Health Care Reform

[yovargas]

The PR effort surely has been bungled quite a bit. Way back when I first voted for Obama, back when he was campaigning on those rounds of inspiring speeches, I thought to myself "Even if I end up not agreeing with a lot of what he does, at least we'll have a great communicator". Oddly, that has not turned out to be the case at all, IMO.

[Voronwë the Faithful]

In my opinion, Obama's biggest mistake was not being more hard-line in the beginning. The original proposal was far simpler and had far less nit-picky carp in it. But Obama thought he could work with the GOP and the Tea Partiers and so he tried to compromise. Which should be a good thing, but it wasn't.

He had the votes (or could have, with some lobbying) and he should have just rammed the original bill through.

In my opinion.

It might be your opinion, but it isn't correct. It wasn't the Tea Partiers that he tried to compromise with, or the GOP in general. It was the so-called moderates in both parties, without whom he could not have passed anything, and who were never going to even go so far as to include a public option. It is a miracle that he was able to get what he was able to get passed (particularly surviving the death of Sen. Kennedy and the shocking election of a Republican Scott Brown to replace him), and an even bigger miracle that it has survived every assault against it since then (Chief Justice Roberts sudden conversion to upholding the law under the tax power might be the most shocking thing ever to happen in the SCOTUS).

The botched roll-out does have the potential to be a serious issue. From what I have read they need to have 7 million signed up through the exchanges by March 31st. If that doesn't happen the insurance companies will start jacking up prices to cover the extra mandated coverage and those who do have insurance will once again pay the price. That, I think, will be the nightmare scenario that could indeed sink the entire Democratic party.

When the roll-out began on Oct 1 and the whole show-down between the Dems & Reps over the shut-down was happening, there was genuine excitement over the opening of the exchanges. That excitement has largely evaporated after more than a month of not being able to use the website. The perception now is that the exchanges don't work. It is going to take a massive PR effort to convince people otherwise, but instead of addressing that many Democrats seem to be running away from the problem and from the ACA in general.

The biggest issue to making it work is getting healthy young people to sign up. Those are the people who are not going to go through the effort of calling in for assistance or going to see an adviser. If the exchanges do not work easily and effectively those people will just give up. Health care isn't a priority for them and if it can't be done simply then many of them just won't do it.

This is right on the money. However, my concern is leavened by two things. As I said above, it is a miracle that it has gotten to this point, and I almost feel like there is some kind of fate that is at work. More realistically, as has been pointed out before, every major social program has gone through a process to get to the point where it works. Despite the rocky beginning, I still believe that this one will too.

[Passdagas the Brown]

Voronwë is, as usual, correct.

Interestingly, if you strip it all down to the core, President Obama was primarily negotiating and compromising with Joe Lieberman, who would not budge in his opposition to a public option. Without Lieberman, there could have been no bill, and the President knew this.

Also, can I say that this is the first month of the law's implementation? The first month of Romneycare in Massachusetts was very rocky, and led to only a few hundred subscribers. Universal healthcare in Canada took about 11 years to shape up into the pretty effective system it is today.

This so-called controversy is primarily the result of a 24-hour news cycle, short attention spans, and deep partisanship.

[tinwë]

My fear is that if these benchmarks, as random and irrelevant as they may actually be, are not met by the predetermined dates then Senate Democrats up for election in '14 will panic and begin jumping ship, giving Republicans the chance to repeal or at the very least eviscerate the law beyond recognition.

Isn't it funny how politics work? A month and a half ago the common wisdom was that the Republicans had so fatally wounded themselves that the party was doomed to extinction. Now the same thing seems to be happening to the Democrats.

[Holbytla]

From the Department of Labor website:

The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until a child reaches the age of 26. Both married and unmarried children qualify for this coverage. This rule applies to all plans in the individual market and to new employer plans. It also applies to existing employer plans unless the adult child has another offer of employer-based coverage (such as through his or her job). Beginning in 2014, children up to age 26 can stay on their parent's employer plan even if they have another offer of coverage through an employer.

Italics mine.

If you can now be on your parent's plan until age 26, then what need would there be to enroll in any type of pay system? None. That is lost revenue.

And again, I am not in any way sociologically opposed to universal health plans, but given the political climate on this issue especially, the plan has to be effective. Most social changes go through fits and starts at the beginning. I understand that and no the plan doesn't have to be perfect, but it has to be viable and quickly before that slim margin of favor erodes.

[tinwë]

But surely the parent is also paying for the child to be on their policy until 26, so if the child can get insured through their own workplace instead of their parent, wouldn't that be preferable? For the parent, at least? It looks to me like that is acceptable. Or am I missing something?

[Voronwë the Faithful]

No, tinwë, you are not missing something.

[yovargas]

That was my take as well - either the parent's work pays or the kid's work pays.

[Primula Baggins]

In our case, there is no work that pays—we're all self-employed—so it makes sense to consolidate costs and deductibles as far as possible.

[Passdagas the Brown]

But surely the parent is also paying for the child to be on their policy until 26, so if the child can get insured through their own workplace instead of their parent, wouldn't that be preferable? For the parent, at least? It looks to me like that is acceptable. Or am I missing something?

Exactly. And despite all the misinformation, a parent has no obligation to insure their child! Young adults simply now have the option to stay on their parents' plan until the age of 26, which they didn't have before. But parents still have to consent!

[Voronwë the Faithful]

I think valid criticism of the ACA is a productive and beneficial thing. But I am really annoyed by criticisms that don't even remotely accurately reflect the truth. That is not, in my opinion, a productive thing.

[Holbytla]

But surely the parent is also paying for the child to be on their policy until 26, so if the child can get insured through their own workplace instead of their parent, wouldn't that be preferable? For the parent, at least? It looks to me like that is acceptable. Or am I missing something?

Apparently I am being unclear again.

Let's take a family of 6. Prior to this bill, when the first child hit 22, he/she needed to acquire his/her own health insurance. The family still had to pay the family rate minus whatever portion their employer kicked in. The 22 year old also had to pay a single rate minus whatever their employer kicked in.
Just for the sake of ease, lets say the family rate cost $200 (the family plan amount won't be any cheaper because there are 5 instead of 6 on the plan) and the single rate cost $100. That's $300 worth of premiums. In today's world, with children being able to stay on their parents plan until age 26 the cost of premiums is $200.

That's great and helps lots of families, including my own. However that is $100 less going into the premium pool. That is one less person that needs to sign up for Obama care, and likely one less healthy person that pays premiums to offset older people.

Health care costs aren't getting cheaper. How is that loss of revenue being offset?

[Primula Baggins]

I think many of those kids who aren't paying those $100/month premiums will be paying the $95/year fine instead. No, or very little, revenue to the plan in either case.

But the fines will go up with time, and already go up with income. And the younger people, many of them, will figure it out. It's possible at any age to be given a diagnosis that costs anywhere from the price of a nice house to your entire lifetime earnings (if you were well, ha ha), with no warning at all. One bad accident, one cancer, one sick baby. How much is $100/month if it saves your entire financial future from being destroyed by that?

(Especially if it's nothing like that much because of premium support?)

The point being, people will figure this out and sign up. People I know, even young ones, seem to get this.

[anthriel]

I think many of those kids who aren't paying those $100/month premiums will be paying the $95/year fine instead. No, or very little, revenue to the plan in either case.

I think Holby is saying that in those situations, the kids wouldn't be paying a fine, either... the fine is for people who opt out of healthcare altogether, and the kids in this example would be covered under their parents' policy.

I think he is pointing out that by raising the age limit on (probably) healthy young people before they are forced into the health insurance stream as individuals, that 4 years of their individual policy revenue (or fine costs) is "lost" to the system.

In ax's quote, it looks like this new rule about children being able to stay on their parents' plan is a bit dependent on if it is a new policy or not; for an older policy, this new option of covered-til-you're 26 doesn't apply if the child's workplace offers employer-based health insurance. In other words, the older plans are not being grandfathered in.

I am not as well informed as others here, so I very well could be misinterpreting this information. But if I am understanding this correctly (again, it's me, let's take that into account here) Holby's point still applies to those families who have NEW coverage.

No, tinwë, you are not missing something.

Well, it appears that I am. As Holby points out, on many plans (well, all the plans I have been on) there is a "family" cost, which includes the children of the family.

It doesn't matter how many children. If you have one child or 10, the family cost is the same. (Which really doesn't make sense, healthcare-is-a-business-wise speaking, but the costs of insuring 10 children to the tune of ten times what other families are paying would be unsupportable for those who have large families.)

But surely the parent is also paying for the child to be on their policy until 26, so if the child can get insured through their own workplace instead of their parent, wouldn't that be preferable? For the parent, at least? It looks to me like that is acceptable. Or am I missing something?

The parent is paying for the child on their policy. But they are not paying MORE. If the child got his/her own policy at their own workplace, those dollars would be new to the health insurance system.

And the healthy young people who would be paying into the health insurance system are "lost" as a new revenue stream. The healthy young ones are the insurance world's Holy Grail, I think. New dollars in with a minimum of dollars out.

[yovargas]

Health care costs aren't getting cheaper. How is that loss of revenue being offset?

It's obvious that on a case by case basis, some people will be paying less then they would have been, but there will also be others paying more. (You have 1 kid who might be paying less, I have 3 friends who will now be paying more since they'll be buying insurance they couldn't before.) How it all washes out from a short-term cash flow POV I have no idea. I'm not really sure it matters that much because what is clear is that having as many people on insurance as possible will save a lot of money in the long run since preventative care is so much vastly cheaper than emergency care. If you can prevent one $100K surgery, it washes out 1,000 people paying $100 less. (Plus the whole that-guy-might-now-not-be-dead benefit.) The economic benefit of that won't likely be felt very soon but I'm confident it will be startlingly obvious 5 years out. I will be very surprised if we haven't all started noticing a decrease in out premiums by then.

[Holbytla]

I certainly don't have many answers nor do I possess the data or the ability to predict what will happen. Certainly the loss of revenue will be somewhat mitigated by new people signing up for insurance, but i don't know if that number is sufficient to offset all of the people between 22-26 that no longer are buying insurance.

If I read correctly, 107,000 people signed up for Obamacare in October. That number needs to increase dramatically.

If I could go to Las Vegas and bet on whether insurance premiums will decrease over the next decade or seven, I would bet everything I own on them increasing.

[yovargas]

Certainly the loss of revenue will be somewhat mitigated by new people signing up for insurance...

It will be a lot of people getting insurance or paying fines for not doing so.

...but i don't know if that number is sufficient to offset all of the people between 22-26 that no longer are buying insurance.

Considering this is the biggest bracket that wasn't paying for insurance in the first place, I don't see why it'd be that big a concern. And it's not like all of those kid's parents even had insurance for their kids to be a part of.

And again, the savings of preventative care should be enormous. Just huge.

[anthriel]

The botched roll-out does have the potential to be a serious issue. From what I have read they need to have 7 million signed up through the exchanges by March 31st. If that doesn't happen the insurance companies will start jacking up prices to cover the extra mandated coverage and those who do have insurance will once again pay the price. That, I think, will be the nightmare scenario that could indeed sink the entire Democratic party.

I think that those who do already have insurance will almost all be paying more, under this new law. I think those who have existing policies will eventually lose them. This is reform, and that's the way reform works. You can't make an omelet without cracking eggs.

The ridiculous mess of the website and the rollout in general is just very unfortunate. Right now, all people are seeing is that their policies are canceled, and replacement policies are generally more expensive. (This is a big whoop, to most people it affects.) They can't even look at what ACA offers, because the website is gorked. That's too bad.

I keep waiting for the Dems to find a way to blame the jacked-up website on Republicans, Tea Partiers, or maybe even Bush. It's only a matter of time...


And to back up my thoughts, here is a website where I have done some reading on this:

http://www.theatlantic.com/business/arc ... cy/281522/

[Voronwë the Faithful]

This is an odd discussion to even be having, because the one part of the ACA that even its most strident critics have avoided talking about is the provision that allows children under 27 to remain on their parents plans if they do not have their own employer-provided coverage. The reason for this is simple; the benefit of this provision so far outweighs any potential detriment that even those who have not exactly stuck closely to the facts have not dared tried to criticize it. As yov notes, this age bracket is the most uncovered group of all. This is not just because these people feel invulnerable and choose not to get insurance; in this day and age people that age are much less likely to be in a position to be employed full-time with full benefits. What some people tend to forget is that the biggest reason why health care costs in the United States is so much higher than in other developed countries is because of the proliferation of uncovered people, which drives up the overall costs both because they only get health care services when they have no choice but to do so (thus avoiding nipping problems in the bud before they get to crisis point) and because the costs get passed on to everyone when they can't pay and they have no insurance. That is why covering as many people as possible is not just a moral imperative, it is an economic necessity.

The flaws that have been pointed out are not flaws of the ACA, they are flaws in the existing system that relies mostly on employer-provided, private-insurance based coverage. The ACA does not, of course, replace that system; it simply attempts to remedy some of its worst aspects. I honestly don't know if it is true that employer provided family plans don't cost any more or less depending on how many children there are (it is not true of privately purchased family plans that I have looked). But if it is true, you can be sure that it is because the insurance companies have concluded that it will maximize their profits, not for any other reasons. And there lies the problem in the system that we are stuck with, at least for now. Until the political will to move to a truly efficient single-payer system that doesn’t divert resources into profits develops, we stuck with making the best of it. I have no doubt at all that if it is given the chance to succeed, the ACA will not only significantly improve the lives of many individuals but also reduce the overall burden of health care costs on our economy.

I am less and less confident that it will be given the chance, because people across the political spectrum are unwilling to look past short-term issues and keep the focus on the long view.


ETA: Cross-posted with anthriel. This statement "I think that those who do already have insurance will almost all be paying more, under this new law." is absolutely false, and part of the propaganda campaign against the law. I am a perfect example of someone who has insurance, and will be paying less*, and Prim is another. The percentage of people whose cost will be going up is much lower than some people have suggested. Yes, they exist, but it is almost entirely because of inequities that existed in a system that placed the greatest burdens on those who could least bear them.

* I am also an example of someone who received a cancellation notice from my insurance company, but unlike many others, I immediately determined that I could do better on the exchange anyway.

[River]

My premium went down this year.

I have employer-sponsored coverage. I can cover myself, myself plus a spouse, myself plus dependent children (no limits as to number), or myself plus spouse plus dependent children, with no limits as to the number of children. HOWEVER, that's not always true. The year before last, it was either myself or a family plan, spouse plus kids. It all depends on the carrier, what sorts of combinations are allowed.

Also, I gotta say, the converage mandates for pregnancy and well-baby checks and vaccines are pretty sweet. Especially since the sticker price on Zoe's DTaP+Hep B+polio shot was ~$1000. WTF??