Where Do We Go from Here? POLL

[Yagents]

The poll results are very balanced. Seems like the "Nothing" crowd are the winners so far.

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This works out to $1500 per person enrollment cost. I'll do it for half that, and a team of 20 agents could produce the same result.

Obamacare program spends $22 million to enroll small fraction of enrollees: Report

Obamacare's enrollment assistance program spent $22 million to enroll 14,500 people in tax-subsidized coverage, a small fraction of the 11 million people who enrolled in the health plans, according to an investigation by the Washington Free Beacon.

 

[Key2Success]

The poll results are very balanced. Seems like the "Nothing" crowd are the winners so far.

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This works out to $1500 per person enrollment cost. I'll do it for half that, and a team of 20 agents could produce the same result.

Obamacare program spends $22 million to enroll small fraction of enrollees: Report

Well then, in the eyes of the government....it was an overwhelming success!

 

[junkman]

I don't see a desire in Congress to fix the system. They catch hell if they repeal. They catch hell if they don't repeal and raise taxes to pay for it. Insurance lobby has a say. RX lobby has a say. Medical lobby has a say. The list goes on.

Politicians keep mouthing about "carrier competition". There is no price competition when the carriers are looking at the same claims. They can force claims down with restricted networks, POS, EPO etc but premiums are all about claims.

Government could have a self-funded plan with carriers administering. That won't happen. The argument about admin costs and Medicare at 2% vs 17% for carrier administered. I'd like to see where those numbers came from and what's included as "administration". I suspect that the 2% number isn't including some necessary services.

Regarding the comment that "Aetna raised rates 4%. That is 1 data point only. Low rate increases (especially 0 increase) ONLY means that the carrier over estimated claims in the preceding year and premiums were higher than necessary essentially meaning that the payer over paid.

Unfortunately, people don't understand this. We had 1 case where renewals were always at least 20% and sometimes 30%. These were a group of accountants and they understood when it was explained - the carrier paid more in claims than it collected in premium. That means 1) your group received a discount off medical expenses and 2) the entire thing was tax deductible. They still didn't like the increases.

To fix this, we need to enroll everyone, stop the inflation and pay for it. We don't need to let carriers "become creative" and sell high commission cheap policies that don't pay claims which is one of the proposals on the tabe.

Does anyone here want to be covered by a hospital plan that pays 70% commission as your only coverage? Didn't think so but some Repub proposals are headed that way in the name of freedom, states rights and free market. **** them for even putting that on the table.

 

[FLM2]

Regarding the comment that "Aetna raised rates 4%. That is 1 data point only. Low rate increases (especially 0 increase) ONLY means that the carrier over estimated claims in the preceding year and premiums were higher than necessary essentially meaning that the payer over paid.

This has been the average increase for Aetna small groups in Florida for the past few years, far more than 'one data point'. And it's county by county, not single groups, that define the rates.

Of course it doesn't match your repeated contentions about your very small world where no one ever qualifies for underwritten health insurance (have you personally polled each and every person you meet with a detailed set of underwriting questions?).

My personal experience, based on 8 years of writing underwritten health insurance pre-2014 (at least 1500 cases), is that 80-90% of my clients qualified for individual health insurance with at least one carrier and without pre-ex exclusions that prevented them from taking the policy. During that time there were less than 5 recissions. I'm not saying that the system should go back to the old status (probably impossible at this point in time) but realism needs to play a role in whatever is done long term.

 

[junkman]

This has been the average increase for Aetna small groups in Florida for the past few years, far more than 'one data point'. And it's county by county, not single groups, that define the rates.

Of course it doesn't match your repeated contentions about your very small world where no one ever qualifies for underwritten health insurance (have you personally polled each and every person you meet with a detailed set of underwriting questions?).

My personal experience, based on 8 years of writing underwritten health insurance pre-2014 (at least 1500 cases), is that 80-90% of my clients qualified for individual health insurance with at least one carrier and without pre-ex exclusions that prevented them from taking the policy. During that time there were less than 5 recissions. I'm not saying that the system should go back to the old status (probably impossible at this point in time) but realism needs to play a role in whatever is done long term.

Aetna in TN has not been a player especially in small group. There was a time when they frequently were the lowest premium carrier. The only problem was there were no Docs in the network. We had a few cases with them and usually move them the next year because the employer decided that the network issues and employee complaints weren't worth the hassle.I understand how rates are composed and know what comprises the pool for the groups I have whether it's the group county or whatever. I've also run calculations that show a group that the carrier deemed "100% credible" was actually only 35% credible looking at 12 month claims and 65% credible at 24 months. This works for the carrier because any statistical variation in 1 group is offset by another group. The employer is left playing silly games like seeing whether the next month is a good claim month or trying to get 1 of at most 5 carriers interested in bidding against the current carrier. bla, bla, bla. Es macht nicht.

I stand by my statement on individual underwriting. You must be prospecting at the gym instead of your employer groups. Even people at the gym aren't necessarily healthy enough for individual underwriting. Rates get really low when underwriting weeds out all of the claims and no, most I know can't pass without riders or outright declines.

We agree at least one thing. We aren't going back to pre-ACA underwriting.

 

[benneaf]

Why Medicare Needs to be part of the Solution

By Andrew F. Bennett III

CEO Insurance That Fits


The Problem of what drives healthcare costs: The three main drivers of healthcare costs are: 1. End of life care, 2. Care of those with Chronic Conditions, 3. Discreet health events (think a heart attack, accident, or stoke that people survive and do not require ongoing care).


The problem of fragmentation: The individual market in the US is divided into so many different risk pools that costs cannot be distributed widely enough to drive costs down. Insurance is regulated at the state level, so you automatically have 50 risk pools. On top of that there are multiple carriers which split the risk pools even more. Even in the large group market there is still a great deal of fragmentation in the risk pools. That fragmentation leads to higher premiums. When risk pools are deeper and more robust risk is spread out further and costs come down.


The insurance card you carry from the large company you work for has an insurance company name on it. What many don't know is that many large companies self-insure and the insurance company provides only administration and probably a stop loss for huge claims. All those companies that self-insure are not in any insurance companies risk pool (except for the catastrophic event). All this fragmentation of risk pools increases costs.


The problem of competition: There is also no competition in the healthcare market outside of Medicare. Outside of Medicare we have the big 5 companies (Humana, Cigna, United Healthcare, Anthem, and Aetna). In addition, many states (about 37) also have not-for-profit Blue Cross organizations. So, in most states there are six major competitors. However, that doesn't paint the whole picture as in most states two of those six organizations have well over 50% marketshare. That is not competition. You can't make a sweet sixteen out of six competitors. In those places where two companies share most of the market you can't even make a final four.


The Solution


When it comes to those issues that drive the most cost in healthcare we need them dealt with in the most efficient way possible when it comes to paying claims. The system that takes care of most of those costs now is Medicare and it is one of the most efficient health insurance systems in the world. Medicare has a Medical Loss Ratio (MLR) of 97%. That means for every $1 that goes into Medicare, 97 cents is used to pay claims or make people healthier. No other health insurance payment system we have in the USA comes close to that.


Despite handling most of the costs associated with end of life care, premiums in the Medicare system are very low compared to what is available outside the Medicare world. When it comes to the cost of those with chronic conditions it costs much more to care for a 72-year-old with diabetes than it did 20 years before when they were diagnosed. Discreet health events (think a heart attack, accident, or stoke that people survive and do not require ongoing care) happen in and out of the Medicare system. The point is that Medicare already handles the lion's share of the major factors that drive healthcare costs and it does so very efficiently.


The proof, as they say, is in the pudding. Outside the world of Medicare if a 64-year old wanting a high deductible health insurance plan with a $5500 deductible and a $6700 out of pocket maximum could expect to pay around $600 a month in premium. A high deductible plan is going to mean substantial out of pocket costs in addition to that premium. Just one year later when the same person turns 65 and goes into the Medicare system they can get the Cadillac plan for half of that. That would be Traditional Medicare, a Part D plan, and a F supplement for around $300. In that case their out of pocket costs will virtually be limited to their prescription co-pays.


Medicare is the largest risk pool in America. If we add tens of millions of people to that risk pool who are not facing end of life care, who do not have chronic conditions, who only occasionally have discreet health events then Medicare Premiums should go nowhere but down.


Medicare provides a base of coverage, but there are deductibles and co-insurance to be paid. There are Part D plans that help cover pharmaceuticals. There are also Medicare Supplements (also known as Medi-gap). For the healthcare of anyone patient there could be up to four payers (Medicare, a Part D plan, a supplement, and the patient may have co-insurance to pay). So be clear, what I am suggesting is not single payer or socialism. What Medicare does is put most of the risk in one single pool and multiple ancillary risks into competitive risk pools.



Again, the proof is in the pudding. There are probably 40 or more companies just in TN selling Medicare supplements. There is a deeper level of competition both for Part D plans as well as Advantage plans. So, for those that want market driven healthcare where competition drives prices down…look no further than Medicare.


There is some talk about selling across state lines. Unless, the coverage is vastly different then a policy in Iowa is probably not going to have substantially different premiums than a policy in Kansas. Some politicians carry on about how each state needs the flexibility to determine its own coverage rules. The way I see it the human body needs pretty much the same care in Tennessee as it does in California. Some men get prostate cancer, some people have broken their foot in a snow sledding accident, some people have torn (dissected is the medical term) arteries, others get pregnant, others have gall bladder issues. All these things require healthcare. All these things happen in each and every state. All these things should be covered.


What I do not support is re-inventing Medicare into a single payer system. Medicare is not now, nor should it ever be single payer. It does not fit our economic culture. Given that Bernie Sanders is out there talking about creating a single payer Medicare for all system this may be news to some. Medicare is also not socialized medicine. Socialized Medicine is where the government owns the hospitals, owns the labs, owns the MRI and CT machines, and all the doctors and support staff are on the government payroll. That's not what Medicare is, it is not what Medicare should be.


If you want to see market driven healthcare, if you want to see everyone have coverage, if you want to see deeper risk pools, if you want to see cost effective health insurance…Medicare has to be part of the answer. It works and it fits the economic culture we have in this country. After than we can actually start to tackle the cost of healthcare and not just health insurance.

 

[TampaHound]

Can I change my poll answer? At one time I would have chosen the bi-partisan approach. However here we are a little more than a year past the election and Trump and the "far right" seem interested in dismantling everything. Even stuff that we all agree works to some extent (Medicare for example).

We are seeing more Moderate Republicans leave the House and Senate, while Trump offers to talk to the Dems but doesn't seem really interested in giving them anything. So I don't see any changes happening anytime soon.

Even if the Dems regain control of the House and Senate in 2018, their will not be enough support on the right to get much done. So...can I change my original answer?

 

[Yagents]

This is a Obamacare poll. You only get one selection during oep

 

[junkman]

@benneaf: med sups only cover last dollar benefits. The Medicare part A& B is highly subsidized. A more accurate measure of actual premium costs is the higher premium charged to higher income people or those that haven't contributed enough and have to buy into the system.

There is no competition at the carrier level since carriers are looking at the same data.

Also, providers do not publish procedure prices. The insured do not price shop or negotiate and are mostly concerned with contract out of pocket limits. Many for example wait until 1/1 then get both knees replaced for one OOP and are only concerned about medical outcome not cost.

Drug companies charge more in this country because they can mostly because we pay for healthcare with insurance. They sell the same drug in other countries for less as long as the price is more than manufacturing costs.

It matters not who administers claims so long as they have the infrastructure. Monthly claims/member is the largest portion of the premium. Tell the carriers that they get $1 PMPM for ASO services and they will line up.

I stand by former statements that the only way to have all eligibles enrolled is to give coverage. The only way to extract payment to those willing to go without coverage is to tax them. We could have copay plans for the lower income people and HDHP with HSAs for higher income people. We attempt to get the same results with the mandate and subsidies. It didn't/doesn't work.

The middle class are the people losing coverage now because premiums have gone through the roof and really become unaffordable.

Annual Premiums for a HW (age 50+) with 1 child hit $24,000 this year. They only need to earn <$80,000 to be stuck paying the full load. The premium is equal to buying a new car every year or a refrigerator every month. Only adverse selection accounts for the ACA premium level and rate increases we've seen. Something needs to change.

 

[benneaf]

Only adverse selection accounts for the ACA premium level and rate increases we've seen.

You pack quite a bit in there, but this one is maybe the biggest doozy. "Only" is a big word here. The reinsurranice program got killed, Trump just rolled back the mandate, he''s not paying cost share subsidies, some states didn't accept Medicaid expansion.... There''s much more than just adverse selection driving up prices.