Graham Cassidy Legislation

[somarco]

Obamacare had the biggest impact on the individual health insurance market. Not so much on group insurance, especially those with 50+

Large groups with employees in multi states work because the benefit package is mostly standardized for all. Very large groups may have regional HMO options but the PPO network performs reasonably well except in the very rural areas.

Employees have few choices other than the employer plan and most of them have no clue the impact Obamacare had on their plan design. They blame the employer and carrier for higher deductibles, copay's and OOP.

National individual plans don't work because of networks, or the lack thereof. Even the BS of Obamacare allowed for state to state differences.

How well Obamacare works depends on whose ox is being gored. If you are paying the full premium you don't like it so well. If you get a free ride in a subsidized plan you think it is great but even that group of people is very small, something less than 15 million people depending on whose numbers you want to believe.

Those on Medicaid like the idea of no premium but they hate the fact they have trouble finding docs willing to take them as patients.

If you think individual health insurance was broken before 2014 you really don't understand risk management.

Health insurance was just as broken as life insurance, car insurance and loans. Only the good risks can purchase life or car insurance (except the high risk folks) or get a loan.

You buy life insurance and car insurance BEFORE you need it, not after the fact. Health insurance used to be that way but no more.

You borrow money BEFORE you need it but you can only get it if your credit is decent.

Whether DC repeals Obamacare or not really doesn't matter. The carriers for the most part have picked up their marbles and gone home. I heard today the House and/or Senate hopes to have R&R ready by the end of the month.

So?

It's not going to change a thing for 2018. Prices will be high and choices few with or without R&R.

I still believe the individual market is dead and will not be surprised if it completely vanishes before 2020. DC needs to be thinking about Medicaid for all to replace individual health. That will be much less expensive than Obamacare or Bernie Health Insurance for all.

 

[VolAgent]

Vol and I were not discussing Premiums. We were discussing consumer needs and Plan Design.

Some states are more expensive and some are cheaper. That is due to the cost of living and cost of care in that area. Not because people in CA have different health care needs than people in TN.

Exactly. Yes costs are higher in LA than Memphis or Nashville, but the actual need doesn't change much.

Ignoring a couple of states that did their own thing, Med Supps are the same regardless of what state you are in. Now, the pricing definitely changes depending on zip code and local costs, but the plan remains the same.

 

[leevena]

Some very good points are being made. A couple of things.

I have not read the details of bill. As usual, it will change so I save myself the time and wait.

Large Fortune 500 companies do not have network issues because they are usually self funded.

Issue with state and their healthcare needs may be something different. I believe it may refer to the concept that each state can create itself as it sees fit. So if california wants to be a single provider with universal care they can. And if my state want to create something on the other end of the spectrum, with underwriting and no guaranteed issue, it can.

Just some thoughts.

 

[junkman]

@somarco,
There are alternatives to borrowing money, buying car or life insurance. I can pay cash to avoid loans, ride my bike to avoid car insurance and do without life insurance. I can even live healthy and try to avoid the healthcare system. Sometimes stuff happens and you end up in the hospital. Healthcare avoidance is at least partially only luck and not up to individual choices.

The system has been broken at least since I've been licensed. Premiums have gone up at double digit rates for years. That's a problem. Pre-ex was a problem until ACA. The ACA pre-ex fix caused other problems. I'm not sad that the old individual system was trashed. I'm sad that the balls to fix it weren't there.

I just read some ridiculous trash by Kaiser saying that "rates are stabilizing as evidenced by the small 4% rate increase after plan modification". Plan design change buys a cheaper plan. It does not mean that rates didn't go up.

The sooner this thing crashes, the sooner we can move on. There are currently no good options in TN for the unsubsidized. Perhaps Congress should be forced to buy on the exchange at full price for their resident state.

 

[AllenChicago]

@somarco,
Perhaps Congress should be forced to buy on the exchange at full price for their resident state.

That's an excellent idea. After all, why do they get a 75% subsidy, when they are way over 400% of FPL?

 

[wc2624]

Yes and no. It's about politics now. The Republicans will have some backlash if they repeal it or not. It's just a matter of how much. Do they want to try and keep traditionally blue states of PA and MI red? They would lose a lot of funding under the current plan.

Ohio is also a loser and that state can go either way. Although it's been blue more than red in the past.

The 2018 elections are just around the corner and if your a Senator in a close district how do you want to be seen? Is the base loyal enough for you to keep your seat? Or do you go home and face an angry crowd?

It stopped being about health care some time ago, now that the Republicans have power, they don't have a solution to the mess they find themselves in.

It won't pass for the reasons above.

I'm in agreement that it is nearly a complete Political issue at this point and all that is at stake is having something...anything....pass.

However I disagree with your conclusion for the same reasons you list and that it will go through.

 

[somarco]

DC run health care / health insurance has ALWAYS been a political issue. It is foolish to believe otherwise.

 

[junkman]

They don't have the votes. Main problem is how each side deals with the other. Winning means getting all of the bennies, not giving enough to the other side.

Union did it after the Civil War, victors split up middle East like they were splitting pie after world war. Only years later do we see full effect.

Congress "could have " written rules where most charges qualify as "allowed" and eliminated adverse selection. Income disparities could be dealt with by plan design. Now we have a cluster headache and the same idiots fighting over all of the marbles.

We need all enrolled with HDHP for those that have money and inexpensive clinics to access the routine non-life threatening small stuff. Most could be handled by the market with regulation to reign in the greed. Unfortunately, you always need regulation to prevent some asses from doing what everyone knows shouldn't be done even if legal. Blowing the tops off mountains is an example.

 

[Yagents]

Many hurdles and I don't believe the stars will line up.

1. Must pass the senate parliamentarian smell test. State waivers won't pass muster.

2. Murkowski "alaska purchase" must be bought to have a chance of getting votes. Then they will work on Collins. McCain will cave as Gov Ducey gave ok.

3. Must be budget neutral at least according to CBO, and the bad numbers from the coming projection will not help public majority opinion of fixing ACA instead.

4. Oh, and the exact bill, down to the comma, must pass the house. Another heavy haul.

 

[SamIam]

Many hurdles and I don't believe the stars will line up.

1. Must pass the senate parliamentarian smell test. State waivers won't pass muster.

2. Murkowski "alaska purchase" must be bought to have a chance of getting votes. Then they will work on Collins. McCain will cave as Gov Ducey gave ok.

3. Must be budget neutral at least according to CBO, and the bad numbers from the coming projection will not help public majority opinion of fixing ACA instead.

4. Oh, and the exact bill, down to the comma, must pass the house. Another heavy haul.

They only need 2 of the 3. senators and they wil buy Lisa. House freedom caucus said they will pass it moderates will to.

They don't care what the CBO thinks

I hope it doesn't pass this bill is brutal I liked the skinny bill better but this is brutal.