If you’re wondering where 94% came from, and to be honest I was too (I had no idea til just now), I found this PDF at the CMS website: link .
The normal AV for a silver plan is exactly what you said, 70%, meaning a person with such a plan would/could be on the hook for 30% of costs.
However, at the very bottom of that PDF it contains this passage about Alternate AV (and Kaiser is obviously aware of it when they created their calculator):
Affordable Care Act cost-sharing reduction (CSR) requirements for enrollees falling below 250% of the Federal Poverty Level (FPL) under section 1402(a) through (c) of the Affordable Care Act. Under the rule proposed to implement section 1402, issuers of qualified health plans must provide plan variations to eligible lower-income enrollees, who have enrolled in silver qualified health plans
To use the AV Calculator to verify the AV of a plan variation, users should select the indicator that the plan meets the CSR standard, and select the desired metal tier. In the below table, we provide guidance on which metal tier should be chosen to align with the expected utilization for each plan variation. Please note that the metal tier continuance tables indicated below should be used regardless of any error message prompting the use of a different continuance table.
And the table:
100-150% of FPL Plan Variation 94%
Farin
October 31, 2013, 12:18am
163
Martin_Hyde:
If you’re wondering where 94% came from, and to be honest I was too (I had no idea til just now), I found this PDF at the CMS website: link .
The normal AV for a silver plan is exactly what you said, 70%, meaning a person with such a plan would/could be on the hook for 30% of costs.
However, at the very bottom of that PDF it contains this passage about Alternate AV (and Kaiser is obviously aware of it when they created their calculator):
And the table:
100-150% of FPL Plan Variation 94%
I see where the disconnect is. Basically, you enroll in “federal” medicaid as an end-run around states that don’t wish to expand medicaid. It costs a token amount each month with what amounts to co-pays to service providers.
That’s sneaky.
But at least the completely destitute are helped. I wish they had done more for the sorta destitute and middle class that have to bear the burden of this.
elucidator:
But, all right, beware the Death Sprial. Damn right I will!
And I sincerely hope that our various insurance companies are also aware of the dread menace of the death spiral. Must be kinda sneaky, since “many insurance companies have had death spirals”. Heavens! A menace so insidious, even after other insurance companies have already fallen prey, others don’t catch on, they just stumble blindly into the Death Spiral Tar Pit, their bones mingle with the stegosauri.
Fotheringay-Phipps:
That’s not the only million dollar question. Because insurance is different. As my learned colleague elucidator expounded earlier, there’s this death spiral issue. If the exchanges benefit all sorts of people in the short run, but the mix of people is skewed to the unhealthy side, which pushes up the rates, which skews the mix further, and so on, then they will ultimately fail.
Early returns not looking good. From the WSJ
Insurers say the early buyers of health coverage on the nation’s troubled new websites are older than expected so far, raising early concerns about the economics of the insurance marketplaces.
If the trend continues, an older, more expensive set of customers could drive up prices for everyone, the insurers say, by forcing them to spread their costs around. “We need a broad range of people to make this work, and we’re not seeing that right now,” said Heather Thiltgen of Medical Mutual of Ohio, the state’s largest insurer by individual customers. “We’re seeing the population skewing older.”
The average enrollee age at Priority Health, a Michigan insurer, has ticked up to age 51 for newcomers, from about 41 years old for plans offered for the current year, said Joan Budden, chief marketing officer. Arise Health Plan, Wisconsin’s largest nonprofit insurer, said more than half its 150 signees are over 50, a higher proportion than expected, while declining to be specific on its target age.
In states that are running their own marketplaces and have seen smoother rollouts, officials are now also reporting a similar phenomenon, suggesting the economics of the law play a role, too. In Connecticut and Kentucky, which have enrolled more than 4,000 people each in private health plans so far, the largest segments of enrollees in new commercial health-law plans are over age 55, much older than industry actuaries say they had anticipated.
The law includes provisions to ease the risks insurers face. For instance, federal funds will reimburse insurers for certain losses if they underestimate costs. But, actuaries say if the overall pool of customers is significantly older than expected, those provisions may not be enough to protect insurers against losses.
It should be emphasized that it’s still early.
Industry experts cautioned that, a month into the health law’s enrollment period, it is too soon to say what insurers’ final pool of members will look like. Medical Mutual, for instance, has seen health-law enrollments so far in the “low triple digits,” and Priority Health has seen fewer than 100. Both are selling on the federal exchange.
A White House official said the Obama administration expects most young, healthy enrollees to wait until the last minute to sign up, citing research showing that pattern when Massachusetts embarked on a similar health overhaul in 2007.
Magiver
November 5, 2013, 5:17pm
165
Martin_Hyde:
This is my cite, using income of $15,250, and a San Antonio zip code/county.
I don’t know if that link will work since I’m linking to the result based on data I entered (it looks like the query string contains the data, so it may work.) But what the website says is:
The elephant in the room is that these policies DON’T pay the percentages they claim unless a medical office agrees to it. That limits who you can go to and increases the burden on them. Market forces will drive potential doctors away from the field of medicine. By default, more people will be visiting fewer doctors.
Top U.S. insurer sees weak Obamacare sign-ups, prepares for delay
Humana Inc said that because of technical problems preventing millions of Americans from accessing the federal HealthCare.gov website since it opened on October 1, the company had slashed its expectations of signing on 500,000 new plan members to an estimate of closer to 250,000.
The insurance industry has lobbied against an extension that would include delaying the law’s penalty for Americans who do not obtain coverage by the end of March, saying it would leave them with a heavier concentration of sicker, costlier patients. That would create even greater business losses and higher prices for consumers down the road, and could require the federal government to come in and cover some of the damage.
But Humana said on Wednesday it was assuming a delay at this point, and that it already cut its view for profits from the new business that it had expected from healthcare reform.
The insurance company concern is presumably based on an expectation that the sickest people will sign up first and the healthy people will straggle in at the end. So the longer the enrollment period is extended, the longer time they are going to have a really sick population on their hands. If so, that would not be a long-term concern, I would think.
Magiver
November 7, 2013, 1:49am
167
Fotheringay-Phipps:
Top U.S. insurer sees weak Obamacare sign-ups, prepares for delay The insurance company concern is presumably based on an expectation that the sickest people will sign up first and the healthy people will straggle in at the end. So the longer the enrollment period is extended, the longer time they are going to have a really sick population on their hands. If so, that would not be a long-term concern, I would think.
the logic is that they expect X number of policies in Y number of days. If you change the variable Y then the economics of their policies fail. “Eventually” doesn’t pay the bills.
So add the insurance companies to the list of those negatively affected by this law.
If they have fewer policies then they have fewer premiums but also fewer claims. Could make a difference in terms of absorbing the fixed costs.
But I suspect that the real issue is what I’ve described.