So, let's debate Obamacare

Great Debates
1

Well, the initial enrollment period is in its final hours. Fans of the legislation are telling us to celebrate the six million people who signed up for individual insurance. (Of course they previously told us “success looks like at least 7 million people having signed up”, but we’ll ignore that.) According to the Washington Post today:
Democrats and insurance industry officials are already seeking ways to blunt what may be the next big controversy: an expected increase in monthly insurance premiums next year for the health plans sold through the federal and state marketplaces.
Hmmm. Seems like not so long ago, Nancy Pelosi said “everybody will have lower rates”. Obama said it would “cut the cost of a typical family’s premium by up to $2,500 a year”. Now suddenly we’re expecting an increase in premiums next year, on top of the already high premiums offered on the exchanges. How did that happen?

I’d say it’s entirely predictable, and indeed many people have been predicting it since the ACA was passed. Let’s look at one example.

The ACA says that for any plan, the cost for men and women must be the same. Now women consume more health care than men. The result of this, for generations, has been that women need to pay more for health insurance than men, on average. That’s basic math: the more you consume, the more you pay. Actuarial science is the science of determining how much it will cost to offer an insurance plan to certain customers and pricing it accordingly. Since women consume more on average, the results lead to women paying more on average. Despite frequent claims that it’s the Republicans who are “anti-science”, the Democrats passed a law which forbids the use of actuarial science to determine separate rates for men and women.

Well, what’s going to happen? Even Democrats know that the insurance companies will only sell plans if they expect to make a profit. Suppose that a company previously sold a plan to male customers for $300 per month and made a 2% profit from an average male customer. Now they must offer the same plan to women. If women buying the plan will, on average, cost the company $350 per month, then the price will have to go up. Male customers will now be paying more and effectively subsidizing the more costly health care of women.

This isn’t the only way in which the ACA forces premiums up. The story is basically the same for the oft-mentioned “pre-existing conditions”. A plan can be sold cheaper if it’s not offered to those with pre-existing conditions. Require that people with pre-existing conditions be allowed to buy any plan and the prices must go up; there’s no way it could not happen. Those without pre-existing conditions are subsidizing those who have such conditions.

Likewise for age. Companies are still allowed to charge more to older customers, but the size of the gap is now limited. So the young subsidize the old. (The old, of course, are much wealthier than the young on average.)

Some folks accuse the health insurance companies of “greed” and are glad that the companies are now legally limited in how they can set their rates. But greed isn’t really the reason for these decisions. A company’s profit margin may remain the same, regardless of whether or not it offers different rates to men and women, or to any two groups. But by offering different rates to men and women, the companies provide cheaper insurance to men than they would otherwise. Likewise by not selling a plan to those with pre-existing conditions, they offer cheaper insurance to those who don’t have pre-existing conditions. Some people might be a little bit peeved to hear that it was greed which allowed them to buy affordable insurance before the ACA, and that they now can’t.

2

Are you telling me premiums didn’t have annual increases before Obamacare?

Anyway, the premiums on Obamacare are lower for the same coverage outside of the exchanges, even without a subsidy.

3

Uh, no. I certainly don’t recall saying any such thing, so I’m not sure why you brought that up.

4

All of that is true and everything is what I was saying when it was being debated. However, people need a fix to the system that the ACA co-opted and then codified into law. I think most people can agree that the ACA is hardly ideal. Some lesser subset would probably agree it’s not even good. I know I would.

But, what fixes can you propose or complete overhauls that we can look at as a counterpoint to what the ACA’s good points are and save money? Are you an NHS-style British booster? A Canadian-style state-run booster? Some mix? Something else?

What is the ITR Champion solution to these issues? If it’s repeal and forget, I’ll just shrug.

Are you telling me that the ACA didn’t increase premiums? :stuck_out_tongue:

5

Yeah, I don’t find higher premiums to be a withering argument in and of itself. Are the premiums higher than they would have paid pre-ACA for equivalent coverage? And if they are, how much do I value helping to provide insurance to those who otherwise wouldn’t be able to afford it?

6

You brought it up. You made a point of claiming that the rates would increase as though there was something odd about that with the implication that such increases would not occur without ACA.
It is the height of disingenuousness to throw up “rates are going up” as a stand-alone point and then act as though that was merely information and not part of your argument.

7

You said Obamacare premiums would go up next year. If all premiums are going up next year, why is that relevant to the debate?

8

What is this thread even about if not that? Nine tenths of the OP is about price increase.

9

What is the debate? That this law shifts some of the costs onto healthier consumers to subsidize higher cost consumers? Yeah, that is true. I don’t see why it negates the ACA, or why going back to the previous system is superior. Insurance rates have been climbing 10-30% a year for years before the ACA.

The ACA is playing a role (no idea how big or small) in slowing medical inflation, which is far more important for the long term financial health of the country.

Also insurance companies are not the problem. The problem with our health care system is that everything costs 2x as much as the rest of the wealthy world. And the reasons for that are legion and could be addressed by someone more expert in health care economics than I. But they include things like a lack of transparent pricing, lack of public and private market pressures, lack of comparative effectiveness, etc. If you address that you can cover everyone for far less.

10

If you’re so concerned about the cost of healthcare, why not start a thread urging the adoption of single payer?

11

See, this is an example why the GOP is accused of being “anti-women”.

Most women don’t believe it’s particularly fair that they are required to pay more for health insurance simply for having more breast tissue and a uterus.

Men paying more for insurance compared to their risk in order to provide good pre- and post-natal care for the women that produce the next generation of humanity seems like a pretty reasonable position.

12

The point is, there is a marked price increase or decrease in coverage that can be specifically blamed on a certain piece of legislation championed exclusively by one party. A lot of voters were hit with lower standards of care because of this. They are now less inclined to vote for that party.

The entire point of the individual mandate was to make more healthy people have to have coverage, so they would subsidize the new less healthy people who had to be given coverage. This was never sold as a price increase or care decrease on existing users. In fact, we were told the exact opposite, that we could keep our existing plans. Instead, those plans were all canceled and replaced with new ones, which the law did nothing to stop.

My sister was a budding Democrat, but I fear she is so disillusioned to no longer being able to afford doctor’s visits (as she now has a $3000 deductible on that) that she will cave in and go with what all her religious right buddies tell her. She feels lied to about this, and frankly, I think she was. What’s worse, is that I helped, because I believed that lie. Of course, if it’s not forbidden, companies are going to terminate the older plans. Of course there would have to be something in the law preventing this for anyone to truthfully proclaim that we could keep our existing plans.

I actually believe that this one issue is what will keep the Republican party from dying. Healthcare is important–which means that people who have less of it are going to be mad.

13

My immediate question here is: what exactly is the debate here supposed to be? Is it (a) that Obamacare could have been formulated much more effectively, or (b) that the whole thing was just stupid and the original status quo was just fine? Or something in between? Just what is it that you’re trying to say?

My general reaction to all of those questions is the following. Of course health insurance companies are “greedy”: they have a fiduciary responsibility to their shareholders to deliver profits and “shareholder value”. So they are doing so.

But every civilized country on the face of the earth has recognized that the key to both sustainable health care funding and a civilized society is a system of guaranteed universal health care. One that acknowledges the moral imperative of health care for all citizens; one whereby provider costs are controlled by virtue of a public authority, and by the elimination of incredibly expensive approval and claim adjudication processes. And one where costs are predictable by virtue of the entire population becoming the risk base.

In such models most private insurers for medically necessary procedures are either extremely tightly regulated non-profits or reduced to irrelevance if not banned altogether, and a public system of regulated or entirely publicly managed health care funding becomes the norm.

Now in this context, tell us again what problem you have with Obamacare. Would you prefer the Coca-Cola market-driven model for critical health care funding?

14

How many people are actually affected though? Considering something like 1/3 of Americans are on medicare, medicaid or the VA, and the majority of the rest of the insured have group insurance through work I don’t think private market insurance was or still is very big. People on medicare advantage will take a hit though.

Employers terminating their plans and dumping people on the exhcanges is a threat as far as I can tell. So was cutting people’s hours to 25 or less to avoid offering insurance.

However, again with insurance premiums going up 10-30% a year long before the ACA, how much of the premium hike can actually be laid at the feet of Obamacare? And employers have been eliminating insurance or reducing coverage for years. How much is due to the ACA, and how much is just historical trends?

Some people are worse under the affordable care act. People on medicare advantage & healthy people who do not get subsidies seem like they will get it worst. A lot of people will be better off though. People age 18-26, people with expensive conditions, businesses that get extra subsides, people newly on medicare ore subsidies on the exchanges, the elderly who want to retire, and in the long run if this lowers medical inflation this will save trillions in public and private spending over the next 75 years. There are enough who benefit from the law to counteract those who lost individual plans or who had their hours cut at work. In a sane political system we’d just change the law to prevent employers from avoiding the law by hiring part timers.

My understanding is several of the most important key provisions and consumer protections like ending rescission, covering kids until 26, eliminating annual and lifetime caps, etc. only increased costs by a few percentage points. And again, premiums are going up double digits every year anyway.

Point is, I would like to see some data that shows how many people are worse off under the ACA, how they are worse off, and how much can be blamed specifically on the ACA (ie things that weren’t going to happen anyway).

15

Umm, no. It wasn’t a stand-alone point - I’m sure it was to counter Obama’s “cut the cost of a typical family’s premium by up to $2,500 a year” bull. You know… one of the many lies he needed to repeat over and over to get this thing passed?

16

The big problem with getting data is that no one is even trying. Each party is (or, at least was) grabbing the sob story that “proved” their case. There’s no concerted effort to gather details for before and after snapshots.

This is a concern for the future for the less crupulous companies, such as WalMart or such. My own company, for instance, has published the numbers and shown that it would be wayyyyyy cheaper (62.4%, in fact) for it to dump the employees on the exchanges and pay the fines.

If we hit another recession road bump or some sectors have heart aches with cash, I would expect that sort of thing to start cropping up.

My biggest complaint was that the ACA continued the system we had, made shopping individually a bit easier and then tacked on a bunch of expensive mandates. They basically codified the old system into law.

Even if we accept the method the ACA uses, I don’t think we should have excluded employees from subsidies on the exchanges. We are literally doing this huge government and private sector shift for 33% of the population riding directly on the backs of the other 66%. I think we could have done much better. We have at least 20 models of national healthcare to draw from…this wasn’t a proper outlet for American exceptionalism. At least in my opinion.

Last year (2012 into 2013) my rates jumped $38 per month. This year (2013->2014) my rates jumped another $48 per month. The two years previous (2010->2011 and 2011->2012), my rates increased by $12 and $11 a month, respectively. While it’s anecdotal, it gives me pause when people say that others aren’t better off.

I’m not sure about preventing inflation. There is a legal block to increasing prices more than X amount, but I don’t anticipate that to last. Perhaps I’m pessimistic, but if there’s two lobbies that are massive on capitol hill, it’s the insurance and medical industry lobbies.

As for the 18-26 year olds, I have an additional issue with that: Young and healthy are the people needed to pay premiums to support the old broken ass retirees, right? Well, the reason we don’t have 18-26 year old sign ups is that they will likely pay way, way less to get on their parents’ family plans than if they were to go exchange shopping. I mean, if a persons’ parents are already on a family plan, there isn’t an extra charge (granted, that’s my view. Some may have additional charges for extra family members). If a persons’ parent is single and has a single plan, moving to a family plan is cheaper (again, at least from my experience) than a new single plan on the exchange, even if that plan is fully subsidized.

I’ve seen this mentioned once or twice but I’ve not seen much on it outside of passive mentioned. Shouldn’t we prefer them on individual plans for that cost offsetting power?

I’d want to see data on this stuff, too. But, again, data collection problems as I mentioned above. If we are lucky, we’ll get useful information five years from now. :frowning:

17

A projected increase is not, in and of itself, a refutation of the claim for overall reductions. If my insurance cost is reduced from $5,000 to $2,500 and goes up, next year, to $2,600, I still see overall savings–particularly, if my private insurance was scheduled to go up to $5,100.

ITR’s point was stand-alone and he is free to debate it, but claiming that he was making a different point so that he can pretend that he did not make one that he clearly implied is silly.

18

ITR, it’s about time for your side to give up on this one.

19

Obamacare just shifts the massive yet invisible cost of ER visits for the uninsured out into the open. Why aren’t you thrilled about that new transparency?

20

Women pay more for health insurance, on average, because their health care costs more, on average. This does not mean that every woman pays more than every man; the effect from gender is small compared to the effect from age, yet no one accuses any political party of being anti-geriatric.

As it happens, in the field of car insurance, men pay more because we’re worse drivers, on average. Even those of us with spotless driving records still pay the premium for being male. And neither political party is seeking to outlaw this, and no one accuses anyone of being anti-man.

Likewise most hair salons charge more for women, since women typically want more elaborate hair care than men. But this doesn’t make salons anti-women; it just makes them pragmatic and realistic.