Where Will We Be in 5 Years Without Reform?

[ABC]

Those are good questions and I can not answer all of them.

I know this if you let me sell a health insurance plan with my state contract to people on the east coast they would save 1/2 if not more.

The problem would be services might not be paid at the same level as their state polices even using national networks. So in my state maybe a wellness visit might have a total possible charge of $1,800. Well in NY those same procedures could cost $3,600 and in LA they could cost $7,500. Now since that contract has my state then they are only going to pay $1,800 and the insured is stuck with the rest of the bill.

This would be a huge factor but we could get most people insured because the premium would drop.


As far as plan sales I would stick with the plan in my state and sell them to other states.

Your national carriers would pick the best state to sell out of from a mandate standpoint. We would have some serious problem in the beginning but they would get worked out.
The Doctors would end up making less. So the Doc. goes from $950,000 to $800,000. That will not change their life style.

ABC...if that were to happen, how would that affect us?

Would we have to be licensed in every state? Would quote engines like Norvax become useless? Would there be thousands of plans we would have to keep track of?

Maybe I'm reading too much into it.

Thanks.

Webcuriousity was used in this post.

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I was asking AL WTF he was talking about.


sorry about that chumps!

 

[somarco]

What needs to happen is interstate health plans.

If carriers can compete in each state without dealing with DOI's mandates then we will see rates drop. Think if 300 carriers competing for health plans in each state.

Crossing state lines won't accomplish anything without relieving carriers of the requirement to cover mandated benefits. If the DOI in each state is inclined to lift mandates, even if for a limited number of plans, then you no longer need to sell across state lines.

Selling across state lines does not relieve the carrier of the requirement to file plans, rates, underwriting guidelines, policy forms, etc. Even if the carrier uses an association model, they are still required to file documents with the state.

And I don't see that having more carriers offering products helps. This is the same argument the folks in DC are using for the public option. They point to states like WV where BX has 85% or so of the market. How will introducing more carriers help?

It won't.

Prospects can't make up their mind from a dozen or more carriers offering 3,000+ plans as it is. I don't see adding more carriers and more plans helping.

Premiums are driven by claims and claims are manipulated by benefit levels. Richer plans pay more claims and (should) have higher rate increases.

Some of the claim totals are influenced by shock claims, but those claims account for less than 10% of total claim dollars. The bulk of claims paid are for chronic conditions, many that could be reversed or prevented with better lifestyle choices.

The idiots in the MSM point out that premiums are increasing at a multiple of wages but fail to mention this is directly caused by carriers paying out more in total claim dollars. Shifting the risk for manageable claims, those under $5,000, back to the insured will make a drastic difference in premiums.

If copays were eliminated and deductibles lower than $5,000 were outlawed we would see a noticeable drop in premiums. Couple that with eliminating state mandates and suddenly health insurance is affordable again.

So in my state maybe a wellness visit might have a total possible charge of $1,800. Well in NY those same procedures could cost $3,600 and in LA they could cost $7,500

Carriers will adjust their rates to reflect the "going" charge for procedures. That means a plan I can offer for $300 will not sell for the same premium in Miami where costs are significantly higher. All other things being equal (such as elimination of the state mandates) means Miami premiums will still be higher than in Atlanta.

 

[sunmed]

Right on Somarco

 

[Crabcake Johnny]

Well since all of this is claims driven it makes sense that unless health is addressed nothing will work.

 

[Bitnis]

What I see is one side pushing for government run healthcare and the other side pushing for status quo. The status quo is a freight train headed for a cliff. I don't see anyone offering a way to make the current system more affordable.

If somebody doesn't come up with a viable alternative real fast like within days, public opinion will move towards whatever CHANGE is being offered. As far as I know, the only change being offered is a public option.

 

[Crabcake Johnny]

I don't see how anyone could push for the status quo. Even the worse most greedy agent knows the current system is broke and we need a drastic overhaul.

No one who's willing to pay for health insurance should be denied. Not all conditions are preventable. This is not auto insurance. Good safe drivers don't get DUI's. Good people can get cancer and have it be completely unpreventable.

People lose jobs, Cobra expires and find themselves unable to afford HIPAA plans. People have jobs where no health benefits are offered. People with benefits find that adding their family jacks the rate to "$850" a month.

I'm for GI. How to go about it? I don't have the answers.

 

[somarco]

Until someone addresses the claim side, the inflationary cycle will continue.

No one in Congress, or anywhere else, is talking personal responsibility which is what it will take. Covering preventive care is not the same. Even wellness programs don't have much if any effect in the short run. Since many fall off the wagon their long term viability is in question as well.

We can address, and lower, premiums using measures outlined above. Eliminate mandates, eliminate copays & lower deductibles.

Those are major starts.

The problem is not so much the cost of health care for serious illness. Those claims are a relatively small portion. Sure, some illness related claims go into the hundreds of thousands and even millions of dollars, but those are not the ones driving premiums. Big claims have less than a 5% impact on premiums. Insignificant.

It is the day to day claims that should never be a claim that drives premiums. It costs money to pay someone to adjudicate a $50 claim. The cost of adjudicating a $500 claim is essentially the same.

Rx claims are automatically repriced via software automatically and instantly. No reason why PCP claims cannot be handled in the same manner.

We could offer GI on a similar basis to dental benefits and have a minimal impact on premiums.

First year, reimburse at 20% or less (for the existing condition), or perhaps set a cap of say $5,000. Second year increase to 50% and maybe $15,000. Third year and later full coverage.

Or we could simply do what I have suggested before and that is put those folks in Medicare. If they are disabled, they will eventually get there in two years. Put them in (on a paying basis) from the get-go and be done with it.

 

[Crabcake Johnny]

I don't believe GI rates will be sustainable without a mandate. We'd need a huge pool of healthy 20 and 30 year olds to keep premiums down.

How do you mandate coverage? You can use the Mass. model...but that's not working.

 

[somarco]

You really can't mandate coverage. Even if you do, as you and others have pointed out, it won't work.

An actuary/friend said there are too many in the uninsured count (pick a number) that are in very poor health. Premiums on a 20 - 30 yr old, unless they impose community rating which really sucks, will not offset the losses on a 50 year old with heart disease.

The Medicare buy-in is the best model for uninsured's, and Medicaid buy-in for those who cannot afford insurance. Implement both along with a mandate.

That is the least disruptive to the overall system, the least expensive, and doesn't require 47 new govt bureaucracies to manage it.

What they are doing in DC, and what they have done in MA, are just plain stupid. It is worse than watching sausage being made.

 

[JustinUpright]

As far as I know, the only change being offered is a public option.

That is because the media doesn't want you to know about the other 25-30 other plans in the house and senate. I am not saying one of those is the answer but the people running the PO through with out any one reading or debating the issue don't have the answer either.

Reform needs to happen but not at the extent of taking freedoms from the citizens.