Why not? That’s how we do all Federal programs: highways, FBI, the Veterans’ Administration, and so on. It obviously isn’t “one size fits all,” but per capita. Adjustments would be made for different situations, such as the centralized population of Rhode Island vs. the decentralized population of Wyoming. More actual processing centers would be needed in Wyoming, to guarantee that everyone lived within twenty miles of one.
But all of these decisions can be made rationally (or else politically…) the same way they are for all other Federal programs.
I work for a software company that uses population health data to create a norm, and then clients send us their data to be compared against that norm. Clients range from employers to ACOs to insurance companies. I work on the research team, which helps come up with the logic behind the software’s risk and gap identification measures.
As for HCCs…they’re chosen by CMS. I have no idea how you’d go about getting one added or finding out why one is added instead of another.
One of the benefits of a single-payer system is that providers don’t have to learn the rules of submitting claims to 500 administrators.
If we have fifty administrators, that’s an improvement, but it’s still fifty separate administrators with their own rules and guidelines, their own processing norms, and their own claims messages on the EOB.That all ends up costing money to the providers who have to program for those things.
But if we have **one **administrator, with **one **set of rules, that’s an even bigger improvement, and a cost savings for providers.
And that 500 administrators aren’t fighting over who is ultimately responsible for the claim. But I would be perfectly okay with a system where health insurance is administered at the state level, since the feds would be able to set broad (or even quite narrow) national guidelines, as they occasionally do with Medicaid.
I’m not sure what point you were trying to make with all this.
I was not saying the fact that healthcare and hospital stocks were down proved anything about the exchanges.
I was saying that the fact that the market punished the stocks of other carriers and of hospitals the same or worse than UHC shows that the assessment of the market (along with others) was that this was not an issue specific to UHC, in contrast to what you and others had been implying.
Actually, it makes perfect sense. The first sign-ups would have been the substantial cohort that wanted could not obtain health insurance prior to the ACA. Needless to say, they are the least healthy population because that’s why they couldn’t buy health insurance. Subsequent cohorts will be more healthy, because those people were less motivated to buy health insurance in the first place. There is some debate to be had over whether these people will actually sign up, but I don’t think there’s much question that those that do will be healthier than those who already have.
The exchanges are not the be-all and end-all for any company’s stock value. The reaction was to lowering their earnings outlook. They had just given an unrealistically rosy report the previous month and now walked it way back.
The market, across all sectors, almost always acts across a sector like this. One large tech company’s profits disappoint and the whole sector dives for a day or several, whether analysts identify the reason for the miss as specific to the company or not. One day market behavior is rarely rational.
UNH is still about 1.5% below where it was 5 days ago. Aetna is up almost 0.7%.
All the market has actually said is that it has been very bullish on the health insurance industry in general ever since ACA passed. Probably excessively bullish … going up two to three fold makes lots of investors scared the bubble is going to pop. Skittish even. UNH’s PE has gone from under 11 in early 2013 to over 18 before this latest earnings report. Now it is just below. The market expects continued modest earnings and profit growth. Overall though the sector is indeed off its late June peaks. Over the past 5 days UNH is down 1.68% more than the average for the sector.
So yes, the market over several days digested news, got nervous for the sector but punished the specific company, UHC, more.
Again though, short-term stock price changes informs little about whether or not UNH’s sudden reversal from a sanguine to a bloody view (funny how the same meaning means different things eh?) about the exchanges is fairly unique to them, to their established reluctance to compete in the space, and to develop the collaborative risk-sharing value-based infrastructures, or industry-wide.
So in your scenario there is some population of healthy-er people that have not yet signed up but will do so increasing the solvency of the exchanges? My thinking is that the people that wanted to sign up, or couldn’t otherwise have gotten insurance, have already done so. The healthy people, the target demographic, already have insurance.
Why would a healthy person belong to the group of people that have not yet signed up, but will all of the sudden do so, en masse, in the near future?
In round figures before the ACA, there were what, 30M uninsured people? Do we think these were generally healthy, and just didn’t get insurance because? Most people already had insurance and continued to do so after ACA. What’s left I wouldn’t expect to be the most healthy demographic.
The penalties for not having insurance are going up.
The penalty in 2014 was one percent of income or $95 (whichever was higher). In 2015, that increased to two percent or $325; for 2016, 2.5% or $695.
Then, too, as people get older they start noticing a few more health problems, and they see people around them who have more health problems. When you’re 26 and invincible, you have different priorities than when you’re 36 or 46. The carefree single twenty-something becomes a thirty-something who has to acknowledge the possibility of a “million dollar baby,” e.g.
Personal anecdote here–probably not useful in broad terms.
I have a 29 year old son. He has no health insurance and didn’t sign up out of laziness the last two years even though he is eligible for subsidy due to low income.
He’s signing up tomorrow night at my house.
I have a 25 year old son who goes off his mom’s insurance seven months from now. He’ll sign up.
As an aside, American Healthcare companies’ names are… sub-optimal Aetna instantly conjures Hades: since the mountain was, like Avernus, considered a shortcut to there.
Anthem is dirgy, as in what will be sung at a funeral.
Tenet sounds religious, and for some reason sounds related to Time. As in time’s running out.
I assume Gravestone Insurance and Shroud were already taken ?
I’m not sure if your interpretation of the table (which is page 7 of the document, but page 13 of the pdf file I believe) is the most informative. The 26-34 age group has 38K people in it, of which 18.2% are uninsured (2014). The age group 45-64 has 83K people in it, of which 11% are uninsured. In the first is about 7K people uninsured. In the second, it’s about 9K people. The proportion is important, but this is a case where the gross figures are also equally if not more important.
As for the penalties - my understanding was that there were a number of ways these could be waived. Even at $700/year, that’s more than the premiums being charged so for younger healthier people, the calculus will still be to forgo insurance as the penalty is cheaper for those on the lower income scale. The higher the income, the more likely it is the employer will provide coverage already and the exchange will not see a demographic windfall from those people.
Time will tell for sure, but I’m not seeing how here will be some significant increase in the exchange plans disproportionately represented by a healthier demographic. Hypothetically, if there isn’t an increase in healthy demographic signing up for the exchange plans, would you say the outlook then is negative?
Only suckers pay the penalty. You can either get a waiver, or structure your withholding so as to avoid any consequence for not paying it. The government is only authorized to dock refunds. They can’t go after you for the mandate tax.
Basically, the government is too chicken to really enforce the mandate, so it’s not really an incentive for many people to sign up.
My mistake on the million. The point is that while there are a higher proportion of younger folks, in gross figures there are more older uninsured still and demographically they will be a resource burden as they sign up if they choose to. The idea is that for the exchanges to improve new sign ups need to be healthier - except that there are more people in the demographically unhealthy groups. I think it depends on who signs up and when, but it’s not certain to me at least that the future waves of people coming on will fit the healthy demographic needed.
As to the penalty, yes they would get the benefit of being insured but that hasn’t previously been sufficient encouragement. The non threat of a penalty would then need to push them over the edge and motivate them to sign up, except the penalty has no teeth. So yes some additional people may be motivated to sign up, I just don’t think it’s a huge numbe .
They are scared because it’s bad politics. There are a lot of laws the government doesn’t enforce because they are scared of the political ramifications. Which is why I always find it funny when certain groups howl when their pet law is not followed.
The 26-34 age group covers a span of nine years; the 45-64 age group covers a span of twenty years. I think you are overlooking that fact when discussing gross figures and proportions. A young person, more likely to be healthy, is also nearly twice as likely to be without insurance as an older person, AND there are more people per year in that younger cohort than amongst the elders.
What is so hard to understand? If you force an insurer to offer a service for below cost, the service provider will react by stopping the availability. Of course, in the Orwellian world of Obamanomics, healthcare has to be free-of course, notice that Congress and the Executive branch don’t use Obamacare-I wonder why?
