Where Do We Go from Here? POLL

Discussion in 'Health Care Reform Forum' started by Yagents, Jul 18, 2017.

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Where do we go from here? POLL

Poll closed Aug 17, 2017.
  1. Nothing - No ACA fixes - status quo

    29.8%
  2. HHS Rulings and band aid bills

    17.5%
  3. Hail Mary repeal and/or replace bill

    17.5%
  4. A bipartisan bill to fix ACA

    35.1%
  1. Yagents
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    Yagents Guru

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    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

     
  2. Key2Success
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  3. junkman
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    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.
     
  4. FLM2
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    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.
     
  5. junkman
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    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.
     
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