WH: The Affordable Care Act Did Not Cause Unjust Premium Increases

[ProSense]

The Affordable Care Act Did Not Cause Unjust Premium Increases

Posted by Stephanie Cutter

Today’s Wall Street Journal reports that some health insurance companies are blaming the Affordable Care Act for premium increases that were planned long before the law was passed. We knew this would happen, which is why the President called on insurance companies not to use the Affordable Care Act as an excuse to implement unreasonable premium increases. In fact, when one insurance company in the State of Washington was called out for telling its beneficiaries that rate increases were due to the Affordable Care Act, that company agreed to issue a new letter clarifying the reasons for the increase.

The premium increases discussed today – many of which were planned before the Affordable Care Act was even signed into law– demonstrate that reform came at a critical time. In fact, consumers have faced unreasonable double digit premium increases for more than a decade, including employer-sponsored plans where premiums have more than doubled since 2000.

The most recent round of premium increase announcements are at odds with a number of health care cost related projections. The Bureau of Labor Statistics reports that medical inflation is currently projected to be 3.2 percent this year. Similarly, The Kaiser Family Foundation concluded that family premiums were rising only 3 percent for this year. Finally, we estimate that any potential premium impact from the new consumer protections and increased quality provisions under the Affordable Care Act will be minimal – no more than 1-2 percent -- which will be further offset by other out of pocket savings implemented in the law. Here’s how:

• Reducing the “hidden tax” on insured Americans: Today, families with insurance pay a $1,000 hidden tax to subsidize care for the uninsured. By making sure insurance covers people who are most at risk, there will be less uncompensated care and the amount of cost shifting among those who have coverage today will be reduced by up to $1 billion in 2013.
  
  
• Improving Americans’ health: By making sure that high-risk individuals have insurance and emphasizing health care that prevents illnesses from becoming serious, long-term health problems, the law will reduce avoidable hospitalizations.
  
  
• Preventing bankruptcy: Medical costs contribute to about half of the more than 500,000 personal bankruptcies in the U.S. in 2007. Bankruptcies can be avoided through ensuring insurance companies can’t drop people when they get sick, can’t place a lifetime or unrestricted annual limit on coverage, or discriminate against kids with preexisting conditions.
  
  
• Preventing illness: Reducing preventable illness through new prevention coverage will result in significant savings. For instance, preventing obesity will lower premiums by .05 to .1 percent. Every dollar spent on immunizations could save $5.30 on direct health care costs and $16.50 on total societal costs of disease. Reducing preventable illness can also increase worker productivity – today, increased sickness and lack of coverage security reduce economic output by $260 billion per year.
  
  
• Reducing Out of Pocket Costs: Preventive health benefits will also help reduce out of pocket costs. For example, guidelines suggest that a 58-year old woman who is at risk for heart disease should receive a mammogram, a colon cancer screening, a Pap test, a diabetes test, a cholesterol test, and an annual flu shot; under a typical insurance plan, these tests could cost more than $300 out of her own pocket.

The Affordable Care Act also includes new resources and authorities to crack down on unjustified rate hikes. Today, 46 states are using resources under the new reform law to pass or strengthen rate review laws which will have a significant impact on keeping rates low. In a number of states (California, Massachusetts, Maine) regulators have already reviewed and rejected these proposed increases. We expect this pattern to continue.

And the new law provides HHS with new authorities to prevent unreasonable increases, including:

• Requiring insurance companies to publicly justify any unreasonable premium increases in 2011 by posting them on their websites.
  
  
• Requiring insurance companies to spend at least 80 percent of premium dollars on health care instead of overhead, salaries or administrative expenses, in 2011. If they fail to do so, they will be required to provide a rebate to consumers.
  
  
• Denying insurance companies, who unreasonably raise premium rates, participation in insurance market Exchanges in 2014.

When reform is implemented, costs will be reduced across the board, premium increases will need to be justified and consumers will be protected.

[BlueIdaho]

1. It was greed - pure and simple.

Just like the increase in premiums last year, and the year before that, and the year before that, and the year before that...

[Skink]

5. Beings as fucked as I am.. I will reply to all.,,

Greed is a word that has no bounds.

Yeah baby!!!!1!

[Skink]

2. Then what did?

it started last decade but what did. .... Yep..

[ProSense]

3. The status quo.

Do you doubt that? Do you think that without reform there would have been no or fewer increases. What about next year and in subsequent years?

[Skink]

7. Step one put food in mouth....

should be right anyhow.

[Jeff In Milwaukee]

4. Oh there you go again...

Impugning the motives of those nice people at the insurance industry.

Why would they lie about something like this?

[Cha]

6. Of course it didn't...you get so you can spot those lies

a mile away..first there's the smell..

[Alcibiades]

8. Provides affordable coverage immediately

Folks with pre-existing conditions now can get coverage by joining the pool. Rates as low as $700 a month! As many as 2,000 people have already signed up!

And we traded away single-payer for this?

[ProSense]

9. "And we traded away single-payer for this?"

Got any comments on this?

[Alcibiades]

64. Those programs sound like a good idea

Doing single-payer piecemeal would take a long, long time, though. Lots of folks will be dead by then.

[bornskeptic]

19. $700 is slightly less than a Medicare buy-in would cost per month.

The full Part A premium in 2010 is $461.00. The full Part A premium is 353.60. This comes to $814.60 for Part A and Part B coverage. Of course most enrollees only pay $96.40 out of the Part B premium, the rest being paid by the trust fund, but presumably a Medicare buy-in would involve the insured paying the full premiums. Of course the $814.60 would not include the cost of prescription drug coverage, which, if added, would probably bring the total cost of a Medicare buy-in to about $900.00 per month.

The point of the high risk pool is to make insurance available to people with pre-existing conditions at about the same rates that that those without a pre-existing condition would pay. It's not intended to provide them with bargain-price insurance. It would be almost impossible to do any more with the mere $5 billion which was allocated to the program.

https://questions.medicare.gov/app/answers/detail/a_id/2260/~/medicare-premiums-and-coinsurance-rates-for-2010

edited to add link

[Alcibiades]

70. It's also apparently not intended to

provide coverage people can actually afford. How many people have signed up for this?

[Nicholas D Wolfwood]

97. We didn't "trade" anything for single payer.

Single payer was never going to happen. Not under any circumstances within the framework of the Congress we have.

[killbotfactory]

202. Single payer was never an option to begin with

The powerbrokers in our government would never allow it. You would have to replace a supermajoriy of congress with pro-single payer folks, which will never happen. The insurance industry is huge, they employ a lot of people, and can grease a lot of palms.

[quiller4]

214. pool rates in my state start at $300

[Milo_Bloom]

10. Wow, WH really spinning like a top on this one.

Saying the increases were planned before the health insurance act was "SIGNED" into law, doesn't mean it wasn't done in reaction to the health insurance act.

It's nice to know that they ASKED them not to do this... guess they didn't ask nicely enough.

And we can expect more for years to come.

Too bad all they have to do to get around the new "ha ha" regulations is act in concert. If all companies raise their rates nearly 15%, it's, by definition, not unreasonable.

We already know from failed attempts that the 80% premium dollar is DOA as a method of cost control.

About the only good thing that could come out of the GOP taking over is the death of this legislation... Unfortunately, there is a whole load of other crazy that would come along. If only we could put them in power long enough to kill this bill and then get them right out.

[ProSense]

12. No they're responding to Murdoch's WSJ and the insurance liars.

They didn't issue a statement saying you should believe them because it would do no good.

[Milo_Bloom]

13. What's the lie?

The health care act DID, IN FACT, cause the rate increases.

If nothing else, it gave them an EXCUSE to raise premiums and since there are no cost controls, they were able to do it without restrictions.

How the WH and dems weren't able to anticipate and ACTIVELY PLAN for this is why this law is such a mess.

[ProSense]

14. "If nothing else, it gave them an EXCUSE to raise premiums"

That's like saying the sun coming up this morning is responsible for premium increases.

What was their excuse for all the other premium increases? Do you really believe they needed an excuse?

[Milo_Bloom]

15. They always need an excuse.

The sun coming up bares no direct relationship to the rates, thus a 34% rate hike would have been much more shocking and created more of a problem for them.

It's like gas prices going up even when gas related crisis X hasn't REALLY effected prices. It provides the excuse.

The passing of an act that the WH claims created major reforms is the perfect opportunity for them to jack the rates.. blame it on the act.. make the democrats look bad and make extra money in the process.

How on earth could the WH and democrats not have anticipated EXACTLY that and taken real measures to avoid it?

[ProSense]

17. It's a lie, and

you're simply buying into it.

But what’s happening now is an industry effort to maximize profits before the marketplace is substantially reformed in 2014. It’s a situation that screams out for a more robust rate review process — something the administration is trying to encourage through state grants.

link

[Milo_Bloom]

18. For the second time... What is the lie??

They are claiming they are raising rates in response to the health care act.

They are.

They aren't mentioning the fact that they didn't HAVE TO.

[ProSense]

20. Here

Health Insurance Premiums Up 131% in Last Ten Years

Health reform is to blame? What was the excuse?

[Milo_Bloom]

22. 13.1% average vs 34% THIS YEAR.

Again... What is the lie???

[ProSense]

23. "13.1% average"

Are you actually trying to argue that this is acceptable?

"Again... What is the lie???"

Answer: The insurance companies are yanking people's chains. You are free to believe them, but it's a lie. In fact, simply accept it and move on.

The President and others who don't rollover in the face of distortions will handle this.

[Milo_Bloom]

41. They ALREADY failed to handle it.

And no, I am not trying to argue it is acceptable. Health insurance companies are legalized criminal syndicates and when you make foolish deals with criminal syndicates you get burned.

For them to sit here and whine that they didn't realize they would jack rates after passage of the bill shows a willingness to spin unmatched since democrats acted SURPRISED that bush attacked Iraq after they voted to give him the unilateral authority to do so.

If bush was in office, I would say he was just too stupid and shortseighted to realize the result of his actions. Unfortunately for Obama, I give him more credit than that, which means them claiming to be shocked and angered is complete BS spin and a poor attempt at damage control...orrrr they really are that stupid?

But, I guess that is what happens when you give criminal syndicates completely control of a market with no restrictions.

[ProSense]

46. "For them to sit here and whine "

They're not whining, they calling out the liars.

Whining suggests that you believe they should just accept the insurance companies false claims.

[Milo_Bloom]

48. The claims aren't false.

They did, in fact, raise rates in response to the health care act.

Just as the WH, no doubt, KNEW or SHOULD HAVE KNOWN they would.


I am sure I don't need to tell you the story of the frog and scorpion, do I?

[golfguru]

76. 13.1% over 10 years is NOT 131%....it is compounding,

not simple multiplication.

8.8% compounding over 10 years = 131%

[Milo_Bloom]

80. Yes, you are right 13.1 would be much higher.

I think it actually comes in around 9%!

Thanks for the correction!

[Lost4words]

96. I no longer trust the motives of the OP

SOS

[hulka38]

210. That is the perfect way to say it Lost4words.

I'm just waiting to see if anything happens to your post, which of course it shouldn't.

[Warren Stupidity]

94. Were they anticipating this two years ago? Three? Ten?

Health insurance inflation has been off the charts for 20 years. The increases on the table are NORMAL for this crap. What is abnormal from 2009-2010 is the huge cost shift from employer to employee. Oddly enough that doesn't get above the horizon.

[scarletlib]

11. This is why a public option is needed. These bastards wouldn't pull this

stunt if they knew people would leave them for the public option.

[denimgirly]

31. 80%+ of the People wanted it -- the WH, Democrats (Most), and of course Repubs said NO

And hence, another reason why the base lost faith and we are scrambling for the mid-terms.

Just DO WHAT YOU SAY YOU WILL DURING CAMPAIGNING and you will be hailed as a leader...nope..when campaign season is done its always, ALWAYS about special interest and how to please them

[golfguru]

50. Exactly! PUBLIC OPTION would mean COMPETITION

As it stands in HCR bill, there is NO competition for the for profit
privately held insurers and the bill allows them to raise rates as high
as they wish until their greed for profits is sated.

The HCR bill does not even allow a customer to buy insurance from out of
state. So you are at the MONOPOLISTIC mercy of the approved only outfits
in your state.

CAMPAIGN CASH WON, ORDINARY WORKING FOLKS GOT THE SHAFT.

[mdmc]

16. Not true according to my employer

we have yearly increases of about 5%. This year we are looking at a 35% increase. My employer claims that the reform bill is the cause of this huge increase. The companies can still do it, so they are doing it.

[ProSense]

21. Your employer is likely relaying what the insurance companies told them

That doesn't mean it's because of reform. The entire claim is preposterous.

[mdmc]

95. Every year we face 5% increases

this year we are facing a 35% increase.

My employer continues to stress that we need to do more to reduce our health care costs, because private insurance companies are going to loot consumers until it is illegal to do so.

I work in the mental health field. My agency and NAMI lobbied hard for health care reform. My agency and NAMI both supported this health insurance reform bill (affordable care act that makes our health care cost rise).

It was my company that informed us that our health care cost would be rising 30% more then it has risen every year before this..

Health insurance cost increases are profitable and legal. This is the only reason we are seeing these increases.

[depakid]

24. No, the legislation simply failed to deal effectively with the problem

and its consequent drain on the American economy. Every dollar that gets sucked up by parasites is one less that gets spent "producing health" or being spent (and creating multiplier effects) in local communities.

Unfortunately, no amount of spin is going to assuage people who will be seeing double digit premium increases and higher coinsurance requirements.

Many will blame "reform" -and in a sense they're correct. The problem hasn't been dealt with.

A whole lot of knowledgeable people warned the Dems that this would happen.

Complaining now that it has is more or less futile.

[ProSense]

25. No, it deals with the problem

But what’s happening now is an industry effort to maximize profits before the marketplace is substantially reformed in 2014. It’s a situation that screams out for a more robust rate review process — something the administration is trying to encourage through state grants.

link

It's just that people who don't like the bill will jump in at every window to help the insurance companies push their lies.

[depakid]

26. LOL- tell that to the people who are and will be seeing double digit increases

and higher conisurance requirements for the foreseeable future.

Democrats now own them.

Enjoy the spin!

[ProSense]

28. You seem to think

that most people believe the insurance companies. There are still people who think. When rate increases are brought under control, no one will care about these opportunistic episodes.

[depakid]

32. I think people will look at their bills- which are impoverishing them

ask why- and blame the party that pretended to do something about it.

And no- rates won't "be under control" now or at any point down the line.

If you knew the first thing about the health care industry or regulatory procedures, you'd grasp that fact, too.

[ProSense]

37. "and blame the party that pretended to do something about it"

Is this another attempt to portray this as a win for Republicans?

[depakid]

49. Republicans, Republicrats and their industry pals did win in several key areas!

Not even the pretence of a public option to move away from inefficient and unsustainable system- and despite campaign promises to the contrary, not even the cost saving band aid of drug reimportation!

[ProSense]

63. They won, they won.

What did the Republicans win? Why is John Boehner having a fit?

[dflprincess]

27. Oh please "before the marketplace is substantially reformed in 2014"

substantial reform would have meant access to care, not mandated premiums.

[ProSense]

29. Substantial reform is

what this bill is

To reiterate, no one will care about opportunistic snipes at the bill when the reforms are fully implemented.

[dflprincess]

36. When the "reforms" are fully implemented and people figure out how badly

they've been screwed the Democrats will be in deep shit. It's not an accident that this doesn't happen until after 2012.

The CBO estimates that the number of uninsured will be back up to 19 million in 2019 and growing. All the bill does is buy the insurance companies time to continue to rob us until the system finally collapses and we have to join the civilized world and see to that Americans can actually get care. Until then we're stuck paying more and more and getting less and less from companies that make their money by finding ways to deny access to care.

Absolutely nothing in this bill guarantees that a person will be able to see a doctor when they need to.

[ProSense]

38. "they've been screwed the Democrats will be in deep shit."

What if that doesn't happen? (And I say that because it will not).

[dflprincess]

59. The only way it won't happen is if the Democrats wake up and figure

out that they need to "fix" the bill before it goes into full effect - meaning they come up with a strong public option or start extending Medicare (which is what LBJ intended to have happen).

Keeping the same crooks that broke the system in charge of it is not going to change anything and will continue to drive people into bankruptcy.

[Milo_Bloom]

44. Absolutely nothing in this bill guarantees that a person will be able to see a doctor when they need

Truer words were NEVER said!

[Exilednight]

33. It doesn't deal with the problem Obama is giving 45 states plus DC $1million ..............

each to go against insurance companies that have billions of dollars in the bank.

So, let's take a closer look at this. The state gets two, maybe three state attorneys to go to court to ask for mountains of paperwork from any insurance company that triggers an audit. Those two, maybe three attorneys gets a few low level staff and a handful of non-paid interns to look for discrepancies.

On the flip side of the coin, the insurance companies have enough money to hire an army of lawyers from the most prestigious law firms whose weekly expense account payout for their firms are larger than the paltry $1million that each state has for an investigative budget.

It like giving the state a donkey to enter a race against a stable full of thoroughbreds.

[ProSense]

35. "to go against insurance companies "

That is not what the grants are for. This isn't for advertising or public relations. This is to establish a review process.

[Exilednight]

39. I know what it is for. It's for state attorneys offices to investigate ..........

insurance companies who unreasonably raise rates.

Here's another part of the legislation that is a joke. What the hell is an unfair amount? Who decides? Is it a 10% increase in Illinois, and a 20% increase in NY? What's the standard? The law never defines what is excessive or unreasonable.

[ProSense]

40. "Who decides?"

The HHS will be involved, but are you suggesting that state, no one, can decide what's excessive and unreasonable?

[Exilednight]

45. There needs to be a uniformed line drawn across the board, and it needs to be ............

controlled by the federal government. There also needs to be a provision that if an insurance companies raises rates beyond the trigger point, there is an automatic investigation. This way, when a repug takes the presidency again, he can't decide to not investigate insurance companies.

Leaving it in the hands of states with no rigid guidelines is just asking for abuse. You will have 45 states with 45 different sets of rules of what constitutes abuse.

Edit: "but are you suggesting that state, no one, can decide what's excessive and unreasonable"

In some states, yes, that is exactly what I am saying. There's no suggestion behind it.

[ProSense]

51. Do you even know what was proposed?

<...>

The Health Insurance Premium Review Grants are one element of a broad effort under the Affordable Care Act to reduce the unreasonable premium increases proposed by some insurers today. Additional resources from this $250 million program will be available in subsequent years to further strengthen State health insurance premium review procedures. Other statutory provisions designed to improve affordability include:

• In 2011, the Affordable Care Act allows the Secretary of the U.S. Department of Health and Human Services to review justifications for unreasonable increases in premiums and make them public;
  
  
• In 2011, insurers will generally be required to spend at least 80 percent of premium dollars on medical care services and quality-improvement activities and limit their spending on overhead, marketing, CEO salaries, and profits; and
  
  
• In 2014, the Affordable Care Act empowers States to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance Exchanges.

link

[Milo_Bloom]

52. Keep in mind, LEGALLY reasonableness is based on the market.

Soooo... if these companies simply act in concert, legally their rate increases cannot be considered UNREASONABLE.

Unless, of course, you can PROVE collusion... lol.. and I think we all know how easy that would be.

[Exilednight]

54. Exactly! These laws are so vague that it's ridiculous. to think that .............

this is even enforceable. And a $1million dollars going against billions?

I'd be willing to bet every last penny that I have in savings that if all 46 DAs getting $1million each brings one case each, five or less will actually win in court. You might have the once in a blue moon victory, but the majority of the time it's he who can pay the most that wins.

[ProSense]

61. "These laws are so vague that it's ridiculous. "

"a $1million dollars going against billions? "

I see the problem, the inability to recognize that people can do thing even if you can't imagine it.

Why do you keep insisting that the grants are designed to pit states against insurance companies in a money battle?

[Exilednight]

67. Money is what the whole fight is over. The grants are designed to go to

state district attorneys offices so they can investigate unfair market premium jumps.

How do you think it's not about money?

[TheKentuckian]

86. They are allowed to fix prices. Remember the anti-exemption was not removed

The bill is fucking a mess the biggest benefit will likely be the clinic expansion which was like 11/900 billion.

[denimgirly]

30. WH is to Blame -- They KILLED the Public Option -- They KNEW this would happen.

Unless they are just dumb. The public option was the bare miniumm that was required to control cost. When they sided with corporate america they knew this would happen.
And now the democrats will suffer the consequences for their stupidity (or is it, complicency)

[ProSense]

34. So if a public option, even a robust one,

was part of the bill it would have stopped the insurance companies from increasing premiums this year?

[Milo_Bloom]

42. Yes.

That is the essence of competition.

[ProSense]

43. Yes what?

They wouldn't raise rates this year based on a public option being implemented in 2014?

Really?

[Milo_Bloom]

47. You like changing what you said, don't you?

Let's recap:

You said, "So if a public option, even a robust one,
was part of the bill it would have stopped the insurance companies from increasing premiums this year?"

I said, "Yes. That is the essence of competition"

Now you acted shocked and claim, "They wouldn't raise rates this year based on a public option being implemented in 2014?"

My question would be... why would we HAVE TO wait until 2014?

[ProSense]

53. No, but you

want to pretend that you didn't know the public option went into effect at the time of full implementation.

Does that fact change your response?

[Milo_Bloom]

55. That is not a FACT.

That is a hypothetical.

So, HYPOTHETICALLY, if the public option didn't go into effect until 2014, it STILL would have led to lower rate increases, because the insurance companies would have to be CONCERNED ABOUT LOSING CUSTOMERS IN THE FUTURE and then being significantly UNDERCUT in 2014 when the public option went live.

However, they have no such fear, thus no motivation to not institute rate hikes now or in the future, since there are no effective cost control measures.

[ProSense]

57. This is rich

"So, HYPOTHETICALLY, if the public option didn't go into effect until 2014, it STILL would have led to lower rate increases, because the insurance companies would have to be CONCERNED ABOUT LOSING CUSTOMERS IN THE FUTURE and then being significantly UNDERCUT in 2014 when the public option went live."

They would be scared to increase rates?

:rofl:

[Milo_Bloom]

60. Yes, that is how business works.

Competition and/or fear of future competition is the strongest motivator there is.

If you don't understand that simple concept, you have no business discussing this topic with anyone.

[Exilednight]

69. Business 101. The more competition, the lower the price........

and typically, the better the product.

[uponit7771]

117. Religion trumps facts, they think companys would hold rates steady for 4 years because of COMING...

...price changes = they don't know about profit motives

[Exilednight]

56. "the public option went into effect at the time of full implementation."

There is no public option. It's a moot point.

But, if you're playing hypatheticals, who is to say that the PO wouldn't have gone into effect right away, or the beginning of 2011. And, if the PO had a set starting price for when it was finally implemented, then no insurance companies would not have gone into excess in raising premiums. They would have to be competitive with federal government's opening price scales.

[Milo_Bloom]

58. It's kinda like my cable company when FIOS announced they were coming to town.

Upon the announcement that FIOS would be coming to my area in the next few years, cable suddenly tripled the speed available for internet access and offered it FOR FREE to anyone who called and requested it. They also started adding HD channels like crazy.

Just the FEAR of future competition can put a company used to a monopoly into a tailspin!

[ProSense]

62. Yeah, that's exactly the same thing.

the health insurance companies are competing with each other just like the cable companies. Why aren't their prices going down?

Here's a bit of news: cable prices haven't gone down and it isn't free.

[Exilednight]

65. In many markets, health insurance companies are not competeing ...........

There are several states where one health insurance provider has a virtual monopoly.

http://healthcareforamericanow.org/site/content/new_report_private_insurers_consolidate_and_control_prices

[ProSense]

66. And health care reform

changes that: Establishing Health Insurance Exchanges and a New Competitive Marketplace

Competition is about giving people choices, and this bill does that.

[Exilednight]

68. If you only have one choice in your state for health insurance, who do you think ............

the state exchange is going to do business with?

This is one of the reasons Obama needed to keep his promise and set up a national exchange.

[ProSense]

71. What are you talking about

There is no such thing as one-plan exchange. Also at least one plan in the exchange has to be non-profit.

[Exilednight]

72. No, that is not what the law says........

It says the exchange has to be non-profit.

Do you even know how the exchange works? If not, I will give you a simple run down. Your state is required to set up a "non-profit exchange". The exchange basically takes federal money and marries it up with a lower premium that is negotiated with a "for profit health insurance company".

Example: NY negotiates with Blue Cross and sets a $1200 yearly premium price. (using round numbers to make it easy)

You decide you want insurance through the exchange.

The exchange then says ok, let's see your W2 so we can see how much you make per year.

Based on what you make, they decide how much of the $1200.00 you will actually pay.

The exchange comes back and says that you will pay half of the premium ($600.00/ year, or $50.00/month)

Federal money will pay for the other half.

Any way you slice it, the for profit insurance companies are getting $1200.

[ProSense]

77. "It says the exchange has to be non-profit."

"Do you even know how the exchange works?"

How will Exchanges be structured?

An Exchange must be a governmental agency or nonprofit entity that is established by a state. States are required to establish separate exchanges for individuals (American Health Benefit Exchanges) and small business employees (Small Business Health Options Program, or SHOP, Exchanges) by January 1, 2014. States can choose to establish a single Exchange serving both individuals and small businesses, or provide coverage through separate entities. States may form regional Exchanges or allow more than one Exchange to operate in a state as
long as each Exchange serves a distinct geographic area.

If a state fails to set up an Exchange by January 1, 2014, the DHHS Secretary will establish and operate an Exchange in the state, either directly or through an agreement with a nonprofit entity.

Funding to establish Exchanges will be available to states from within one year of enactment (i.e., 2011) until January 1, 2015, when states must ensure that their Exchanges are self-sustaining. States are required to allow Exchanges to charge assessments or user fees to participating health insurance issuers or to provide other means of generating funding.

The federal Office of Personnel Management (OPM) is required to contract with insurers to offer at least two multi-state plans in each Exchange, including at least one offered by a non-profit entity. Each multi-state plan must be licensed in each state and must meet the requirements of a qualified health plan. These multi-state plans will be offered separately from the Federal Employees Health Benefits Program (which OPM administers) and will have a separate risk pool.

Do you?

[Milo_Bloom]

81. Oh dear god.. are you serious?

This doesn't mean the insurance will be offered by a non-profit entity, it means the non profit entity will be coordinating with the for profit insurance companies!


So, you will have two different entities negotiating with FOR PROFIT INSURANCE COMPANIES. One of these entities must be a non profit (meaning they aren't keeping a cut for themselves).

This, actually, will work to drive costs UP, since it ads ANOTHER layer between you and your doctor. You see non-profit doesn't mean without cost!

[ProSense]

83. Are you?

"at least two multi-state plans in each Exchange, including at least one offered by a non-profit entity."

The non-profit here is the one of the multi-state plans, not the exchange.

[Milo_Bloom]

85. Yes, I am quite serious.

"at least two multi-state plans in each Exchange, including at least one OFFERED BY a non-profit entity" (emphasis added)

OFFERED BY. The PLAN isn't NON PROFIT. The ENTITY OFFERING the plan is NON PROFIT!

It's just a NON PROFIT BROKER. Not a NON PROFIT INSURANCE COMPANY!

[Mimosa]

93. In GA the plan offered is essentially the same substandard expensive BC/BS plan I have right now!

Blue Cross/Blue Shield is behind the same expensive high deductible plans offered by the 'exchange' here in GA. So to get the same as I have now I'd have to drop my current insurance for 6 months and apply. The premiums for a $2,500 deductible plan would be about $600 a person (over 55) a month. *eek* And at the site they give all kinds of warnings saying the plan may run out of money before 2013 or something like that. x(

[ProSense]

100. It's a non-profit plan

Slowing the growth in health care costs is one goal of health reform. Under the Senate bill (scroll to page 2086), at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets. The Director of the Office of Personnel Management would enter into contracts with private insurers to offer the multi-State plans. (OPM currently administers the Federal Employee's Health Benefit Program.)

link

Think Healthy San Franscisco.

[Milo_Bloom]

102. No it is not!

Healthy San Francisco IS a real public option.

All this cruddy health care act gives us is a non profit BROKER.

[ProSense]

103. What the hell are you talking about?

I gave Healthy San Francisco as an example of a non-profit plan that the OPM can contract with.

[Milo_Bloom]

106. No.

Since Healthy San Francisco cannot offer services to the entire state.


You honestly don't understand how this works, do you? This is all about pooling and making bulk deals with FOR PROFIT companies (unless a STATE happens to have a public option within it!). The concept is that if you have a broker with a large buying pool make a deal with multiple companies, they can get a better rate than individuals shopping on their own. The broker then passes the savings onto the consumer.

The only thing the health insurance bill mandates is that ONE of the brokers the state deal with be a NON PROFIT ENTITY.. in other words, they don't take a cut of the savings for themself.

This has NOTHING.. ABSOLUTELY NOTHING to do with not for profit HEALTH CARE / HEALTH INSURANCE.

[ProSense]

108. "unless a STATE happens to have a public option within it!"

Healthy San Francisco was an example, and there are many states that have non-profit models (Connecticut, Washington, Oregon) that can be expanded. The purpose of the 2014 time frame is to give states time to set up the infrastructure.

California:

* JOINT VENTURES AND PUBLIC OPTIONS: SB56 (Alquist) would foster new public health insurance options by allowing county-based Medicaid managed health care plans (such as Alameda Alliance for Health, LA Care, and San Francisco Health Plan) to enter into joint ventures, offer broader provider networks, and be viable choices in the marketplace.

[Milo_Bloom]

110. IF that is the plan, it borders on insanity.

MOST (the Vaaaast majority) of states are NOT developing non-profit models and having state run plans expand beyond their borders is nearly impossible.

So your claim is that the government delayed all this in the HOPES that states will develop non-profit state run insurance models and offer them into the exhcanges?

[ProSense]

111. "MOST (the Vaaaast majority) of states are NOT developing non-profit models "

Although state Exchanges are not required to be up and running until 2014, work is already underway to conduct the necessary market research and planning. These grants will give states the resources to conduct the research and planning needed to build a better health insurance marketplace and determine how their Exchanges will be operated and governed. States can use these funds for a variety of initial planning activities including, but not limited to:

<...>

Each State has the option to establish and operate its own Exchange or partner with another state or states to operate a multi-state Exchange. If a State decides not to create an Exchange for its residents, HHS will help establish one on their behalf. This offers states flexibility while making sure Americans have access to affordable new coverage options available under the Affordable Care Act.

link

[Milo_Bloom]

113. So it IS, IN FACT, worse than I imagined.

Like their HOPES that the insurance companies would not raise rates in response to this bill, their entire plan is based on hopes and dreams that people will do what they want them to do????

Not only are you continuing to confuse the concept of EXCHANGES with MULTI-STATE-PLAN (two different things entirely), you fail to understand the most basic aspect of how this all works.


You are very slowly convincing me to actually try and get republicans into office to make sure this bill gets defunded.

[Exilednight]

91. The first sentence from your post ............

"An Exchange must be a governmental agency or nonprofit entity that is established by a state."

Which is exactly the same thing I said. The exchange has to be non-profit, not the actual insurance provider.

[ProSense]

99. Think about what you are saying

"An Exchange must be a governmental agency or nonprofit entity that is established by a state."

The following section is about the multi-state plan

The federal Office of Personnel Management (OPM) is required to contract with insurers to offer at least two multi-state plans in each Exchange, including at least one offered by a non-profit entity. Each multi-state plan must be licensed in each state and must meet the requirements of a qualified health plan. These multi-state plans will be offered separately from the Federal Employees Health Benefits Program (which OPM administers) and will have a separate risk pool.

The non-profit here is the one of the multi-state plans, not the exchange. You're making the claim that the exchange must be non-proift. If you believe this, "including at least one offered by a non-profit entity," refers to the exchange, then it contradicts your claim that the exchange must be non-profit.

[Milo_Bloom]

107. You do not understand what a "multi-state plan" is.

The "multi-state plan" is a BROKER. Not ACTUAL INSURANCE. All the Multi-State-Plan does is buy insurance (at bulk rates) from FOR PROFIT insurance companies.

[ProSense]

109. No,

you're the one who doesn't understand:

Slowing the growth in health care costs is one goal of health reform. Under the Senate bill (scroll to page 2086), at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets. The Director of the Office of Personnel Management would enter into contracts with private insurers to offer the multi-State plans. (OPM currently administers the Federal Employee's Health Benefit Program.)

link

[Milo_Bloom]

112. Read the actual law!

Lets do as your article tells us and scroll to page 2086 in the law and actually read what it says.

"‘‘(3) NON-PROFIT ENTITIES.—In entering into
2 contracts under paragraph (1), the Director shall en3
sure that at least one contract is entered into with a
4 non-profit entity."

First, The ENTITY in this case is a BROKER.


Second, did you even bother to read the conclusion of the article you linked to?

"So, what impact will the multi-State option have on the cost of health care? Not much, according to the Congressional Budget Office. In a December letter to Majority Leader Harry Reid, the CBO was skeptical that that such nationwide plans would be offered, especially one including only nonprofit insurers. CBO predicted that insurers offering a multi-State plan would probably participate in the State Exchanges anyway. Thus, said CBO, "the inclusion of this provision did not have a significant effect on the estimates of federal costs or enrollment in the exchanges" CBO used when it "scored" the bill. "

Your lack of understanding and/or dishonesty in dealing with this matter is quite disturbing.

[ProSense]

114. That clip states exactly what I did: "at least one contract is entered into with a non-profit entity

Here is the statement from page 9 of the CBO letter (PDF):

The proposal would call on OPM to contract for two national or multi-state health insurance plans—one of which would have to be nonprofit—that would be offered through the insurance exchanges. Whether insurers would be interested in offering such plans is unclear, and establishing a nationwide plan comprising only nonprofit insurer might be particularly difficult. Even if such plans were arranged, the insurers offering them would probably have participated in the insurance exchanges anyway, so the inclusion of this provision did not have a significant effect on the estimates of federal costs or enrollment in the exchanges.

[Milo_Bloom]

115. Only you don't understand what it actually says.

The entity is a BROKER who assembled the "multi-state plan".

That ENTITY has to be non profit.. not the contracted for insurance.

[ProSense]

116. You don't seem to understand

One of the multi-state health insurance plans has to be non-profit. You keep talking about a broker. The plan is the non-profit and the coverage is purchased through it.

"The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets. The Director of the Office of Personnel Management would enter into contracts with private insurers to offer the multi-State plans. "

This is no different from contracting with private companies under Medicare, which does so for prescription drugs and Medicare Advantage.

[Milo_Bloom]

118. "The plan is the non-profit and the coverage is purchased through it"

You do understand that is the definition of a broker, right?

[ProSense]

119. Do you understand Medicare?

These are brokers:

Below is a link to a file containing the amounts that companies pay independent agents/brokers to sell their Medicare drug and health plans. Companies that contract with Medicare to provide health care coverage or prescription drugs typically use agents/brokers to sell their Medicare plans to Medicare beneficiaries. Sometimes these agents/brokers are employees of the contracted company. In other situations, the companies hire independent agents/brokers who are not employees to sell the companies' Medicare plans. Generally, agents/brokers receive an initial payment in the first year of the policy and half as much for each of the next five years if the member remains enrolled in the plan. Agents/brokers must be licensed in the State in which they do business, annually complete training and pass a test on their knowledge of Medicare and health and prescription drug plans, and follow all Medicare marketing rules. Agents/brokers are subject to rigorous oversight by their contracted health or drug plans and face the risk of loss of licensure with their State and termination with their contracted health or drug plans if they don't comply with strict rules related to selling to and enrolling Medicare beneficiaries in Medicare plans.
The information contained in this file has columns for each Medicare plan with the following information: State, county, company name, plan name, whether the company uses independent agents or not, the amount(s) paid to independent agents for selling the plan in the first year of enrollment following the sale, other plan identification numbers, and whether the plan information displayed requires correction. The information within the various columns can be sorted to more easily find compensation information about the plan or plans you are interested in.

link

[Milo_Bloom]

120. For everything.. spin spin spin.

Are you really trying to compare medicare advantage plans to original medicare???

is there a point? You are just going to try to change the subject again and pretend you are discussing something different.

You wonder why the democrats are in such trouble.. well, here it is.

You are completely unable to be the least bit honest about what you think is a key piece of legislation.

You completely misrepresent how it functions and then when it is pointed out, you claim you were talking about something else or link to unrelated articles/blog posts to deflect the discussion.

I have to say that after yesterday's and today's discussion I am more committed than ever to see the vast majority of this bill repealed / defunded. Because if the bill's biggest supporters can't be honest about its actually contents and effects, I shudder to think of what reality will be like.

[ProSense]

123. Facts, facts, facts

Since the beginning of the Medicare program, CMS has contracted with private companies to operate as intermediaries between the government and medical providers.<5> These contractors are commonly already in the insurance or health care area. Contracted processes include claims and payment processing, call center services, clinician enrollment, and fraud investigation.

link

<...>

ELIGIBILITY AND FUNDING

On July 1, 1966, Medicare, authorized by title XVIII of the Social Security Act, offered health insurance to almost all Americans age 65 or older. Coverage consisted of hospital insurance (part A) and supplemental medical insurance (part B), and benefits mirrored those then available from Blue Cross and Blue Shield plans. A payroll tax paid by employees, employers, and the self employed funded part A, which was available without cost to all those 65 or older who were insured under the old age retirement and survivors program of title II of the Social Security Act. Part B was open to all aged citizens and legal aliens who had resided in the country for 5 or more years. Beneficiaries who voluntarily enrolled in part B paid a monthly premium of $3.00, which was estimated to be enough to fund 50 percent of part B costs, and federal general revenues covered the remainder.

<...>

ADMINISTERING MEDICARE

The Department of Health and Human Services (HHS)7 has overall responsibility for administering Medicare. Much of this authority has been delegated to the Health Care Financing Administration (HCFA)8 which sets overall policy for Medicare by (1) establishing regulations that implement and interpret applicable laws, (2) contracting with claims processors and utilization and quality review organizations that perform the day-to-day functions of operating Medicare, and (3) administering various provider survey and certification functions.

The administrative structure for Medicare remains largely as it was when the program began. Insurance companies contract to process and pay claims, furnish services to beneficiaries and providers, and safeguard against fraud and abuse through such activities as cost report auditing, medical review, and assuring other responsible insurers pay before Medicare. Part A contractors are called intermediaries and those for part B are called carriers. Providers nominated insurers to be intermediaries and most elected to be served by the local Blue Cross plan in their area. Other companies that served as intermediaries included Aetna, Mutual of Omaha, Prudential, and Travelers. HCFA selected the insurers to be carriers and most of them were local Blue Shield plans along with commercial insurers such as Metropolitan Life, General American, Prudential, and Occidental. Most states had one carrier, but some had multiple carriers. Intermediary and carrier contracts operate on a cost basis without an allowance for profit and HCFA has used a negotiated budget process to set upper limits on costs.

Initially, over 100 insurance companies had Medicare contracts. Over the years, the number of contractors has been reduced as less efficient contractors were replaced, contract areas were consolidated, and some insurers discontinued contracting for various reasons. Today, thirty-eight different insurers hold contracts. Two types of specialized contractors have also been established. Six regional home health intermediaries process claims for services furnished by freestanding home health agencies (hospital based agencies continued to be served by the hospital intermediary). Four durable medical equipment regional carriers handle most claims for equipment, prosthetics, orthotics, and supplies.9 Processing these types of claims is quite different than for other types and it was thought that the regional contractors, by specializing, could better handle the peculiarities of these claims.

link

[Name removed]

125. Deleted message

Message removed by moderator. Click here to review the message board rules.

[ProSense]

126. Oh my!

:rofl:

[Milo_Bloom]

127. Game. Set. Match.

When they pull out the emoticons, you know you have won.

[ProSense]

129. .

Facts. Facts. Facts.

[Milo_Bloom]

130. Quoting to debunked spin fails everytime.

[ProSense]

131. Here's why I'm laughing

You:

"Your first link is talking about brokers between the fund and the actual PROVIDERS. Not insurers. Just more spin from you, since we are talking about purchashing INSURANCE, not ACTUAL SERVICES via the exchange.

The second link is about OUTSOURCING ADMINISTRATION."

From the first link:

Since the beginning of the Medicare program, CMS has contracted with private companies to operate as intermediaries between the government and medical providers.<5> These contractors are commonly already in the insurance or health care area. Contracted processes include claims and payment processing, call center services, clinician enrollment, and fraud investigation.

What do you think insurers do? They process claims. They are not providers. Medicare is the administrator. When they contract out "claims and payment processing, call center services, clinician enrollment, and fraud investigation," that's basically the doing what insurers do.

Second link says the same thing and more:

The Department of Health and Human Services (HHS)7 has overall responsibility for administering Medicare. Much of this authority has been delegated to the Health Care Financing Administration (HCFA)8 which sets overall policy for Medicare by (1) establishing regulations that implement and interpret applicable laws, (2) contracting with claims processors and utilization and quality review organizations that perform the day-to-day functions of operating Medicare, and (3) administering various provider survey and certification functions.

The administrative structure for Medicare remains largely as it was when the program began. Insurance companies contract to process and pay claims, furnish services to beneficiaries and providers, and safeguard against fraud and abuse through such activities as cost report auditing, medical review, and assuring other responsible insurers pay before Medicare. Part A contractors are called intermediaries and those for part B are called carriers. Providers nominated insurers to be intermediaries and most elected to be served by the local Blue Cross plan in their area. Other companies that served as intermediaries included Aetna, Mutual of Omaha, Prudential, and Travelers. HCFA selected the insurers to be carriers and most of them were local Blue Shield plans along with commercial insurers such as Metropolitan Life, General American, Prudential, and Occidental. Most states had one carrier, but some had multiple carriers. Intermediary and carrier contracts operate on a cost basis without an allowance for profit and HCFA has used a negotiated budget process to set upper limits on costs.

Now that you admit the Medicare is outsourcing, what exactly is the difference between a plan administered by the OPM that contracts with insurance companies?

Answer: There is none.

[Milo_Bloom]

133. You honestly don't read your links, do you?

Even when you bold the part that debunks what you said????

They are about contract with PROVIDERS aka or "health care area" and OUTSOURCING ADMINISTRATION.

The difference is that the price in the second scenario is set by the FOR PROFIT INSURANCE COMPANIES who control the PRODUCT, unlike in medicare, where the PRODUCT PRICE is set by the NON PROFIT ENTITY.

[ProSense]

136. "They are about contract with PROVIDERS aka or "health care area" and OUTSOURCING ADMINISTRATION. "

I really think you're kidding or just can't admit you are wrong

"intermediaries between the government and medical providers.<5> These contractors are commonly already in the insurance or health care area.


Insurance companies contract to process and pay claims, furnish services to beneficiaries and providers, and safeguard against fraud and abuse through such activities as cost report auditing, medical review, and assuring other responsible insurers pay before Medicare. Part A contractors are called intermediaries and those for part B are called carriers. Providers nominated insurers to be intermediaries and most elected to be served by the local Blue Cross plan in their area....HCFA selected the insurers to be carriers and most of them were local Blue Shield plans along with commercial insurers such as Metropolitan Life, General American, Prudential, and Occidental.

[Milo_Bloom]

137. There you go again...

Confusing part 1 with part 2 and trying to combine parts of lines that don't relate. Those already in the insurance area are the ones providing outsourced administration, the ones in the health care area are the providers.

let's make this really really simple for you.


Who sets the prices of Medicare?

[ProSense]

139. "Who sets the prices of Medicare?" What?

Did I claim that the multi-state plan is the same as Medicare? Still, since you asked, what do you think it means for the OPM to be the administrator?

‘‘(4) ADMINISTRATION.—The Director shall implement this subsection in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers under the Federal employees health benefit program under chapter 89 of title 5, United States Code, including (through negotiating with each multi-state plan)—

‘‘(A) a medical loss ratio;
‘‘(B) a profit margin;
‘‘(C) the premiums to be charged; and
‘‘(D) such other terms and conditions of coverage as are in the interests of enrollees insuch plans.

‘‘(5) AUTHORITY TO PROTECT CONSUMERS.—The Director may prohibit the offering of any multi-State health plan that does not meet the terms and conditions defined by the Director with respect to the elements described in subparagraphs (A) through (D) of
23 paragraph (4).

PDF

[Exilednight]

141. "Did I claim that the multi-state plan is the same as Medicare?" Yes you did. Upthread.

[ProSense]

143. I did no such thing

My comments were specifically about contracting.

Medicare contracts with private companies just as a non-profit entity would.

Nice of you to show up after making the claim that the it was only the exchange that was a non-profit entity.

[Milo_Bloom]

148. oooo.. soo close right here.

"Medicare contracts with private companies just as a non-profit entity would."

This is one of the first things you have gotten right... now.. let's see if you can figure out the difference.

Medicare contracts with private companies to preform largely administrative tasks (in the case of insurance companies) and for bulk purchasing purposes in the case of actual providers.

the "non profit entity" would be contracting with private companies to purchase..... TA DAAA.. THE INSURANCE ITSELF!

[Milo_Bloom]

142. Love watching you walk it back.

LOL.

[ProSense]

144. There was no walk back.

Show me specifically where I stated the multi-state plans are the same as Medicare.


You have been all over the place on this trying to avoid the fact that you were wrong about the fact that one of the multi-state plans had to be a non-profit entity.

[Exilednight]

145. Total walk back.!

LOL.

[ProSense]

146. And that makes twice that you were wrong. n/t

[Exilednight]

149. And you have yet to be right. LOL n/t

[ProSense]

151. So you're still under the impression that

the exchange will only include one plan in some states?

The OPM must contract with two in each exchange. What exactly is a one-plan exchange?

[Milo_Bloom]

153. Classic right here...

In this post ProSense tries to claim that you were talking about the EXCHANGE, when we were ACTUALLY discussing the essence of competition in the health care industry.

[Milo_Bloom]

147. you backed it right up and out the door!

The walk back was the fact that you saw where I was going with it and rather than take your position to its logical conclusion, you decided to sidestep by claiming I was saying something about what you said, rather than actually address the issue, which is that the INSURANCE from Medicare is based on an actual NON-PROFIT model, while the INSUARNCE from the exchanges is from FOR PROFIT COMPANIES.

Now, to correct you for about the fourth time. I agree one of the multi-state plans has to be non-profit. What you are completely failing to understand is that the "multi-state-plan" is, in fact, a BROKER, who has assembled a collection of FOR PROFIT INSURANCE OPTIONS and made deals to purchase them in bulk to reduce pricing. All it means is that there is no ADDITIONAL PROFIT tacked onto the cost; however, you will still have additional COSTS, profit just won't be one of them.

[ProSense]

150. Medicare contracts with insurers. The OPM contracts with insures

That is the similarity. That doesn't mean the programs are exactly the same.

If you can't understand the difference, then I can't help you.

[Milo_Bloom]

152. I understand the difference perfectly.

You are the one who keeps trying to avoid it.

[Mimosa]

92. "Obama needed to keep his promise and set up a national exchange."

Exactly right!

I know conservatives and small business owners who wanted that. If Obama had kept that promise he would have far more support now from the 'persuadable middle' who voted for him and are now disappointed because he didn't do right on this one vital issue.

It may surprise proSense and the pom pom crowd but I still support Obama on several issues. But he screwed us all over on health care. BIG TIME.

[Milo_Bloom]

75. And even where they are "competing" are they really?

One only needs to search for insurance in NY or California where there is "LOTS" of "competition" to see how few choices you actually have.

[Exilednight]

90. In greater NY you only have two real options .........

My cards all say United Healthcare, but United Healthcare is owned by Oxford who also owns several smaller health insurance companies. The only other real choice is Aetna.

When you look around, it looks like there are more insurance companies than there really are. This is because there is one big umbrella company doing business under several different names.

[dflprincess]

121. Trust me when I tell you,

United HealthGroup aka "the Evil Empire" owns Oxford, not the other way around.

http://en.wikipedia.org/wiki/UnitedHealth_Group

In July 2004, UnitedHealth Group acquired Oxford Health Plans and all of United Healthcare's New York-based small group contracts are now Oxford Health Plans products

[Exilednight]

140. Either way, all I know is that I have zero choice of providers. n/t

[Milo_Bloom]

73. oooooooooookay.

I'll pretend for a second that you are not feigning ignorance here and play along.

First, I will go over the specific example.

I moved into my area in 2003 and have used cable for internet since coming here b/c it was the highest speed option available (DSL was capped at 7MB and cable offered 10). Pretty much every year, the cost of my internet access increased, along with the cost of the television package. I was constantly begging Time Warner for faster access, but they told me it was impossible unless i wanted to pay hundreds of dollars a month to have a dedicated line brought to the house.

However something funky happened in 2007... Verizon FIOS announced that they would FINALLY be laying fibre in my general area. They offer speeds up to 50MB for $99.99 (about 30 or 40 more than I am currently paying for Time Warner, but at 5x the speed I couldn't wait.)

SUDDENLY I get an e-mail that if I just call and tell them I was EXTREME SPEED, they would increase me to 30MB.. FOR FREE. No cost increase.

What's even more amazing.. since then the internet portion of my bill has remained fairly static and we have been receiving channel updates constantly. Now, I happen to have known that Time Warner put fibre down in my area in about 2001.. so they always had the ability to do this. However, it wasn't until Verizon was going to introduce FIOS that they actually decided to use it.

No one is claiming that prices are GOING DOWN... however, they certainly aren't going up as fast as they were BEFORE more competition was introduced and THAT is the essence of competition.

Second, let's relate this to the health care industry. First, we have to understand that unlike super fast internet and 20 varieties of HBO, health care is mostly a necessity and not a luxury. Unfortunately, some people are forced to TREAT health care as a luxury, but the industry knows and understand that for the majority of the population it is a necessity.

Much like the oil industry (another peddler of necessities) the health care companies act in concert for their own and the industry's best interest. If you actually SHOP for health care, you find out fairly quickly that prices are INCREDIBLY static, kinda like gas stations. Yeah, someone may be a penny lower here and there and maybe if you move to a completely different state (ie, drive 10 miles out of your way) you can find something that is shockingly cheaper than you are paying, but if you look in that area.. you find that price isn't that outrageous after all. The funny thing is, when prices go up at one station, they go up all over the place, EVEN THOUGH supposedly many of these stations are receiving their gas from different sources, so, in theory, the price at one station shouldn't NECESSARILY change the price at another.. yet it does... but, I digress.

Right now, in the health care industry, you have a fairly small number of companies who provide different variations of the same service all at REMARKABLY similar prices. They also realize they have customers by the short and curlies, since changing insurance companies can be a royal pain in the ass. So long as they continue to act in concert, as they have always done, and continue to raise prices they will all get a healthy slice of the pie.

However, if another option existed... one THEY (the criminal syndicate I spoke of earlier) did not control and could not influence, it would introduce chaos into the sytem... their NECESSITY wouldn't be NECESSARY anymore and they would be force to react in the same way time warner reacted to FIOS.

[Mimosa]

74. ProSense, have you no shame at last?

Your act is wearing thin with people who are struggling and can't afford health insurance any more.

What's your next post? "Wait until 2014! It will be great"?

[ProSense]

78. You think people who are struggling are

spending all their time distorting health care reform? The bill is helping millions of people, and more relief is needed. Still, don't think for a second that people who are struggling are siding with insurance companies and want to return to the status quo.

[Milo_Bloom]

82. Unfortunately the millions of people it is helping are the stockholders of the insurance companies.

[ClarkUSA]

79. Thanks! While some people proffer demonizing rhetoric, you always give us well-sourced facts.

Bookmarked to print out for my GOTV group this weekend.

K&R still brings it to zero. Seems like some people don't want the truth about HCR to be disseminated but supporters of this Democratic administration will continue to speak truth to power.

[Mimosa]

87. The truth is nothing has changed for the majority

"Affordable Health Care"? Where can I find some?

For example all adults can be denied health insurance coverage because of preexisting conditions. Premiums are still unaffordable and go up according to age.


There are plans which the insurance companies (mainly Blue Cross/ Blue Shield, which is now calling itself 'Anthem') are offering in states which will accept people with pre-existing conditions who have been UNINSURED FOR 6 MONTHS. But they are exactly like the expensive high deductible sub-standard plan my partner and I have right now which runs us $895 a month with a $10,000 per person annual deductible. I think in GA the 'exchange plan' runs $500-$600 a person a month for $5,000 deductible plans, 80/20 coverage. For 2 people that would be nearly $10,000-$12,000 a year.

There are millions of people whose insurance payments are literally BREAKING us. We can't afford to save for our old age, we can't afford to go out to dinner or even a weekend trip. *Seriously, think of the stress and the struggle of having to work harder to pay increasing premiums you can't really afford.* Every month we consider dropping it and getting out from under the grinding wheel. BUT if something happened we could lose our house.


And because of the high deductibles some people still go bankrupt if they get a catastrophic illness.

Keep telling us how good this 'health insurance reform' is. In 2014 it will still be unaffordable for many. But before then people who can't afford insurance but aren't poor enough for Medicaid (or don't qualify because of varying incomes) will still get sick and not be covered.

Please quit trying to tell us this is a GOOD plan because it clearly isn't.

*edited for typos*

[Hekate]

84. Thank you for fact-based reporting.

Insurance companies are still the Evil Empire, and still need a lot more regulation before this is over. But we already knew that, and so did Obama. What we have is an excellent first step, but it's only the first step.

Hekate

[Mimosa]

88. What 'fact based reporting'?

I'm sure ProSense is a nice person but she is incessently presenting the Health care reform Bill to be what it isn't. THERE IS NO PUBLIC OPTION.

Hekate, do you and proSense not understand a word of what I am posting? Don't you understand what Milo Bloom is posting? We are living under this system as it is, and as it will be in 2014. People who buy their own insurance understand it better than those who don't. We have more incentives! Don't you think we want and need things to improve, to become affordable?

Or do you think all the people who are sick over this abortion of a health care bill 'didn'y really love Obama'?

I did. I worked for his election and contributed to his campaign because I believed he would get us something better. health care reform was my issue. :(

[Nicholas D Wolfwood]

98. And what did you do after the election?

You know, while Rome was burning, while the tea partiers demonstrated incessantly, while death threats were made against liberals in Congress, while Town Hall meetings turned into screaming matches?

What did you do then? Not one fucking thing.

[Name removed]

105. Deleted message

Message removed by moderator. Click here to review the message board rules.

[ProSense]

101. "I'm sure ProSense is a nice person "

What is it with you and comments like this?

"Hekate, do you and proSense not understand a word of what I am posting? "

You don't know what you're talking about and on top of it you'r condescending.

[Mimosa]

200. Deleted by author n/t

[Vinca]

89. By 2014 the "hidden tax" won't be hidden. Those who still have insurance

will be paying it whether the uninsured are covered or not. Big insurance is now making a cottage industry of devising ways to cram everything into that "80% must be spent on health care" category. There are 2 giant flaws in the health insurance bill: the meat of it doesn't take go into effect for 4 years and there is no affordable, public option. Big insurance has years to convince the sheeple how wonderful they are and, judging from television commercials currently airing, the campaign is underway.

[dflprincess]

122. And don't think for a minute they won't find a way around the "80%"

as Wendell Potter has warned us.

BWT only about 3% of Medicare's expenses go to admin costs - so 20% does seem a tad excessive. But, of course, Medicare doesn't have to pay any executive salaries.

[GeorgeGist]

104. Nor did it prevent them ...

which I have to assume was intentional.

[ClarkUSA]

124. Do you have proof of this?

Because Section 2794(a)(2) requires health insurers to "submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase, and prominently post this information on their Internet Web sites."

[Milo_Bloom]

128. So all they have to do is claim it isn't unreasonable?

Good system there.

[ClarkUSA]

132. "all"? Why don't you call/write HHS and ask them re: the requirements for Section 2794(a)(2)?

Section 2794(a)(2) requires health insurers to "submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase, and prominently post this information on their Internet Web sites."

Yeah, it is "a good system" compared to what was there before... which was nothing.

[Milo_Bloom]

134. There is nothing there now.

Unreasonableness is a legal standard.

So long as the industry raises pricess IN CONCERT (as they have ALWAYS DONE) it isn't unreasonable by definition.

[ClarkUSA]

135. Your opinion doesn't trump my facts. I supplied evidence that there are safeguards in place.

Section 2794(a)(2) requires health insurers to "submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase, and prominently post this information on their Internet Web sites."

[Milo_Bloom]

138. Not my opinion. It is FACT.

Unreasonableness is a legal standard.

"to the Secretary and the relevant State a justification for an unreasonable premium increse..."

If the industry acts in concert, it is, by definition, not unreasonable.

Those are the facts you have to learn to live with.

[ClarkUSA]

154. lol! Your opinion (" There is nothing there now.") is not supported by a shred of evidence.

<< Unreasonableness is a legal standard. >>

Prove it. You'll have to call/write HHS and ask them re: the requirements for Section 2794(a)(2) and show how your opinion is relevant to federal law.

Section 2794(a)(2) requires health insurers to "submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase, and prominently post this information on their Internet Web sites."

<< If the industry acts in concert, it is, by definition, not unreasonable. >>

Show me a relevant legal case where this was the judicial determination. As far as I know, industry collusion leading to price manipulation is against the law. Also, what evidence leads you to believe that the HHS will allow any sort of HCR insurance price fixing to occur under Secretary Sebelius' watch via Section 2794(a)(2)?

<< Those are the facts you have to learn to live with. >>

I didn't see any facts. I see someone who seems to dislike all of the Democratic legislative efforts under this Democratic president.

Why do you spend so much time on a site that supports Democrats?

[Milo_Bloom]

155. The section you keep quoting IS the evidence.

"submit to the Secretary and the relevant State a justification for an unreasonable premium increase"

They only have to present a justification if the increase is "unreasonable"

When an industry acts in concert, it is, by legal definition, REASONABLE. This is well established from a plethora of product liability cases where in companies were found to comply with all reasonable standards, because it was the way a particular industry works.

So long as the health insurance companies continue to act in concert, their actions are BY DEFINITION not unreasonable and thus, they don't have to justify themselves to anyone.

So, as stated, there are no protections against future rate hikes.

[ClarkUSA]

156. ROFL! Sure it is. You really have got nothing to back up all that rhetoric, do you?

Thanks for kicking this OP, though. It's nice how helpful you are in getting ProSense's facts out.

Keep it up!

:rofl:

[Milo_Bloom]

158. The facts back it up.

I am hoping to keep this thread kicked for a while, since it completely debunks you and prosense, who are perfect examples of the problems the democrats are facing this year.

All spin, no substance.

[ClarkUSA]

159. What facts? List them then and link to credible sources for verification. So far, you got nuthin'

Your track record appears to be full of similar attempts to demonize Obama legislative accomplishments via negative unsubstantiated rhetoric.

You seem to dislike all of the Democratic legislative efforts under this Democratic president and those who support Democrats and this Democratic president as well.

Why do you spend so much time on a site that supports Democrats?

[Milo_Bloom]

161. This site is for Democrats and OTHER progressives.

[ClarkUSA]

183. What does that make you then, considering your neverending barrage of negativity re: Dems?

[ClarkUSA]

184. *crickets* from Milo Bloom on that list of facts w/sourced links

No facts, no links, no credibility.

[ProSense]

160. You have a tendency to cast your opinions as facts. For example,

"keep this thread kicked for a while, since it completely debunks you and prosense"

That is not a fact, not even remotely.

[Milo_Bloom]

162. It is a reality.

Watching you take quotes out of context and pretend to misunderstand the most basic concepts is the essence of spin and the reason the democrats are in trouble. too many people spinning to create a narative that simply isn't true.

[ProSense]

163. What does this mean:

Slowing the growth in health care costs is one goal of health reform. Under the Senate bill (scroll to page 2086), at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets. The Director of the Office of Personnel Management would enter into contracts with private insurers to offer the multi-State plans. (OPM currently administers the Federal Employee's Health Benefit Program.)

link

‘‘(4) ADMINISTRATION.—The Director shall implement this subsection in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers under the Federal employees health benefit program under chapter 89 of title 5, United States Code, including (through negotiating with each multi-state plan)—

‘‘(A) a medical loss ratio;
‘‘(B) a profit margin;
‘‘(C) the premiums to be charged; and
‘‘(D) such other terms and conditions of coverage as are in the interests of enrollees insuch plans.

‘‘(5) AUTHORITY TO PROTECT CONSUMERS.—The Director may prohibit the offering of any multi-State health plan that does not meet the terms and conditions defined by the Director with respect to the elements described in subparagraphs (A) through (D) of
23 paragraph (4).

PDF

Go ahead, state your understanding of what that means.

Explain it to those of us who you claim "take quotes out of context and pretend to misunderstand the most basic concepts."

[Milo_Bloom]

164. Actually...

Please tell us what YOU think it means.

I have stated what it ACTUALLY means many many many many many times.

Your definition has shifted with the wind.

So let's nail it down.

What do YOU think it means.

[ProSense]

165. What a cop out

Go ahead, you said I was wrong and took the information out of context, so explain it to me.

That is unless you can't?

[Milo_Bloom]

166. I already have. many many many times in this thread.

You are the one who hasn't. You just keep quoting it as if you have proven something, but you don't actually understand what it is. if you do... tell us what you THINK it means.

you can't, can you?

[ProSense]

168. Why are you so afraid, after claiming I was wrong? n/t

[Milo_Bloom]

169. Afraid of what??

I have explained it Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436614) Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436507) Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436678) and a BUNCH of other times.

Everytime you are presented with the actual explanation you requote the same thing which doesn't say what you THINK it says.

So, again, what do YOU think you are quoting?

Why are you unable to explain it in your own words.


USE YOUR WORDS!

[ProSense]

170. None of those are a response to my question, which is

tell me what this means:

Slowing the growth in health care costs is one goal of health reform. Under the Senate bill (scroll to page 2086), at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets. The Director of the Office of Personnel Management would enter into contracts with private insurers to offer the multi-State plans. (OPM currently administers the Federal Employee's Health Benefit Program.)

link

‘‘(4) ADMINISTRATION.—The Director shall implement this subsection in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers under the Federal employees health benefit program under chapter 89 of title 5, United States Code, including (through negotiating with each multi-state plan)—

‘‘(A) a medical loss ratio;
‘‘(B) a profit margin;
‘‘(C) the premiums to be charged; and
‘‘(D) such other terms and conditions of coverage as are in the interests of enrollees insuch plans.

‘‘(5) AUTHORITY TO PROTECT CONSUMERS.—The Director may prohibit the offering of any multi-State health plan that does not meet the terms and conditions defined by the Director with respect to the elements described in subparagraphs (A) through (D) of
23 paragraph (4).

PDF

Go ahead, state your understanding of what that means.

You claimed I "take quotes out of context and pretend to misunderstand the most basic concepts."

You are afraid to make a direct interpretation of the information above. You linked to statements you made that do not directly state what the above means.

So go ahead and explain the above information. What have you got to fear? You believe you are right and I am wrong.

So explain it to me.

[Milo_Bloom]

171. Classic right here...

The links I gave you explain EXACTLY what it means. in fact, I actually quote from the law and explained what it means.

Why are you afraid to use your words?

[ProSense]

172. It's pretty clear that you don't want to respond

because you can't or are afraid to express your views in plain sight.

It's a simple exercise: explain information in your own words. You are constantly accusing people of being wrong and stating that your opinions are facts, but a simple exercise to interpret factual information scares you.

[Milo_Bloom]

173. .

Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436614)
here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436678)
Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436236)
Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436273)
Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436593)
Here (http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=436704)

Why are you so afraid to use your own words like I have over and over and over and over again?

USE YOUR WORDS

[ProSense]

174. .

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=437987

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=435886&mesg_id=438008


What are you afraid of?

[Milo_Bloom]

175. Obviously nothing, since I have done it already.

Why haven't you???


USE YOUR WORDS!

[ClarkUSA]

176. No, you haven't at all. You have continually avoided providing sourced facts to back up your claims.

Your modus operandi is clear.

[Milo_Bloom]

178. Done it many many many times.

As proven by the links I have provided.

[ClarkUSA]

180. That's completely untrue and an utter fabrication. You haven't offered a shred of evidence.

Unlike the OP and I.

[Milo_Bloom]

181. In YOUR case, the proof is in the statute you keep quoting.

No links are necessary with you. The statute speaks for itself quite well.

With ProSense, I have provided links dozens of times, including to the actual law, which he/she refuses read.

[ClarkUSA]

185. That's doublespeak. You haven't got anything substantive to offer, as usual, just empty word play.

You seem to dislike all of the Democratic legislative efforts under this Democratic president and those who support Democrats and this Democratic president as well.

Why do you spend so much time at a forum that supports Democrats?

[Milo_Bloom]

187. Just offering a dose of reality

to the people who spin themselves dizzy and wind up bringing the party down with them.

[ClarkUSA]

188. So "reality" to you = unsubstantiated negative rhetoric attacking Dems & Democratic policy?

<< Just offering a dose of reality to the people who spin themselves dizzy and wind up bringing the party down with them.>>

Hmm... so you claim you're saving "the party" by anonymously blogging at Democratic Underground and "offering a does of reality" aka. attacking every single Democratic policy initiative passed by the Democratic Congress and signed into law by the Democratic President and by ridiculing Democratic supporters of this Democratic President?

Which party are you referring to?

[Milo_Bloom]

191. Just the ones who spin reality out of control.

[ClarkUSA]

192. Who are "the ones" be on this thread? ProSense and I? Stephanie Cutter from the WH?

Oh, and you never answered me.

<< Just offering a dose of reality to the people who spin themselves dizzy and wind up bringing the party down with them.>>

Which party are you referring to? Who are "the people who spin themselves dizzy"? Name them.

[Milo_Bloom]

195. Anyone who spins outside of reality.

The party = the democratic party. You know the one that is likely to get squished in the midterms because the base is fed up and the people don't feel they have ACTUALLY accomplished anything, b/c people think it is a good idea to lie and spin about what has actually been accomplished.

[ClarkUSA]

197. "people think it is a good idea to lie and spin"? Do you think ProSense and I are doing that? nt

[ProSense]

177. OK

It requires the OPM director to contract with and administer two multi-state plans (one of which must be a non-profit) to provide coverage in the individual and small employer markets via each exchange. The Director negotiates the terms of the contracts and has the right to prohibit plans that do not meet the conditions he set forth.


Your turn, what does this mean:

Slowing the growth in health care costs is one goal of health reform. Under the Senate bill (scroll to page 2086), at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets. The Director of the Office of Personnel Management would enter into contracts with private insurers to offer the multi-State plans. (OPM currently administers the Federal Employee's Health Benefit Program.)

link

‘‘(4) ADMINISTRATION.—The Director shall implement this subsection in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers under the Federal employees health benefit program under chapter 89 of title 5, United States Code, including (through negotiating with each multi-state plan)—

‘‘(A) a medical loss ratio;
‘‘(B) a profit margin;
‘‘(C) the premiums to be charged; and
‘‘(D) such other terms and conditions of coverage as are in the interests of enrollees insuch plans.

‘‘(5) AUTHORITY TO PROTECT CONSUMERS.—The Director may prohibit the offering of any multi-State health plan that does not meet the terms and conditions defined by the Director with respect to the elements described in subparagraphs (A) through (D) of
23 paragraph (4).

PDF

[Milo_Bloom]

179. Now that we have the definition down... let's work on the meaning.

That is EXACTLY what it says and EXACTLY what I have been telling you in my links.

Where you seem to have a problem is that the "multi-state-plan" is essentially (and actually) an ENTITY, as described in the law. Read the law carefully, "multi-State plans (one of which must be non-profit)" and also look at the language in the "non profit entity" portion.

"‘‘(3) NON-PROFIT ENTITIES.—In entering into
2 contracts under paragraph (1), the Director shall en3
sure that at least one contract is entered into with a
4 non-profit entity

The "multi-state-plan" is a bulk buyer/broker who has assembled options from various FOR PROFIT entities, exactly the way the federal health benefits work.

The ASSUMPTION in the law is that buy buying in bulk, they can get better rates and pass these onto consumers.. in one case the multi-state-plan will PROFIT from the transfer, in another case, the multi-state-plan will simply be a pass through + administrative costs.

The law is very clear. The NON PROFIT ENTITY is NOT THE INSURANCE COMPANY... it is the entity who ASSEMBLES THE PLAN. The insurance company is STILL PROFITING from the sale of the insurance.

So now we go to effect.

While the director has the power to prohibit a multi-state plan, so long as the insurance companies do what they have ALWAYS done and act in concert, the director can't do anything about it, since he/she is REQUIRED to contract with at least 2 plans. So, as long as the insurance industry continues to raise prices together (as they have ALWAYS done), there is absolutely nothing the director can do... he/she remains at the mercy of their pricing, which is effectively UNCONTROLLED.

[ProSense]

182. Now that's funny

You: "The 'multi-state-plan' is a bulk buyer/broker who has assembled options from various FOR PROFIT entities, exactly the way the federal health benefits work"

Who is the OPM contracting with: the multi-state plan or the insurance companies?

If they are contracting with the multi-state plan, a non-profit, who is offering the coverage when the law states:

"at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

You: "in one case the multi-state-plan will PROFIT from the transfer, in another case, the multi-state-plan will simply be a pass through + administrative costs"

Are the multi-state plans the point of sale in the above scenario? Is one of them a non-profit?

You: "The law is very clear. The NON PROFIT ENTITY is NOT THE INSURANCE COMPANY... it is the entity who ASSEMBLES THE PLAN. The insurance company is STILL PROFITING from the sale of the insurance."

Is the assembling entity the one selling the plan?

Are the insurance companies, drug companies and other providers making a profit in the following scenario?

Since the beginning of the Medicare program, CMS has contracted with private companies to operate as intermediaries between the government and medical providers.<5> These contractors are commonly already in the insurance or health care area. Contracted processes include claims and payment processing, call center services, clinician enrollment, and fraud investigation.

link

<...>

ELIGIBILITY AND FUNDING

On July 1, 1966, Medicare, authorized by title XVIII of the Social Security Act, offered health insurance to almost all Americans age 65 or older. Coverage consisted of hospital insurance (part A) and supplemental medical insurance (part B), and benefits mirrored those then available from Blue Cross and Blue Shield plans. A payroll tax paid by employees, employers, and the self employed funded part A, which was available without cost to all those 65 or older who were insured under the old age retirement and survivors program of title II of the Social Security Act. Part B was open to all aged citizens and legal aliens who had resided in the country for 5 or more years. Beneficiaries who voluntarily enrolled in part B paid a monthly premium of $3.00, which was estimated to be enough to fund 50 percent of part B costs, and federal general revenues covered the remainder.

<...>

ADMINISTERING MEDICARE

The Department of Health and Human Services (HHS)7 has overall responsibility for administering Medicare. Much of this authority has been delegated to the Health Care Financing Administration (HCFA)8 which sets overall policy for Medicare by (1) establishing regulations that implement and interpret applicable laws, (2) contracting with claims processors and utilization and quality review organizations that perform the day-to-day functions of operating Medicare, and (3) administering various provider survey and certification functions.

The administrative structure for Medicare remains largely as it was when the program began. Insurance companies contract to process and pay claims, furnish services to beneficiaries and providers, and safeguard against fraud and abuse through such activities as cost report auditing, medical review, and assuring other responsible insurers pay before Medicare. Part A contractors are called intermediaries and those for part B are called carriers. Providers nominated insurers to be intermediaries and most elected to be served by the local Blue Cross plan in their area. Other companies that served as intermediaries included Aetna, Mutual of Omaha, Prudential, and Travelers. HCFA selected the insurers to be carriers and most of them were local Blue Shield plans along with commercial insurers such as Metropolitan Life, General American, Prudential, and Occidental. Most states had one carrier, but some had multiple carriers. Intermediary and carrier contracts operate on a cost basis without an allowance for profit and HCFA has used a negotiated budget process to set upper limits on costs.

Initially, over 100 insurance companies had Medicare contracts. Over the years, the number of contractors has been reduced as less efficient contractors were replaced, contract areas were consolidated, and some insurers discontinued contracting for various reasons. Today, thirty-eight different insurers hold contracts. Two types of specialized contractors have also been established. Six regional home health intermediaries process claims for services furnished by freestanding home health agencies (hospital based agencies continued to be served by the hospital intermediary). Four durable medical equipment regional carriers handle most claims for equipment, prosthetics, orthotics, and supplies.9 Processing these types of claims is quite different than for other types and it was thought that the regional contractors, by specializing, could better handle the peculiarities of these claims.

link

[Milo_Bloom]

186. *SIGH*

You can lead a horse to water....


"Who is the OPM contracting with: the multi-state plan or the insurance companies?"

Neither. "Health Insurance Issuers" "which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark" aka BROKERS. These are sub-corporations created for the purpose of selling insurance. The director contracts with them. You have an entity that can sell insurance in mulitple markets and contracts to do so through the director.

"If they are contracting with the multi-state plan, a non-profit, who is offering the coverage when the law states:

"at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

The problem is the law DOESN'T state that. You are misquoting the law to create a false narrative or maybe what you WISH it said. The law ACTUALLY states:

First the direction must contract with health insurance issues, "to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage."

Second, the non profit section states, "‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity." Just the ENTITY has to be non-profit. The BROKER, not the insurance.

Are the insurance companies, drug companies and other providers making a profit in the following scenario?

Of course, but not from the selling of insurance... only from the sale of actual products, actual services and administrative duties... no money for nothing.

[ProSense]

189. Neither? LOL!

"Who is the OPM contracting with: the multi-state plan or the insurance companies?"

Neither. "Health Insurance Issuers" "which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark" aka BROKERS. These are sub-corporations created for the purpose of selling insurance. The director contracts with them. You have an entity that can sell insurance in mulitple markets and contracts to do so through the director.

If the contract isn't with the multi-state plans or the insurance companies who is the contract with?

OVERSIGHT BY THE OFFICE OF PERSONNEL MANAGEMENT.—

‘‘(1) IN GENERAL.—The Director of the Office of Personnel Management (referred to in this section as the ‘Director’) shall enter into contracts with health insurance issuers (which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark), without regard to section 5 of title 41, United States Code, or other statutes requiring competitive bidding, to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage.

‘‘(2) TERMS.—Each contract entered into under paragraph (1) shall be for a uniform term of at least 1 year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. In entering into such contracts, the Director shall ensure that health benefits coverage is provided in accordance with the types of coverage provided for under section 2701(a)(1)(A)(i)of the Public Health Service Act.

‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity.

PDF

"If they are contracting with the multi-state plan, a non-profit, who is offering the coverage when the law states:

"at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

The problem is the law DOESN'T state that.

It doesn't:

‘‘(1) IN GENERAL.—The Director of the Office of Personnel Management (referred to in this section as the ‘Director’) shall enter into contracts with health insurance issuers (which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark), without regard to section 5 of title 41, United States Code, or other statutes requiring competitive bidding, to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage.

[Milo_Bloom]

190. Typical spin and misquoting

ProSense asks: If the contract isn't with the multi-state plans or the insurance companies who is the contract with?

But ignores that the answer was ALREADY GIVEN: "Health Insurance Issuers" "which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark" aka BROKERS. These are sub-corporations created for the purpose of selling insurance. The director contracts with them. You have an entity that can sell insurance in mulitple markets and contracts to do so through the director.


Then he/she tries to claim that something wasn't addressed, when it, in fact was specifically addressed. he/she offers this quote... conveniently cut off...

"If they are contracting with the multi-state plan, a non-profit, who is offering the coverage when the law states:

"at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

The problem is the law DOESN'T state that.

Here is the part he/she forgot, wherein I quoted exactly the same part of the law he/she quoted, only went on to show why it doesn't state what he/she claimed.

You are misquoting the law to create a false narrative or maybe what you WISH it said. The law ACTUALLY states:

First the direction must contract with health insurance issues, "to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage."

Second, the non profit section states, "‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity." Just the ENTITY has to be non-profit. The BROKER, not the insurance.

Now why would he/she DELIBERTLY pretend that the explanation wasn't part of the original message?

So why not address the issue actually raised instead of pretending a bunch of things weren't explained? Why not address your misreading of the law and your false statements? Why just cut off the explanation and pretend it wasn't offered?

Why all the spin and misquoting?

[ProSense]

193. This is why you cannot answer direct questions

ProSense asks: If the contract isn't with the multi-state plans or the insurance companies who is the contract with?

But ignores that the answer was ALREADY GIVEN: "Health Insurance Issuers" "which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark" aka BROKERS. These are sub-corporations created for the purpose of selling insurance. The director contracts with them. You have an entity that can sell insurance in mulitple markets and contracts to do so through the director.

Here was my response, including your quote:

"Who is the OPM contracting with: the multi-state plan or the insurance companies?"

Neither. "Health Insurance Issuers" "which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark" aka BROKERS. These are sub-corporations created for the purpose of selling insurance. The director contracts with them. You have an entity that can sell insurance in mulitple markets and contracts to do so through the director.

If the contract isn't with the multi-state plans or the insurance companies who is the contract with?

Can you answer that question directly? What do you think "common ownership and control" means? Can you also point to the word "BROKERS" in the law? Here the text directly from the law:

OVERSIGHT BY THE OFFICE OF PERSONNEL MANAGEMENT.—

‘‘(1) IN GENERAL.—The Director of the Office of Personnel Management (referred to in this section as the ‘Director’) shall enter into contracts with health insurance issuers (which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark), without regard to section 5 of title 41, United States Code, or other statutes requiring competitive bidding, to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage.

‘‘(2) TERMS.—Each contract entered into under paragraph (1) shall be for a uniform term of at least 1 year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. In entering into such contracts, the Director shall ensure that health benefits coverage is provided in accordance with the types of coverage provided for under section 2701(a)(1)(A)(i)of the Public Health Service Act.

‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity.

PDF

Let me repeat the questions: If the contract isn't with the multi-state plans or the insurance companies who is the contract with? Can you answer that question directly? What do you think "common ownership and control" means? Can you also point to the word "BROKERS" in the law?

Then he/she tries to claim that something wasn't addressed, when it, in fact was specifically addressed. he/she offers this quote... conveniently cut off...



"If they are contracting with the multi-state plan, a non-profit, who is offering the coverage when the law states:

"at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

The problem is the law DOESN'T state that.


Here is the part he/she forgot, wherein I quoted exactly the same part of the law he/she quoted, only went on to show why it doesn't state what he/she claimed.


You are misquoting the law to create a false narrative or maybe what you WISH it said. The law ACTUALLY states:

First the direction must contract with health insurance issues, "to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage."

Second, the non profit section states, "‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity." Just the ENTITY has to be non-profit. The BROKER, not the insurance.

If you "quoted exactly the same part of the law" how can you claim "The problem is the law DOESN'T state that."

Could it be that you're running around in circles to try to mask that you're wrong?

[Milo_Bloom]

194. More misquoting, more spin.

I did answer the question directly. You just choose to ignore it so you claim it wasn't answered: "These are sub-corporations created for the purpose of selling insurance"


If you "quoted exactly the same part of the law" how can you claim "The problem is the law DOESN'T state that."

You stated, "at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

The law does not say that. This is YOUR misinterpretation of the law.

The law has two DIFFERENT PARTS that you are combining incorrectly. AGAIN

You are misquoting the law to create a false narrative or maybe what you WISH it said. The law ACTUALLY states:

First the direction must contract with health insurance issues, "to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage."

Second, the non profit section states, "‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity." Just the ENTITY has to be non-profit. The BROKER, not the insurance.

[ProSense]

198. "These are sub-corporations created for the purpose of selling insurance"

Can you provide a link to those exact words?

If you "quoted exactly the same part of the law" how can you claim "The problem is the law DOESN'T state that."

You stated, "at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

The law does not say that. This is YOUR misinterpretation of the law.

The law has two DIFFERENT PARTS that you are combining incorrectly. AGAIN




You are misquoting the law to create a false narrative or maybe what you WISH it said. The law ACTUALLY states:

First the direction must contract with health insurance issues, "to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage."

Second, the non profit section states, "‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity." Just the ENTITY has to be non-profit. The BROKER, not the insurance.

Here is the merge of my statement and yours (in italics)

"You stated, 'at least two multi-State qualified health plans must be available as part of the Exchange in each State (at least 2 multi-State qualified health plans through each Exchange in each State). The multi-State plans (one of which must be non-profit) (the Director shall ensure that at least one contract is entered into with a non-profit entity.") would provide coverage in the individual and small employer markets (shall provide individual, or in the case of small employers, group coverage).'"

Here is the law:

OVERSIGHT BY THE OFFICE OF PERSONNEL MANAGEMENT.—

‘‘(1) IN GENERAL.—The Director of the Office of Personnel Management (referred to in this section as the ‘Director’) shall enter into contracts with health insurance issuers (which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark), without regard to section 5 of title 41, United States Code, or other statutes requiring competitive bidding, to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage.

‘‘(2) TERMS.—Each contract entered into under paragraph (1) shall be for a uniform term of at least 1 year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. In entering into such contracts, the Director shall ensure that health benefits coverage is provided in accordance with the types of coverage provided for under section 2701(a)(1)(A)(i)of the Public Health Service Act.

‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity.

PDF

Here is your last claim:

Then he/she tries to claim that something wasn't addressed, when it, in fact was specifically addressed. he/she offers this quote... conveniently cut off...



"If they are contracting with the multi-state plan, a non-profit, who is offering the coverage when the law states:

"at least two multi-State qualified health plans must be available as part of the Exchange in each State. The multi-State plans (one of which must be non-profit) would provide coverage in the individual and small employer markets."

The problem is the law DOESN'T state that.


Here is the part he/she forgot, wherein I quoted exactly the same part of the law he/she quoted, only went on to show why it doesn't state what he/she claimed.


You are misquoting the law to create a false narrative or maybe what you WISH it said. The law ACTUALLY states:

First the direction must contract with health insurance issues, "to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage."

Second, the non profit section states, "‘‘(3) NON-PROFIT ENTITIES.—In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity." Just the ENTITY has to be non-profit. The BROKER, not the insurance.

Repeat: If you "quoted exactly the same part of the law" how can you claim "The problem is the law DOESN'T state that."

Could it be that you're running around in circles to try to mask that you're wrong?

[Milo_Bloom]

196. Gotta run.

Going away for the weekend with the family.

I strongly suggest you consult an attorney about the actual MEANING in this law.. because the stuff you are saying is so far from reality it is only going to get you and the party in trouble.

[ProSense]

199. Have fun

and when you get back the facts will still be the same:

Choice of Qualified Plans. In addition to qualified health plans offered by private insurance carriers, new nonprofit Consumer Operated and Oriented Program (CO-OP) plans that meet qualified health plan requirements may be offered through the exchanges. In addition, the federal Office of Personnel Management (OPM) will contract with private insurance carriers to offer multistate plans through each exchange. At least one of the new multistate plans must be nonprofit.

Multistate Plans. The legislation requires the director of the federal Office of Personnel Management (OPM) to contract with health insurers to offer at least two multistate qualified health plans (at least one nonprofit) through the exchanges in each state for individuals and small employers. OPM would negotiate contracts similar to the way in which it currently negotiates contracts for the Federal Employees Health Benefits Program (FEHBP). OPM can prohibit multistate plans that do not meet standards for medical loss ratios, profit margins, and premiums. Multistate plans will be required to cover essential health benefits and meet all of the requirements of a qualified health plan. States may require multistate plans to offer additional benefits, but they must pay for the additional cost. Multistate plans must comply with 3:1 age rating, except where states require more protective age rating. Multistate plans must comply with the minimum standards and requirements of FEHBP, unless they conflict with the health reform law. FEHBP will maintain a separate risk pool and remain a separate program.

link

[woo me with science]

157. Oh my god.

I didn't realize they had the gall to call it "The Affordable Care Act."


War is peace. Freedom is slavery. Ignorance is strength.

[GSLevel9]

167. did they wave their hand in a Jedi Mind Trick move? nt

[Mimosa]

201. Questions about the 'Affordable Health Care Act of 2010

Prosense, your accusation that I don't know what I'm talking about and that I am 'condescending' is untrue as it is hurtful.

Please tell me how my partner and I (both over 55 , both with pre-existing conditions) can obtain affordable health insurance in the state of GA? Partner is self-employed with a highly variable income.

We're not poor enough for Medicaid. Nor do we want to scheme to get on it. We are struggling to pay a mortgae too. If anything catastrophic happened to either of us then a hospital could take our home from us.

I posted that the only 'health care reform' option in our state (GA) is a high premium, high deductible plan run by Blue Cross/Blue Shield (our current provider). The premiums are $600 a person. That is more than we are paying now, though the deductible is less. The co-pays are about the same.

But it isn't about me. We are in the same situation as millions of other hard working people, many of whom don't have health insurance or are dropping their health insurance because of unaffordable premiums.

You keep posting that the Healthcare Reform Act of 2010 is a good thing. You are the person who doesn't understand and who is condescending. I bet you have good health insurance you can afford. You probably don't lie awake at nights wondering what will happen if you have to quit paying premiums you can't afford and if you then incurred hospital bills you can't pay.

The President and Congress did not do the best they could. You and others keep posting things we who are struggling know aren't true. The opportunity for real change was squandered. It may not come around again. And people who hang on until 2014 may well find themselves in the exact same situation, albeit with some tax credits. And if they are struggling part time employees or self-employed they may opt to go without health insurance and pay the penalty to the IRS.

This bastardised mess of a health insurance law isn't like Medicare. It isn't like the systems in other developed countries. It wasn't what the citizens wanted. The president didn't meet with the regular people or the family care providers when they were planning what would happpen. He actually declined to meet with his own family doctor of 22 years who wanted to suggest some ideas. President Obama and his advisers met with health insurance, hospital corporation and pharmaceutical corporation CEOs. Congress has long been in bed with these special interests. I think many of us who supported Obama believed he would rise above the demands of the monied interests and do what would truly benefit us. He could have talked about it on TV to help educate the people who might be susceptible to the 'socialist' bullshit.

The legislation which was done was one big mess. It may be harder to 'fix later' than you think because the insurance companies were actually made federally entrenched as part of the official system.

[woo me with science]

216. +1000000

Thank you for this superlative post.

[jeanpalmer]

203. It's pretty clear HCR did not even slow down

premium increases. Companies are raising rates right and left and HCR is doing nothing to stop them. The new provisions like coverage for pre-existing conditions and for young adults up to 26, are very costly; and those costs are merely being passed on to consumers. Your headline doesn't say it stops rate increases, only that it doesn't cause "unjust" ones. If a 20% increase can be just, what is unjust?

Many carriers also are seeking additional rate increases that they say they need to cover rising medical costs. As a result, some consumers could face total premium increases of more than 20%.

Aetna, one of the nation's largest health insurers, said the extra benefits forced it to seek rate increases for new individual plans of 5.4% to 7.4% in California and 5.5% to 6.8% in Nevada after Sept. 23. Similar steps are planned across the country, according to Aetna.

Regence BlueCross BlueShield of Oregon said the cost of providing additional benefits under the health law will account on average for 3.4 percentage points of a 17.1% premium rise for a small-employer health plan.

In Wisconsin and North Carolina, Celtic Insurance Co. says half of the 18% increase it is seeking comes from complying with health-law mandates.

http://online.wsj.com/article/SB10001424052748703720004575478200948908976.html

The main problem is that the new provisions are not affordable for most people.

Of the estimated 4 million Americans eligible for the program, only about 2,000 had applied as of Aug. 1 in the 23 states

http://www.tampabay.com/news/health/pre-existing-health-condition-insurance-premium-too-expensive-for-many/1119922

[Vinca]

204. I took some flak when I complained about the cost of the pre-existing pool

in New Hampshire (state run and highest rate $1,600+ per month), but it turns out only 12 people have signed up as of the end of August. Guess I'm not alone in thinking the rates are out of the ball park. When the plan was originally proposed, it sounded like there would be a choice between a federal plan or a state plan, if offered. It turns out there is no choice. If a state has opted to open their pre-existing pool up to more people, that's the plan and they charge what they charge. I feel as if I've been a victim of bait and switch.

[ClarkUSA]

205. It's pretty clear it will make insurance more comprehensive and more accessible

The Affordable Care Act has two basic components.

There are, first, provisions to cut the cost of care—like reductions in what Medicare pays some providers, cuts in subsidies for private insurance companies, and a tax on generous health benefits that economists believe will reduce private health care spending. These features come on line quickly (except for the tax) and, year after year, will reduce what we spend on health care.

The second group of provisions would make insurance more comprehensive and more accessible. These include expansions of Medicaid as well as the creation of subsidies for lower- and middle-income people who buy private insurance. These mostly come on line in 2014 and, when they do, will cause a one-time jump in health care spending.

Put these components together and you get a steady reduction in spending growth, interrupted by a spike in 2014.

The sum total of spending between 2011 and 2019 is slightly higher than it would been without reform, but the difference is miniscule—and, arguably, a tiny price to pay for the extra security reform brings to tens of millions of Americans. No less important, the annual rate of growth in 2019, the final year in the projection, is slightly lower than it would have been without reform... when we talk about “bending the curve,” that’s what we mean--reducing the rate of growth, so that we spend less money in the future. And the curve is bending in the right direction.

http://www.tnr.com/print/blog/jonathan-cohn/77587/getting-the-story-straight-health-care-costs

[Mimosa]

206. A chart projecting an imaginary future ? People need affordable health care now

The 'Affordable health care Act of 2010' did not provide it.

As I said the same Blue Cross Blue Shield corporation which is yanking up our premiums beyond affordability offers a similar more expensive plan under the GA part of the health care Reform as part of this dastardly fake health care reform.

It's the same in other states. People aren't signing up for these plans because they can't afford them.

[ProSense]

207. Yes, people need affordable health care now, and they

would not have gotten it had the health care bill failed. Using the time frame in which the bill is being phased in to claim it didn't do something is like saying the consumer bureau isn't doing anything because it isn't up an running yet.

Via the high risk pools, the bill has already made insurance affordable for the those who have been without it or paying tens of thousands of dollars for health care.

Again, it didn't bring down overall cost, but it significantly reduced the liablity to the most vulnerable, those with a pre-exisiting condition and no coverage.

[Mimosa]

209. Not affordable for many people

ProSense,the plans you are talking about are only affordable for younger people. People over 40 or over 55 are the ones most in need of help.

Here's the plan available for people in GA:

http://www.healthcare.gov/law/provisions/preexisting/states/ga.html




Pre-Existing Condition Insurance Plan: Georgia

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On July 1, eligible residents of Georgia will be able to apply for coverage through the state’s Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.

To qualify for coverage:

* You must be a citizen or national of the United States or lawfully present in the United States.
* You must have been uninsured for at least the last six months before you apply.
* You must have had a problem getting insurance due to a pre-existing condition.

PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.

Below are the monthly PCIP premium rates for Georgia by the age of an enrollee.

Ages 0 to 34: $323

Ages 35 to 44: $387

Ages 45 to 54: $495

Ages 55+: $688

In addition to your monthly premium, you will pay other costs. You will pay a $2,500 deductible for covered benefits (except for preventive services) before the plan starts to pay. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

Learn more about the Pre-Existing Condition Insurance Plan and apply.

A couple over 55 would have to pay nearly $1,400 a month plus the $2,500 deductible and copays. That's in network.

[Vinca]

211. New Hampshire is even worse.

If both my husband and I could afford coverage, we'd be looking at about $3,000 a month. It sucks to
be old in America. http://www.healthcare.gov/law/provisions/preexisting/states/nh.html

[ProSense]

212. This is the high risk pool.

For everyone up to 54, the total cost is between $6,375 and $11,890. Over 55, the total cost is between $10,756 and $14,206.

Some among the currently insured are complaining about premiums of $1,000 to $1,200 per month. It will offer an affordable alternative to those currently being denied coverage because of a serious illness who would otherwise be liable for tens of thousands in health care costs.

High-risk pools early test for health overhaul

Again, the reforms are being phased in, and the high risk pool and other measures are to provide relief until the program is fully implemented.

[jeanpalmer]

215. Those plans are affordable only for the the well-to-do

That's why nationwide only 2400 people out of 4 million eligible had signed up for the program as of Aug 1. The plan might have made health care "more affordable" than without it, but it still is not affordable. By the time you factor in premiums and deductibles, people over 55 are looking at $12,000 a year in up front costs before any benefits kick in. Then there will be co-pays.

What good does it do to reduce the cost of a $15,000 plan to $12,000, for people living on $30,000 a year or less? Either way, it's unaffordable. I'm guessing only those people who have really high medical costs, e.g. cancer and heart patients, will sign up. It makes sense for someone with $30,000 in costs to buy insurance even if the cost is $12,000. But for the average person whose current costs are significant but lower, it doesn't make financial sense to sign up.

This program is an advantage to the few who are facing high medical costs and who can afford the premiums. Not so much help for anyone else.

[ProSense]

217. No

As of mid August, 2,400 people applied for the plans run by the government.

In the 22 states where the plans are run by the federal government, a total of 2,400 people have applied as of Aug. 13, according to HHS, which would not release numbers for each state because it said they're "fluid." Application numbers vary considerably in other states that launched their own plans July 1: Montana had 100; New Hampshire, 12; New Mexico, 82; Oregon, 400; and South Dakota, 31. Connecticut could not provide an applicant total but said one person had been enrolled as of last week.

The national number is higher. For example, in PA, more than 1,700 of the 2,600 applicants are eligible.

The government began accepting applications in August so the 2,400 is for a less than two-week period. It will take time for these numbers to grow.

[totodeinhere]

208. It may not have directly caused the premium increases, but it didn't prevent them either.

And it should have if it had really been a bona fide HCR bill.

[Doctor_J]

213. It's been kind of a disaster politically and legislatively

Most of the critics when it was passed were right on the money - it made the Health Insurance companies' position even more lucrative than they already were. The stories like Vinca's seem to outnumber the success stories about 10:1. I was surprised at the time that Obama caved in to Big Insurance, knowing he and the Dems would be stuck with the results. He's a political novice compared to Bill Clinton.