying for anyway?

I am so sick of paying so much and getting so little in return. Healthcare in this country is such a joke

that were given millions of new suckers via a democratic administration.

To me, it's no joke at all. I'm not laughing now, nor when this abomination was being proposed, nor when that rat bastard Baucus (D- INSURANCE) had single payer advocates---

ARRESTED AND LED OUT OF THE HEARINGS

I won't be taking part in any farking mandate.

I AM part of the Resistance. Watch us grow.

... is now getting a subsidy.

Absent HCR, EVERYFUCKINGBODY would continue to pay more each year than the previous.

Big corporations and wealthy folks like to avoid taxes so we'll just get the bill.

We are executing a scheme from a right wing think tank design to preserve existing profit centers and stave off systemic reform stuffed with scores of TeaPubliKlan amendments allowed with zero votes for extra and cherries on a shit sundae with a few pay to play features that "curb some of the worst excesses" of an unreformed parasite cartel.

Imagine the surprise. That will be hilarious.

You don't have to wait till tax time to benefit from it.

HR informed us last week that our premiums will go up 34% this year and as much as 38% next year. My deductable went from $500 to $1000 this year. I paid 17% in income taxes this year, I paid 11% two years ago. I only made $4000 more this year then two years ago. I just don't know how much more I can pay.

What else is new? Part of the objective of the ACA is to slow the increases in costs and premiums.