The Dismantling of ObamaCare - Ongoing Updates.

[ARus]

And risk assessment is,necessary when we are pricing on what is essentially a sample of the population. When we cover the population, underwriting is not necessary and rates are simply claims trended + an admin charge. That is how carriers manage their various blocks.

I've looked at group claims where the carrier said it was 100% credible. My calculations showed only a 35% r^2 looking at rolling 12 month experience. At 24 months r^2 jumped to 65% which is still significantly below 100%. Throw in a std deviation and the renewal justification becomes pure hocus-pocus for a 1,000 member group.

Back off and consider renewals from carrier perspective and you realize that the groups are each smaller samples of the larger block. Carriers manage to break even on claims and whatever direct expenses are associated with a group and keep the admin fee for overhead.


There are huge economies of scale and per-person admin charges are next to nothing. This is observed by looking at a completely self-funded case.

ACA has had horrible and unpredictable claim experience because of adverse selection. The 2 options are to prevent adverse selection either by underwriting or enrolling all. Carriers use underwriting as competition. The healthy jump on the most stringently underwritten plan they can get. Unfortunately, health while under some individual control isn't completely controllable.

One statistic said "only" 6% of the population are covered by individual health plans. Some of those can pass underwriting. Personal philosophy determines what you want to do with the 3% or so that can't. You could say "pinche it let them pay or do without ". Or you figure some other way - even if your only reason for doing so is the realization that you may be there someday. Time goes fast and all will get sick sometime.

I repeat, the Repubs have no intention of fixing any thing and are getting boxed in. Cancel and/or institute pre-ex and they will be heald accountable . They will simply let it die while pretending to do something and of course blame Obama.

Pinche Trump

Yep, it was a banana peel from his party.

 

[atthewood]

I just don't understand why (other than too much pressure from the lobbyists) there is no talk about controlling the costs from providers first rather than about lowering insurance costs. Start from the horse not the cart. Make costs for procedures mandatory and easily available. Like a menu at McDonalds with the calorie count. Then there will be real competition. Then the prices being charged will go down and likely premiums will also. I heard one physician on Fox about 2 weeks ago talk about this but no one before and no one since. To me it's a no brainer.

 

[Yagents]

Price transparency and let market drive prices down

 

[Chazm]

I just don't understand why (other than too much pressure from the lobbyists) there is no talk about controlling the costs from providers first rather than about lowering insurance costs. Start from the horse not the cart. Make costs for procedures mandatory and easily available. Like a menu at McDonalds with the calorie count. Then there will be real competition. Then the prices being charged will go down and likely premiums will also. I heard one physician on Fox about 2 weeks ago talk about this but no one before and no one since. To me it's a no brainer.

Price transparency is one thing but this idea of the govt controlling cost by mandatory cost for procedures is horrible. Name on time the govt artificially creates or controls a cost and it works out well.

We need transparency not more govt controlled cost.

 

[somarco]

controlling the costs from providers

Take a trip down memory lane and study how well wage and price controls worked under the Nixon administration.

We need transparency

Price transparency exists if you do not present an insurance card and tell your provider you will pay cash.

 

[scagnt83]

Price transparency exists if you do not present an insurance card and tell your provider you will pay cash.

That is not true in a free-market sense of the phrase.

Price transparency must exist on the front end of a transaction, not the back end once the services are already complete.

Most Dr offices can't even tell you how much a simple strep test is if you ask.

 

[bluemarlin08]

My experience with price transperancy:

Office visits usually are, I could pay cash and cheaper than under plan
MRI and CT scans are the same, sometimes 50% less.
Never tried anything else.

 

[kgmom219]

My experience with price transperancy:

Office visits usually are, I could pay cash and cheaper than under plan
MRI and CT scans are the same, sometimes 50% less.
Never tried anything else.

2 Hospitals.

X hospital of Dallas

X hospital of Allen

One Parent Company

15 miles apart.

Same Insurance Plan/Network

Hospital A, "normal" delivery?
$2400

Hospital B, "normal delivery"?
$4700

Its ridiculous. And there is no easy way to get the info.

 

[yorkriver1]

That is not true in a free-market sense of the phrase.

Price transparency must exist on the front end of a transaction, not the back end once the services are already complete.

Most Dr offices can't even tell you how much a simple strep test is if you ask.

Up front transparency could work, potentially with a proactive carrier. The beginning of this has appeared: Anthem BCBS is calling insureds who have an MRI or CT scan ordered to tell them if there is another facility with lower cost. One problem, they aren't calling early on. They need better hands on communication and client coaching/assistance for this to work. A client last week mentioned receiving Anthem's call, but it was received the day before the procedure.

 

[somarco]

Most Dr offices can't even tell you how much a simple strep test is if you ask.

They can if you don't use your insurance card and pay cash. Have you ever tried?

no easy way to get the info.

How did you get it?

Up front transparency could work, potentially with a proactive carrier.

I have had health insurance through several carriers and had the ability to get estimates by procedure and by provider on several routine procedures. I have posted this before and apparently I am the only one who has found this and used it in the past.

Beating a dead horse here, but offer to pay cash and you will discover transparency.

Or maybe Ned and his providers are unique.

Too many people treat their health insurance card like a no limit credit card and never bother to research non-emergency procedural prices and drug prices before hand.

Before Obamacrap mandated maternity for all, I had clients that self funded their maternity bills. I gave them a "cheat sheet" on how to discover average costs and negotiate with the doc and hospital. Quite a few took my advice. One even put up a web page about his experience.