Tom Price & HHS's New Actions

[nylife11023]

The carriers want to be able to cherry-pick via pre-ex underwriting.

That is politically unacceptable.... unless there are "equal coverage" government-paid high-risk pools available to accept impaired risk.

We know from experience that risk pools end up being bottomless pits that money is thrown in... or the reimbursement levels are too low such that providers won't join the networks.

If there is 'gridlock' all the carriers are going to leave the exchanges. What will take their place? My guess (read the bold words again!) will be IFP single payor... with a mandate of some kind. And perhaps it will morph into a program that will eventually remove the tax advantages that group plans have.

But it doesn't have to be.

The new administration and the GOP Congress have this one-time chance to not only change payment mechanisms but to actually control the costs of healthcare and stem the annual 10%+ increases.

I hope they take their time and do it right. The country can limp along for two or three years with ACA while the best minds in the healthcare sector hammer out a system that will work for the next twenty five.

It is a great opportunity for agents to step-up to have a seat at the table and be part of the dialectic. The last time agents were thrown under the bus by NAHU. I hope it is different this time.

 

[junkman]

The carriers want to be able to cherry-pick via pre-ex underwriting.

That is politically unacceptable.... unless there are "equal coverage" government-paid high-risk pools available to accept impaired risk.

We know from experience that risk pools end up being bottomless pits that money is thrown in... or the reimbursement levels are too low such that providers won't join the networks.

If there is 'gridlock' all the carriers are going to leave the exchanges. What will take their place? My guess (read the bold words again!) will be IFP single payor... with a mandate of some kind. And perhaps it will morph into a program that will eventually remove the tax advantages that group plans have.

But it doesn't have to be.

The new administration and the GOP Congress have this one-time chance to not only change payment mechanisms but to actually control the costs of healthcare and stem the annual 10%+ increases.

I hope they take their time and do it right. The country can limp along for two or three years with ACA while the best minds in the healthcare sector hammer out a system that will work for the next twenty five.

It is a great opportunity for agents to step-up to have a seat at the table and be part of the dialectic. The last time agents were thrown under the bus by NAHU. I hope it is different this time.

10% is the long term problem that has been around since at least 1985 that I know of. The country has managed to tolerate it. The ACA rate increases is the 10% trend on top of run-away utilization of ACA. My group plans are still kickin along at 10%. My ACA went up 100% this year.

Tom Price won't do squat to fix things. He don't care.
How about we take the same plan designs that Congress has. I'd be happy to pay the full premium. Congress has their employer (us) pay 1/2.

The full load for me would be only $600 for the family with a lower OOP than I've seen in years.

 

[Libertarian4Trump]

In a lot of counties this past OEP, the only on-exchange carrier that paid first year commissions was Ambetter. Problem is, Ambetter has a terrible provider network in many areas. What's going to happen when this becomes the norm, when the only option you have for your clients that pays any commish (I don't work for free) are crappy carriers that no doctors want to accept?

 

[Yagents]

They just extended grandmother's plans until Dec 31 of 2018. Yay! Now it's up to the carriers and states to allow it.

 

[AllenChicago]

They just extended grandmother's plans until Dec 31 of 2018. Yay! Now it's up to the carriers and states to allow it.

I don't like this. Why not just make them legal for an infinite amount of time, if the insurers want to?

 

[kgmom219]

I don't like this. Why not just make them legal for an infinite amount of time, if the insurers want to?

You're killing me. I am going to give you my standard line I give to engineers, computer people, etc.

"Its HEALTH INSURANCE. Its NOT LOGICAL. If it was logical, it wouldn't be health insurance. The sooner you accept that there is no logic in health insurance, the happier you will be"

 

[Yagents]

I don't like this. Why not just make them legal for an infinite amount of time, if the insurers want to?

If you haven't noticed, a common theme is "copy Obama admin":

1. It's in the law that grandmothered must terminate, Obama extended them via HHS ruling to avoid being caught in his lie of the century, Trump is copying and extending further. Libs don't have a counter argument, nor claim he is undermining the law. This feature can only be changed with a full repeal.

2. OEP was going to be 45 days in 2019, Trump just moved it up to this year. If it's good for the market in 2019, why not now. No counter argument.

3. IRS - has been accepting "silent" returns in past, will just continue to do so in the future.

4. SEP verification, was going to be 50% in June, now will be 100% of applicants.

I'm sure there are more examples of these easy changes.

 

[scagnt83]

Only thing that will fix this mess is to combine the Group Insurance demographics along with the Individual Insurance demographics. (Sure that will scare a lot of people initially, but it will do wonders for competitiveness and efficiency within the economy. Deep down, no-one "likes" having their policy handcuffed to their current job)

Move health insurance market to all HD Plans w/ HSAs. (proven to lower over-utilization)

Provide options again on what people do and dont want covered with their insurance. (I dont need chiropractic benefits, and my 45 year old neighbor who's tubes are tied does not need pregnancy benefits)

Let the Feds provide a reinsurance program for those who can afford insurance but have excessive claims. (this takes away subsidies at the individual level and directly lowers premiums instead, which cuts red tape and simplifies things for the american people)

Let those who cant afford private insurance go on Medicaid or buy into Medicare based on income.

Done.

 

[junkman]

Scant, exclusions of things like, chiropractic and maternity are minor because the claims are small. The big maternity claims are for premature births. Newborns are covered and would be regardless. There is no large maternity premium for a 45 yr old. It is the young that get pregnant easily. They need maternity coverage. Those benefits cause a 1 time change. Likewise with wellness. Trend is the real problem.

Dumping the currently enrolled into the group pool would cause group rates up. We need the healthy that have opted out of ACA. Figure out how to get them without giving coverage and you've earned your keep. Figure out a politically acceptable way to pay for it. Coverage paid with taxes on all and HSA options for higher income would do it.

Low incomes don't buy without 1st dollar benefits and don't pay unless forced. Higher incomes opt for lower premiums because they an fund several thousand in claims.

People above the subsidy level are who is being priced out now especially those 45 +.

There is some small group of "Margaret Thatcher conservatives" that say on the one issue of health care everyone deserves access. This group is promoting government health care.

Whatever comes out we'll deal with. Current proposals are only smoke and mirrors.

 

[scagnt83]

Scant, exclusions of things like, chiropractic and maternity are minor because the claims are small.

It was a simple example of the many different "essential health services" that Ocare required policies to cover.

And no it is not minor. I used to sell individual health back when you could actually choose what benefits you needed. Maternity, Chiro, and Mental Health services used to jack up the premiums a good bit.

Perhaps you consider a 20% increase minor. I do not.

When I heard the requirements I immediately knew premiums would rise a minimum of 20% over the first couple of years of ACA. Because I knew how much those things raised premiums when added on to a policy.

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Dumping the currently enrolled into the group pool would cause group rates up. We need the healthy that have opted out of ACA. Figure out how to get them without giving coverage and you've earned your keep. Figure out a politically acceptable way to pay for it. Coverage paid with taxes on all and HSA options for higher income would do it.

It all comes out of the same pot... tax dollars. Group Premiums might not be going up at the same rate. But businesses are being taxed more to help pay for ACA. Which supreses compensation within those businesses.

Employees might not have seen large premium increases yet. But the employers have seen them. Instead of passing it down, they absorb the extra cost. That extra cost, combined with higher taxes, has suppressed incomes for those employees.

How do I know this? Because I still work the group market and business owners are telling me this all the time "wish I could give raises this year, but this 15% insurance increase just killed that idea".


The healthy who have opted out of ACA would do extremely little to stabilize rates. Obama blamed it all on 20 somethings not buying coverage. Thats total BS. Look at the numbers. It was unsustainable even with the young healthy demographic. The whole thing was designed to implode so that universal coverage would be the only solution.