Previously posted
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Originally posted by Tubetone:
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Originally posted by Redford1970:
from Tubetone
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What about grandfathering those who have chosen continuing insurance to have preexisting coverage continue? What about giving some sort of credits to companies who take on preexisting condition consumers? There seems to be a lot of transitional ideas that could be kicked around.
This is what ObamaCare did on paper, then reneged by paying 20 cents on the dollars proscribed by the law


I appreciate all the expertise/experience you bring to this discussion.

Can you think of any ways to ease the consumer cost/availability questions while protecting those who were forced off their old plans under Obamacare?
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In a big picture way, this is a math problem that can't be solved politically. At least not in a politically palatable fashion... not if it is to get bi-partisan support. The issues are not easily understood. There are complex interactions. The public confuses healthcare with insurance and they believe insurance is the problem, when, in fact, insurance premiums only reflect the underlying cost of claims. Claims that are rising. Both the unit price of services and the rate they are utilized is ever increasing.

The ACA/ObamaCare added regulations to insurance companies. Barring Pre-Ex Condition provisions, mandated coverage until age 26, inclusion of certain coverage, controlling Medical Loss Ratios, open enrollment periods and criteria, and government reinsurance. NONE of those are healthcare. Healthcare is made up of the services we receive (hospital stays, tests, office calls, physical therapy, surgeons fees etc).

The ACA also did some lesser known things to RAISE cost. Added administrative burdens, reduced Medicare Reimbursements (leads to cost shifting by Providers), and new hidden taxes.

The short term answer re consumer costs?, simply larger and larger government subsidy. Unfortunately, small and moderate size businesses will want their share and will make the problem bigger (more expensive). The pool of insureds has deteriorated. You literally need everyone in to lower UNIT consumer costs. We've already seen that the penalties were not sufficient. You'll need a penalty about equal to the premium. That's a non-starter politically.

Long term, we need to address (1) lifestyle issues which, by industry estimates, cost us all an unnecessary 35%. Our society wants a pill for everything, when the better answer is exercise and weight control. Obesity is a huge driver of healthcare costs. Society suffers from drug abuse claims, both legal prescription drug abuse and the illicit kind. It's another big cost driver. (2) Cost shifting to commercial plans when the Feds squeeze Medicare and Medicaid reimbursement. Most hospitals get 45-55% of their revenue from Medicare. When that is cut, they raise prices to non Medicare patient who are covered by private/commercial insurance.(3) Defensive medicine driven by litigation. Excessive tests, unnecessary tests because you MIGHT go to court one day. (4) R & D on prescriptions nearly exclusively carried by the USA. Misuse or overuse. (5) an aging population (6) more high tech stuff entering the market. (7) shortage of Doctors

I don't see existing customers being kicked off plans they have now. If pre-ex is once again allowed, new pools will be created and better risks will migrate there for the lower premium. Eventually, old pools, will price themselves out of existence. This could take 4-5 years but is totally dependent on legislation. The Devil is in the details. Will there be reinsurance? Will there be mandated Loss Ratios? Until we know that, can't say. The basic problem that remains is the people with pre-ex conditions are not a fixed pool. New people get added daily. We all get older.

And your last questions, People being forced off their OLD pre ACA plans is, in part, a case of plan improvements (services added not previously covered). True, some really basic catastrophic plans were eliminated. Some provider networks were reconfigured and people lost access to their favorite doctor. I don't see the clock turning back anytime soon.

My last comments are about competition and the scope of the ACA.

Healthcare, all of it, is delivered locally. My Troy, Mi hospital does not compete with hospitals across the Ohio, Indiana or Illinois State lines. Rarely do our Doctors compete. Don't look for competition to address any cost issues.

98% of all Employers with 200 or more FT employees offer group health. About 55% of smaller Employers do. Of all those having insurance now, the majority do NOT buy their coverage on the Federal Exchange. Their deductibles are much more reasonable. There are some ACA impacts but not at all what individual buyers face. The impact of ACA is all but negligible on those on Medicare. It continues to surprise me how nearly everyone has strong opinions on it, yet most aren't directly touched.

The other elephants in the room;
1. Productive people that pay are picking up the tab for those that don’t.
2. End of life care and resulting costs are totally out of control and the decisions are largely based on people’s emotions, not reality.

This whole ACA scheme did nothing to control costs. They just shifted the burden on a smaller group while expanding those that participate in the benefits.
Who would have thought that would raise prices?

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