I’m not sure it will be worth discussing insurance details in this thread, but let’s give it a try. You can’t end the pre-existing condition exclusion without seriously damaging or even bankrupting the insurance industry. Insurance companies depend on most people being healthy and only some being costly, and a few very costly. You can’t allow people to wait until they are sick to sign up for insurance, because healthy people won’t sign up until they are sick.
It’s a three legged approach – everyone has to sign up…so you can eliminate the pre-existing exclusion…requiring subsidies for people who can’t afford insurance but are required to anyway.
Obamacare has had one of those legs sawed off, the individual mandate, which has no penalty and no mechanism to enforce currently. The subsidies cut off too early. We need to beef them up. And we need to make the mandate a real thing. Only then, do we get to 3 legs. Gee, where have I heard this before?
I’m surprised as anyone that it’s still going as well as it is. I guess enough people signed up when they had to and got enough benefit that inertia keeps them insured. This can’t last, of course – need to get that leg back on.
Back to the policy, one question was what was the best way to get people covered? Who will need subsidies? Well, young people tend to not have much money, but tend to be healthy, so if they’re lucky enough to have parents with insurance, let them stay on until 26. Medicaid was fairly effective at covering the very poor – expand that to cover the not-as-poor. And so on.
puddleglum, can you respond to the responses to your post? It seems to me that they could use a response from you – either a clarification or an admission that you were in error.
In 2013 the census bureau changedthe questions it asked about health insurance. They did this because of consensus that the old survey was overstating the amount of people without insurance. This resulted in an immediate change in the estimated number of people without insurance. Given that the uninsured rate stayed in a narrow range for the 20 years before the change in survey and has stayed in a narrow range since the change in survey almost all of the change in the 2013-2014 time period should be thought of as an artifact of the change in survey.
Growth rates in health care spending were down slightly for two years after being higher than normal the previous two years. As your cite says after higher growth the two years following Obamacare implementation the growth of health care spending resumed its slow growth rate that had been the norm for the decade before. No reason to give credit to Obamacare for a growth rate going back to what it was the five years before Obamacare.
Similar take as the census, currently estimated as 9% uninsured (different estimates can vary some, depending on sampling techniques). Uninsured rate reduced greatly in 2014, when the exchanges powered up. Anyway you look at it, the uninsured rate in the US is much lower than before, and the plummeting took place when the ACA’s exchanges started.
Employer based health insurance has never had the pre-existing condition rule. The old rule did not just cover those who never had insurance, but those who might have lost insurance coverage and then had to sign up for a private plan.
However the mandate still makes sense, just because young people always will subsidize old people. I’d be fine letting the young off the hook so long as they promise to never grow old.
What good is a premium/policy when your deductible and max out of pocket expense is like $10k (on the low side)? You’re still up shits creek if you have an accident but hey, your doctors visits are $25 instead of $75.
Even now, most people who had insurance before, now have a policy with premiums that are basically the same as they were paying before with much less monetary coverage.
Middle class peeps who don’t get any subsidy still need to keep on hand, every year, enough to pay the premium, the deductible, and the max out of pocket expense, plus whatever “percentage” of coverage thereafter 60/40 80/20 etc. it’s an abomination.
It used to be that a households biggest expense was a mortgage. Nowadays, insurance is often the largest expense.
Nice factoid. I wonder what those census bureau numbers were? They were NOT the ones in my cite. Those were based on Gallup’sapples to apples numbers of “Americans’ answers to the question, “Do you have health insurance coverage?” Sample sizes of randomly selected adults in 2018 were around 28,000 per quarter.”
To expand on the CDC cite above you can follow to their data set for the uninsured rates:
Dayum. An over 43% drop in the number of uninsured from when the law was signed to the end of Obama’s terms. Uh yeah that is fewer people going without insurance. But still a ways to go.
Their method each time samples about 35,000 households and about 87,500 individuals. Their results and Gallup’s pretty much agree.
The real question though is hinged on whether better preventative/wellness care and earlier detection and intervention will in fact over time lead to significant cost savings. That it leads to healthier lives lived longer is a pretty much sure thing, but less spent over time as more live longer, even as they live better? Not as much of a sure thing.
Indeed some of this may have happened even without the ACA as the industry was already in flux making some changes to contain costs and to incentivize value. The ACA pushed it along though for sure.
So, while I encourage you to push Republican health care ideas HARD during the upcoming election season, I don’t have your electoral success in mind when I do so.
That is categorically false, and a misunderstanding so bad that I can’t let it stand. What employer-based insurance did or did not cover depended entirely on the employer and the policy. Some employer insurance plans didn’t kick in for three months after employment, some didn’t cover pre-existing conditions for a year, and a whole bunch of them wouldn’t cover any pregnancy expenses for a year.
The census is the agency that handles the National Health Interview Survey for the CDC. It is the same information about the survey that was changed in 2013.
There’s no survey that doesn’t confirm that, and the way you talked about the uninsured rate was to present it in the least favorable light. I definitely think the ACA needs a lot of work, as any large bill would. Costs are still an issue, and “underinsured” is a growing problem. But the ACA has had a noticeable impact on the uninsured rate. And if it were repealed, the CBO estimated that about 17 million people would lose their insurance immediately, and 27 million within two years and 32 million within 8 years.
Accepting your premise that the CDC’s data before 2013 might be invalid (which time permitting I will return to) there is the simple fact that from that first of the new census methodology year, 2013, when the exchanges opened, to the end of the Obama terms, there was a drop in the uninsured from 16.9 to 10.3, a decrease of 39%.
Gallups’ numbers using a different data set went from 18.0 to 10.9 in that same time period, a same 39% decrease.
Your link on the changed census method mentions that for historical comparison one should look at the American Community Survey (ACS)
Uninsured rates dropped by nearly 40% by multiple different apples to apples means of measurement.
survinga is completely correct.
Last of all - it seems that while the census bureau administers the NHIS for the CDC it is NOT what had its method changed in 2013. Its methods had been last revised in 1996 and in the field 1997.
Rather than addressing this claim directly, I want to pose a follow-up question to you — a follow-up which often helps illuminate economic subjects.
Books balance; equations equate. If an organization takes in $1 million over a year, then $1 million in combined payouts or cash accrual will occur over the same time-frame. The payouts may be to suppliers, stockholders, corrupt politicians, or whoever, but money doesn’t disappear.
In your scenario where you allege someone receives less healthcare for the same money, where do you think that extra money ends up?
Obamacare has been a quite successful policy overall, with the obvious caveat that its “success” has so much geographic variability that any discussion of the policy can be selectively skewed to adhere to negative Republican biases. I.e., Obamacare has been a smashing success in my state of CA - which created its own state-based marketplace (Covered CA), aggressively marketed it, and expanded Medicaid (Medi-Cal in CA) - while it has been less successful in states like TX and FL, mostly due to those states’ refusal to expand Medicaid.
Still, a couple of things about the ACA’s design stick out now for being spectacularly foolish policy decisions. First off, for all the hoopla over the individual mandate - massive political opposition, enduring unpopularity, and the 2012 SCOTUS case - the bottom line is that the ACA is totally functional without that penalty because it’s the subsidies that keep consumers enrolled rather than the government’s inducement to acquire a policy. It would be the largest of ironies now that the insurance market has mostly stabilized without the mandate if the Fifth Circuit were to toss the entire law because of a cockamamie Republican argument that the mandate is actually inseverable.
Secondly, and this is the element that makes the initial ACA drafters look the most foolish in hindsight, lawmakers really, really underestimated the ability of Medicaid expansion to be as successful as it turned out to be in bringing insurance to people. Expanding Medicaid was, if anything, an afterthought in the ACA formulation phase, and yet that’s been the most successful and popular part of the entire program. It’s why you see so much renewed interest in Medicare-for-all - that’s the easiest and most politically safe way to expand coverage to people!
If I as a provider see that your accident bill is likely to be $50K or $100K, but you have insurance, then I know that I’m going to get paid for most of the bills, even if I have to work with you or struggle to collect or even write off that last $10K that is your responsibility.
If I as a provider see that your accident bill is likely to be $50K or $100K and you have no insurance, then I know that I’m going to struggle to get paid any significant part of your bills, and may end up having to write off that entire amount. What is my motivation to provide you anything more than the barest minimum treatment consistent with my obligations under EMTALA or other laws?
The hospital ER is obligated to provide some level of emergency treatment at least to stabilize your condition. The physical therapy office, to name one example, has no such obligation, and is free to tell you to go away, even if PT would benefit your recovery. They do not have to accept you as a patient until and unless you can prepay the entire amount of your expected bill, and it is not at all uncommon that they do tell uninsured patients exactly that. With insurance, even with high and perhaps unpayable deductibles, you can get in the door; without insurance, that door is firmly closed.
On your first point, I agree that the exchanges have largely stabilized. However, there was an initial surge in premiums to take the dropping of the mandate into account. And for middle-class people who make too much to get subsidies, they have now essentially been priced out of the market. The main problem with the ACA, aside from political sabotage, was that the original scale of subsidies was too weak, and people in that middle-class category who don’t get employer-based insurance can’t afford a decent policy. So, the exchanges still stand, but the customer-base is mostly people making near-Medicaid-eligible wages (poor people, and sick people). Obviously, the ACA targeted this group. But we need to beef up the subsidies so that a broader group of the population is attracted to the exchanges.
On your second point, I agree 1000%. As an aside, I think about 35 or 36 states have adopted the expansion. The holdouts are almost all red states (and some purple states). Getting all 50 states into the expansion would be good for the country as a whole, and it would also be good for rural hospitals, which would then get more funding…
I didn’t appreciate being required to buy insurance that started off expensive and got multiples worse each year. But as flawed as the ACA was, at least it was an effort. Now that it’s been neutered I hope we can learn from it and move on with something better.
It has been neutered from the start and Republicans have no clue how to institute a better plan. If you want it improved, you should vote for Democrats.
Good riddance. Why are we keeping these dinosaurs around anyway? And worse, why are we acting like they are the only stakeholders in this debate? Why should I care about them when they never cared about me, and did everything in their power to avoid paying my bills despite that being the only “service” they ostensibly offer? They’re nothing but parasites, pure and simple. Gross, low, reprehensible parasites.
Fuck 'em. That’s what I think about the insurance industry. And I’m far from the only one.