I don’t know about Europe, but Minnesota appears far from 90% MLR. Here (PDF) is the 2011 report on loss ratios in Minnesota. On page six it shows loss ratios of 83% and 80% for Individual and Small Employer plans. So they have met the PPACA MLR requirements for Small Employer plans but not Individual. I didn’t see any info on Large Employer plans, but I believe they issued refunds in 2012, indicating they missed the mark.
This site says:
It didn’t go far enough, but whatever. It can hardly be worse than the existing system.
It’s a start, but we really really need to disentangle health care from employer benefits. The unintended consequence of this law is that more an more employees are going to find themselves multiple part-time jobs because employers are going to replace as many full-time employees as they can with part-timers so that they can avoid providing benefits. This might be good for health care consumers, if the exchanges work well, but not so good if you go from a 35-hour/week job to a 20-hour/week job at the same time. Not to mention all the non-health benefits you’ll no longer be getting.
It’s a first step in entirely the wrong direction. The first thing I would have done to fix your healthcare system would be to extend the same tax breaks for non-employer sponsored health insurance, thereby making the insurers more dependant on keeping the goodwill of their customers. By threatening to fine people who don’t buy this product, the ACA does the opposite.
The ACA doesn’t go far enough as has already been said.
Bending the cost curve by reimbursement reform would go a long way in addressing the solvency issue of Medicare as well as making healthcare more affordable for all. Just slashing reimbursement rates for Medicare does not lower costs, in fact it does just the opposite, because providers just increase volume to make up for the cut.
The biggest flaw I see in the ACA is that the Independent Payment Advisory Board (IPAB) is specifically prohibited from considering the Patient Centered Outcomes Research Institute’s (PCORI) recommendations when trying to cut Medicare spending. This is ludicrous. Reimbursement rates should be tied to quality measures. Of course all over the internet/media these two agencies are commonly portrayed as ‘rationing boards’ which is quite inaccurate. PCORIs recommendations have ‘no teeth’ because the “findings from comparative effectiveness research may not be construed as mandates, guidelines, or recommendations for payment, coverage, or treatment or used to deny coverage.”
I think it’s a fantastic way to financially destroy families like mine that are just barely in the middle class range.
I think the plan does amazing things for those who previously wished to purchase insurance, but could not.
I think the plan does very little to address the significant problems and costs of health insurance and health care in our country.
I think it’s kind of a mess in many ways.
I am greatly in favor of doing away with the “pre-existing condition” problem where if you have anything wrong with you, you’re effectively uninsurable. I am totally fine with the idea that in order to make that work, you have to make everybody pay. But I think that the actual implementation is pretty terrible.
I am fearful that this will become another incredibly expensive transfer from the young to the old (like Medicare and Social Security), and will result in even more unsustainable long-term budgetary problems. The way it was implemented in stages to maximize income in the first few years and only introduce costs later to bring the 10-year estimate to a desired mark strikes me as a… dishonest
There was a story on NPR’s Planet Money the other day about a breast-pump boutique shop in Manhattan that was doing gangbusters business because health insurance is now required to pay for breast pumps. I doubt that this particular change will really be that costly in the scheme of things, but it represents a continuance of a major problem with our healthcare system: We will never control costs as long as people are insulated from all costs of their medical choices. I’m not saying that breast pumps shouldn’t ever be covered. I’m saying that it seems reasonable that some insurance plans would cover them and some wouldn’t, and it should probably cost you more to get the fanciest pump than to get the budget one.
And it looks like a bunch of states aren’t really sure if they’re going to set up exchanges in time, some probably as a political statement, and some because, well, the rules aren’t really written, so they’re not sure what they’re getting into. I expect many more unintended consequences of this sort, and I expect that they’ll pretty much all end up being more expensive than we thought.
So I’d say I’m cautiously pessimistic.
As someone Working in Health Insurance, I can say that it is a great thing for Lawyers and actuaries. There is still so much room for interpretation in that monster of paperwork, nobody really knows what exactly the plans are going to be, and are feverishly looking for, and finding, loopholes.
After reading this article about our current system, I think the opposite will be true. Fewer people will face bankruptcy level medical bills because they will have insurance.
I doubt that the cost of being forced purchase insurance will bankrupt families, whereas the uninsured costs of medical care often do.
(Still, as noted the ACA does little to address the cost issues we must face as a nation)
Here’s a fascinating article on how the sequester is likely to affect the ACA rollout.
The bottom line: sequester is going to make it (even more) difficult for HHS to implement the law, but the administration is going to move heaven and earth to get everything done anyway.
The problem is that relatively few people face medically-induced bankruptcy compared to the huge number of people who are just getting by as it is who will now be forced to pay for insurance they can’t take advantage of because they can’t afford the deductibles and co-pays. So they’ll still get sick/hurt/whatever, and the only difference between then and now is that they’ll have less money for clothes, food, rent, car payments, etc.
Both Michael Bloomberg and Bill Gates on Charlie Rose last Friday night were lamenting the clusterfuck (my word, not theirs, but same meaning) the ACA is, and both were critical of Obama’s allowing congress, with its obeisence to special interests and pork and mutual backscratching, to write the bill themselves rather than for Obama, in his executive capacity, to consult with experts and then submit a bill to congress for passage. Perhaps if we’d elected someone with more experience and/or political courage it would have been done that way.
Get it in place first, and then fix. Not bold, not exciting, merely practical. Given the hysterical level of opposition, the wonder is not that it is imperfect, the wonder is that it exists.
And we just had years of bold leadership from an alpha lemming. No thanks.
Sorry but I can’t quite buy into “Do something, even if it’s wrong” as an acceptable style of government.
I am pretty sure it took a lot of political courage to get that bill passed. Say what you want about it, but getting that bill passed briefly cost the Democrats Ted Kennedy’s seat in the Senate (until recently, obviously) and many seats in 2010 at all levels of government. Even when the law was unpopular, Obama stuck by it. I would say that counts as “political courage” by any measuring stick.
I’m not sure what more you think Obama could have done. Written a bill and then demanded Congress pass it without alteration or amendment? I am pretty sure that would upset way way more people. The fact of the matter is, legislation is ALWAYS a process like this. We’re talking about a Democratic Senate that had to pull votes from Max Baucus, Joe Lieberman, Ben Nelson, and other Senate moderates–to say nothing of all of the Blue Dogs that populated the Democratic House contingent in 2008-2010.
Legislating is the job of Congress, not the president.
The Clintons tried that. It didn’t work. UHC efforts have been going on for a century, but Obama got something passed.
Neither I nor Bloomberg nor Gates suggested that any bill submitted to Congress should be passed without alteration or amendment. Both are part of the process as it was intended to work. But what Obama essentially did was say “You guys come up with some sort of plan, and whatever it is I’ll sign it.” And that’s not the way it’s supposed to work.
The president is supposed to use due diligence and consult with smart people and experts in the field and come up with what he thinks is a good plan, which he then submits to congress to pass, amend or do as it sees fit. He’s not supposed to just outline a vague concept and then turn it over to 535 people, all of whom have different objectives and different concerns and are beholden to different special interest groups, and who largely vote for the other guys’ provisions provided the other guys vote for his, etc., etc., with the proviso that whatever they come up with, he’ll sign it. What you get that way is exactly what we’ve got - a huge clusterfuck full of problems implemented in a bill that no one really knows the contents of, and which in this case makes things harder for the very people it was supposedly passed to help.
I said that such an approach to creating a bill lacks political courage because it spreads the blame for its unpopularity among 535 congress people rather than the one guy sitting in the White House.
However, I’m not necessarily convinced Obama was acting out of political cowardice. He may simply have been too inexperienced to know what his job is supposed to entail, and/or too green to feel able to marshal the congressional support he’d need for his own plan were he able to come up with one, in which case he should have waited until he was able to marshal enough support among the public and congress to allow him to exercise the leadership a president is supposed to show in getting legislation passed.
But either way, Obama is responsible for allowing this huge clusterfuck of a health bill to be foist upon the American people, and for the fact that it will, again, end up hurting most the very people it was supposed to help.
No he didn’t, as I just explained. Congress got it passed and he merely approved it. He did very little as far as fashioning the plan, creating support for it, and moving it through Congress. In fact, he did so little that saying he did very little is probably giving him too much credit.
Not by mine. Doing the wrong thing isn’t courageous just because you cop some much-deserved flak over it.
Horsefeathers.
No major American political effort has ever succeeded at first go.
Trial & error & tinkering is our motif.
This.
The Dems gave away too much of the farm before it even got to the table. I would’ve loved to see an unsubsized public option beat the insurance companies at their own game.
More importantly, it doesn’t address the fundamental flaw in the system: Capitalism is great for consumer goods, but it sucks for services. The concept that a privatized system maximizes profit by maximizing efficiency is noble in theory, but in practice, the responsibility to shareholders outweighs the responsibility to consumers without true choice. Sucks at hospitals, sucks at prisons, police next?