Yes that’s an important distinction. But the law mandates what the plan characteristics must be, as you know.
I used to work with an association group health plan. It thrived financially when it was underwritten, but when our Board decided it should be guarantee issue, their intentions were soon undermined by the ensuing claims experience. We found our group was the plan of last resort for high risk members. The plan went into death spiral…etc. When I saw there was no universal mandate for participation in ACA plans, I expected same would result in those plans…and here we go.
In case you were not aware, I am against the PPACA. Therefore, please do not take what I say as an endorsement of the law. However, more importantly, I am also against the spread of misinformation.
What you presented is the basis for the mandate. If you force companies to accept people with pre-existing conditions, essentially remove the underwriting portion, you need healthy people to pay premiums into the pool.
Ron, as you know, losses drive premiums. High premiums equate to low enrollment.
The mandates put forth by the PPACA turn profitable companies into losers (BCBS, United,Humana, Cigna) . The more losses, the higher the premiums. The higher the premiums the higher the subsidies the higher you and my tax bill.
If your against the PPACA, you vote republican no matter who lands on the ticket. A vote for the Dems is a vote to keep this thing going.
Ron, I am not aware of your positions because I don’t contribute routinely to these posts. However, I think I’m agreeing with why ACA doesn’t work by giving an example of what happened to us. It’s just logical if there is guarantee issue and no mandate to force currently healthy people to buy insurance that the plans will eventually fail.
The American people and members of Congress who supported ACA did not understand that. Most of our legislators don’t understand much of what they vote on.
Speaking for myself, in reply to your post to Ron; the failure of ACA to entice young risk to insure is the primary reason for the Government to stay out of the business of insurance. What would entice young people to insure is a challenge for the industry to tackle. It has solved other problems of affordability and availability for other lines through novel means and innovations; e.g. No Fault Auto as an alternative to 1st dollar tort liability, and high deductibles.
Unfortunately, the ACA has compressed the range of rates from low to high, forcing greater subsidization by young or healthy to enable older or sicker risks to afford / obtain insurance.
Look to the innovators in the insurance industry for the answers, not me. I am only barely smarter than your average polar Berra.
April 20, 2016 at 8:07 am
Ron says:
Like or Dislike:
1
1
libra,
The ACA does include a mandate. It is the part of the law the Republicans are most against, but was originally their idea. Ironic.
At the end of the day, Universal Health Care, paid for through the government and administered by private companies, provides the most solutions. It eliminates high deductibles/co-pays, out of network issues, government administration of health care (Medicare, Medicaid and the VA), annual enrollment, and pre-existing condition exclusions. It would provide health care for all citizens, allow companies to have the same plan for all states, free up companies from having to provide coverage or make hiring decisions, increased bargaining power with pharmaceutical and medical supply companies, preventative care, and more jobs in health care.
I would even throw in a rule that, if an illegal immigrant goes for care, they are to be treated then detained for a deportation hearing.
April 20, 2016 at 8:15 am
Ron says:
Like or Dislike:
1
3
Yogi Polar Berra,
You said, “It has solved other problems of affordability and availability for other lines through novel means and innovations” They have had decades to do this in health care, but could not come up with anything. What was Einstein’s definition of insanity again?
When the innovators cannot come up with anything, that is when the government steps in to promote the general welfare of the people.
April 20, 2016 at 9:09 am
Yogi Polar Berra says:
Like or Dislike:
1
0
@Ron;
I suspect the health insurance industry could solve some of the problems, but it takes cooperation with health care providers seeking ways to lower health treatment costs, to lower costs of malpractice insurance, to increase the supply of doctors, to change insurer licensing across the US, etc. You know; those underlying costs that are passed back to consumers.
If the health insurance industry lowered its costs, it would also have to lower its staff levels, whose costs are included in expense loads. Lower costs would also leave less $ for management to pay itself.
It’s clear that a White Knight needs to come from outside the health insurance industry to shake things up! Unfortunately, Jonathan Gruber and Nancy Pelosi were not anywhere nearly qualified to resolve the underlying problems (they are more comparable to knights in “The Holy Grail (Monty Python)”). But both were able to fool enough of The People, or conceal the truth in thousands of pages of inane text, to get ACA passed.
April 20, 2016 at 10:23 am
Ron says:
Like or Dislike:
0
1
Yogi Polar Berra,
I don’t disagree with you. The problem is that tens of millions of people have been; going without coverage, paying exorbitant premiums, going bankrupt, and/or dying while we wait for the White Knight who has had decades to come and save the day. As a compassionate country, we need to do better than what we had or what we currently have.
If you want to add caps on medical malpractice suits to my plan, that is fine.
April 20, 2016 at 2:11 pm
FFA says:
Like or Dislike:
2
2
“It’s clear that a White Knight needs to come from outside the health insurance industry to shake things up”
Hello Don Trump! He just may be smart enough to find the people that are smart enough to solve the issues that existed pre PPACA and actually make things affordable by the old school definition. May not like his methods, but he gets things done.
April 20, 2016 at 7:05 pm
Yogi Polar Berra says:
Like or Dislike:
2
0
@FFA: Trump’s plan includes repeal of McCarran-Ferguson (1945) aka Public Law 15. For 71 years, it has provided a limited exemption for the US insurance industry from Anti-trust laws passed in the early 1930’s, and exemption from Federal regulation, to allow data combination in rating and research bureaus. The limited exemption requires adequate regulation by states in lieu of Federal regulation. Trump shouldn’t fix what ain’t broke, or there’ll be Hell toupee! But seriously; PL-15 enables small insurers to compete by ‘renting’ actuaries and policy form writers at the bureaus. They can ‘buy’ their research to improve efficiency, and for accurate/ statistically reliable-credible loss costs.
After reading Trumps’ plan to repeal PL-15, I realized he also favors a single-payer. We know how well that works for Medicare, Medicaid, and The VA. No thanks!
April 19, 2016 at 2:46 pm
Yogi Polar Berra says:
Like or Dislike:
4
0
I agree to some of the above banter. But, back to the topic; why do employers send their retirees to the healthcare exchanges? It’s costs; i.e. the effect on premium charges for their group programs. It’s not out of concern for ex-employees’ financial well-being, or enduring loyalty; some retirees also collect benefits from other companies.
The article discusses how Baby Boomer Generation retirements skews the population of retirees younger, reducing pooled costs. But that will eventually lead to a skewing to the high end of ages, eventually leading to retiree pool affordability problems. Borrowing from Oliver Hardy, who occasionally said something similar to Stan Laurel; “This is another fine mess you’ve gotten us (me) into, Mr. Obama!”
Add Liberty Mutual to the list Retirees are given three (3) months to switch to an Insurance exchange despite LB record profits. Of course the LB CEO retires with a massive pension and continued use of the company Jet.
This should help the obamacare loss ratio……..continue to grow.
But Jack, its affordable!
I’ll buy it when our politician’s have to.
Why do people still believe that the PPACA (Obamacare) is a health insurance company/plan?
It is a law, not insurance. It does not provide coverage and there are no loss ratios.
Yes that’s an important distinction. But the law mandates what the plan characteristics must be, as you know.
I used to work with an association group health plan. It thrived financially when it was underwritten, but when our Board decided it should be guarantee issue, their intentions were soon undermined by the ensuing claims experience. We found our group was the plan of last resort for high risk members. The plan went into death spiral…etc. When I saw there was no universal mandate for participation in ACA plans, I expected same would result in those plans…and here we go.
libra,
In case you were not aware, I am against the PPACA. Therefore, please do not take what I say as an endorsement of the law. However, more importantly, I am also against the spread of misinformation.
What you presented is the basis for the mandate. If you force companies to accept people with pre-existing conditions, essentially remove the underwriting portion, you need healthy people to pay premiums into the pool.
Ron, as you know, losses drive premiums. High premiums equate to low enrollment.
The mandates put forth by the PPACA turn profitable companies into losers (BCBS, United,Humana, Cigna) . The more losses, the higher the premiums. The higher the premiums the higher the subsidies the higher you and my tax bill.
If your against the PPACA, you vote republican no matter who lands on the ticket. A vote for the Dems is a vote to keep this thing going.
Ron, I am not aware of your positions because I don’t contribute routinely to these posts. However, I think I’m agreeing with why ACA doesn’t work by giving an example of what happened to us. It’s just logical if there is guarantee issue and no mandate to force currently healthy people to buy insurance that the plans will eventually fail.
The American people and members of Congress who supported ACA did not understand that. Most of our legislators don’t understand much of what they vote on.
Speaking for myself, in reply to your post to Ron; the failure of ACA to entice young risk to insure is the primary reason for the Government to stay out of the business of insurance. What would entice young people to insure is a challenge for the industry to tackle. It has solved other problems of affordability and availability for other lines through novel means and innovations; e.g. No Fault Auto as an alternative to 1st dollar tort liability, and high deductibles.
Unfortunately, the ACA has compressed the range of rates from low to high, forcing greater subsidization by young or healthy to enable older or sicker risks to afford / obtain insurance.
Look to the innovators in the insurance industry for the answers, not me. I am only barely smarter than your average polar Berra.
libra,
The ACA does include a mandate. It is the part of the law the Republicans are most against, but was originally their idea. Ironic.
At the end of the day, Universal Health Care, paid for through the government and administered by private companies, provides the most solutions. It eliminates high deductibles/co-pays, out of network issues, government administration of health care (Medicare, Medicaid and the VA), annual enrollment, and pre-existing condition exclusions. It would provide health care for all citizens, allow companies to have the same plan for all states, free up companies from having to provide coverage or make hiring decisions, increased bargaining power with pharmaceutical and medical supply companies, preventative care, and more jobs in health care.
I would even throw in a rule that, if an illegal immigrant goes for care, they are to be treated then detained for a deportation hearing.
Yogi Polar Berra,
You said, “It has solved other problems of affordability and availability for other lines through novel means and innovations” They have had decades to do this in health care, but could not come up with anything. What was Einstein’s definition of insanity again?
When the innovators cannot come up with anything, that is when the government steps in to promote the general welfare of the people.
@Ron;
I suspect the health insurance industry could solve some of the problems, but it takes cooperation with health care providers seeking ways to lower health treatment costs, to lower costs of malpractice insurance, to increase the supply of doctors, to change insurer licensing across the US, etc. You know; those underlying costs that are passed back to consumers.
If the health insurance industry lowered its costs, it would also have to lower its staff levels, whose costs are included in expense loads. Lower costs would also leave less $ for management to pay itself.
It’s clear that a White Knight needs to come from outside the health insurance industry to shake things up! Unfortunately, Jonathan Gruber and Nancy Pelosi were not anywhere nearly qualified to resolve the underlying problems (they are more comparable to knights in “The Holy Grail (Monty Python)”). But both were able to fool enough of The People, or conceal the truth in thousands of pages of inane text, to get ACA passed.
Yogi Polar Berra,
I don’t disagree with you. The problem is that tens of millions of people have been; going without coverage, paying exorbitant premiums, going bankrupt, and/or dying while we wait for the White Knight who has had decades to come and save the day. As a compassionate country, we need to do better than what we had or what we currently have.
If you want to add caps on medical malpractice suits to my plan, that is fine.
“It’s clear that a White Knight needs to come from outside the health insurance industry to shake things up”
Hello Don Trump! He just may be smart enough to find the people that are smart enough to solve the issues that existed pre PPACA and actually make things affordable by the old school definition. May not like his methods, but he gets things done.
@FFA: Trump’s plan includes repeal of McCarran-Ferguson (1945) aka Public Law 15. For 71 years, it has provided a limited exemption for the US insurance industry from Anti-trust laws passed in the early 1930’s, and exemption from Federal regulation, to allow data combination in rating and research bureaus. The limited exemption requires adequate regulation by states in lieu of Federal regulation. Trump shouldn’t fix what ain’t broke, or there’ll be Hell toupee! But seriously; PL-15 enables small insurers to compete by ‘renting’ actuaries and policy form writers at the bureaus. They can ‘buy’ their research to improve efficiency, and for accurate/ statistically reliable-credible loss costs.
After reading Trumps’ plan to repeal PL-15, I realized he also favors a single-payer. We know how well that works for Medicare, Medicaid, and The VA. No thanks!
I agree to some of the above banter. But, back to the topic; why do employers send their retirees to the healthcare exchanges? It’s costs; i.e. the effect on premium charges for their group programs. It’s not out of concern for ex-employees’ financial well-being, or enduring loyalty; some retirees also collect benefits from other companies.
The article discusses how Baby Boomer Generation retirements skews the population of retirees younger, reducing pooled costs. But that will eventually lead to a skewing to the high end of ages, eventually leading to retiree pool affordability problems. Borrowing from Oliver Hardy, who occasionally said something similar to Stan Laurel; “This is another fine mess you’ve gotten us (me) into, Mr. Obama!”
Add Liberty Mutual to the list Retirees are given three (3) months to switch to an Insurance exchange despite LB record profits. Of course the LB CEO retires with a massive pension and continued use of the company Jet.
I’m guessing you’re a Liberty retiree. Provide me your email address and I’ll send you a copy of the letter I’m sending to Liberty and OneExchange.
Great article