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Insurance Costs Under Obamacare - Page 5

post #61 of 739
Quote:
Originally Posted by Pennglock View Post

Somewhat related to this thread:

A RCT of patients participating in Oregon's Medicaid expansion was just published. The results? Health outcomes not improved over the control group, but boy-howdy, did they ever utilize the fuck out of the medical system.

Now lets look the other way and not let this stop us from rolling out the program nationwide. Its only going to cost a few hundred billion.

http://www.nytimes.com/2013/05/02/business/study-finds-health-care-use-rises-with-expanded-medicaid.html?_r=0
Let me tell you how completely f*cking shocking this is. About six months ago I started doing some moonlighting in a rural ER. Before then I'd been pretty shielded from patients' bad medical decisions. In order to get to see a neurosurgeon you have to either be pretty legitimately sick (or have back pain and insurance, but that's beside the point) but in the ER, where there's no barrier to seeing a physician, Medicaid and Medicare patients have the lowest possible threshold for seeking medical care. Of the 30-40 patients I see in any given 24 hour period, ten of them will have had nausea and vomiting for less than 24 hours (often less than 3 hours) and another ten will have had a cough and nasal congestion for less than 24 hours. Rarely have any of these patients tried over the counter treatments. There is no incentive for these patients to try to take care of things on their own and there is no disincentive for wasting medical resources. The worst are the 75 year old women because they call ambulances to pick them up for these problems.
post #62 of 739
Quote:
Originally Posted by hopkins_student View Post

Let me tell you how completely f*cking shocking this is. About six months ago I started doing some moonlighting in a rural ER. Before then I'd been pretty shielded from patients' bad medical decisions. In order to get to see a neurosurgeon you have to either be pretty legitimately sick (or have back pain and insurance, but that's beside the point) but in the ER, where there's no barrier to seeing a physician, Medicaid and Medicare patients have the lowest possible threshold for seeking medical care. Of the 30-40 patients I see in any given 24 hour period, ten of them will have had nausea and vomiting for less than 24 hours (often less than 3 hours) and another ten will have had a cough and nasal congestion for less than 24 hours. Rarely have any of these patients tried over the counter treatments. There is no incentive for these patients to try to take care of things on their own and there is no disincentive for wasting medical resources. The worst are the 75 year old women because they call ambulances to pick them up for these problems.

I am Jack's complete lack of surprise.
post #63 of 739
Quote:
Originally Posted by hopkins_student View Post

Let me tell you how completely f*cking shocking this is. About six months ago I started doing some moonlighting in a rural ER. Before then I'd been pretty shielded from patients' bad medical decisions. In order to get to see a neurosurgeon you have to either be pretty legitimately sick (or have back pain and insurance, but that's beside the point) but in the ER, where there's no barrier to seeing a physician, Medicaid and Medicare patients have the lowest possible threshold for seeking medical care. Of the 30-40 patients I see in any given 24 hour period, ten of them will have had nausea and vomiting for less than 24 hours (often less than 3 hours) and another ten will have had a cough and nasal congestion for less than 24 hours. Rarely have any of these patients tried over the counter treatments. There is no incentive for these patients to try to take care of things on their own and there is no disincentive for wasting medical resources. The worst are the 75 year old women because they call ambulances to pick them up for these problems.

I don't understand why some people are like this and other's like my great Aunts won't ask for help despite being close to death and alone in their 90s. Is it upbringing?
post #64 of 739
Quote:
Originally Posted by texas_jack View Post

I don't understand why some people are like this and other's like my great Aunts won't ask for help despite being close to death and alone in their 90s. Is it upbringing?
My opinion on this is not particularly PC. The path to government dependency does not exist in a vacuum. For most of these people it's probably the same set of intrinsic characteristics that led them to become dependent on government in the first place that also leads them to being dependent on other people for even their most minor problems. I suspect that the Medicare patients who exhibit the same behavior are just former Medicaid patients who have turned 67.
post #65 of 739
"There is no incentive for these patients to try to take care of things on their own and there is no disincentive for wasting medical resources. The worst are the 75 year old women because they call ambulances to pick them up for these problems."

I am pretty sure that Medicaid pays 100% of everything.

Just a $10 Co-Pay would probably make a big difference.
post #66 of 739
Wait... the Dems ran an entire election calling Republicans liars for the same assertion. I love how short American memories are.

"It makes an untruth out of what the president said, that if you like your insurance, you could keep it," said Joe Hansen, president of the United Food and Commercial Workers International Union. "That is not going to be true for millions of workers now."



Some unions now angry about health care overhaul


Quote:
WASHINGTON (AP) — When President Barack Obama pushed his health care overhaul plan through Congress, he counted labor unions among his strongest supporters.

But some unions leaders have grown frustrated and angry about what they say are unexpected consequences of the new law — problems that they say could jeopardize the health benefits offered to millions of their members.

The issue could create a political headache next year for Democrats facing re-election if disgruntled union members believe the Obama administration and Congress aren't working to fix the problem.

"It makes an untruth out of what the president said, that if you like your insurance, you could keep it," said Joe Hansen, president of the United Food and Commercial Workers International Union. "That is not going to be true for millions of workers now."

The problem lies in the unique multiemployer health plans that cover unionized workers in retail, construction, transportation and other industries with seasonal or temporary employment. Known as Taft-Hartley plans, they are jointly administered by unions and smaller employers that pool resources to offer more than 20 million workers and family members continuous coverage, even during times of unemployment.

The union plans were already more costly to run than traditional single-employer health plans. The Affordable Care Act has added to that cost — for the unions' and other plans — by requiring health plans to cover dependents up to age 26, eliminate annual or lifetime coverage limits and extend coverage to people with pre-existing conditions.

"We're concerned that employers will be increasingly tempted to drop coverage through our plans and let our members fend for themselves on the health exchanges," said David Treanor, director of health care initiatives at the Operating Engineers union.

Workers seeking coverage in the state-based marketplaces, known as exchanges, can qualify for subsidies, determined by a sliding scale based on income. By contrast, the new law does not allow workers in the union plans to receive similar subsidies.

Bob Laszewski, a health care industry consultant, said the real fear among unions is that "a lot of these labor contracts are very expensive and now employers are going to have an alternative to very expensive labor health benefits."

"If the workers can get benefits that are as good through Obamacare in the exchanges, then why do you need the union?" Laszewski said. "In my mind, what the unions are fearing is that workers for the first time can get very good health benefits for a subsidized cost someplace other than the employer."

However, Laszewski said it was unlikely employers would drop the union plans immediately because they are subject to ongoing collective bargaining agreements.

Labor unions have been among the president's closest allies, spending millions of dollars to help him win re-election and help Democrats keep their majority in the Senate. The wrangling over health care comes as unions have continued to see steady declines in membership and attacks on public employee unions in state legislatures around the country. The Obama administration walks a fine line between defending the president's signature legislative achievement and not angering a powerful constituency as it looks ahead to the 2014 elections.

Union officials have been working with the administration for more than a year to try to get a regulatory fix that would allow low-income workers in their plans to receive subsidies. But after months of negotiations, labor leaders say they have been told it won't happen.

"It's not favoritism. We want to be treated fairly," said Hansen, whose union has about 800,000 of its 1.3 million members covered under Taft-Hartley policies. "We would expect more help from this administration."

Sabrina Siddiqui, a Treasury Department spokeswoman, declined to discuss the specifics of any negotiations between the administration and union officials. But she said the law helps bring down costs and improve quality of care.

Katie Mahoney, executive director of health policy at the U.S. Chamber of Commerce, said employers were concerned about possible increases in health care costs and would do what was needed to keep their businesses running and retain worker talent. The Chamber has not taken a position on the union concerns, but Mahoney said it was highly unlikely that the administration would consider subsidies for workers in the union plans.

"They are not going to offset the expense of added mandates under the health care law, which employers and unions are going to pay for," Mahoney said.

Unions say their health care plans in many cases offer better coverage with broader doctors' networks and lower premiums than what would be available in the exchanges, particularly when it comes to part-time workers.

Unions backed the health care legislation because they expected it to curb inflation in health coverage, reduce the number of uninsured Americans and level the playing field for companies that were already providing quality benefits. While unions knew there were lingering issues after the law passed, they believed those could be fixed through rulemaking.

But last month, the union representing roofers issued a statement calling for "repeal or complete reform" of the health care law. Kinsey Robinson, president of the United Union of Roofers, Waterproofers and Allied Workers, complained that labor's concerns over the health care law "have not been addressed, or in some instances, totally ignored."

"In the rush to achieve its passage, many of the act's provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer-sponsored coverage could keep it," Robinson said.

Harold Schaitberger, president of the International Association of Firefighters, said unions have been forceful in seeking solutions from the Obama administration, but none have been forthcoming. While Congress could address the problem by amending the health care law, Schaitberger said Senate Democrats told union leaders earlier this month that any new legislation was highly unlikely.
post #67 of 739
It's always great when the a new burden is placed on other folks but apparently is foul play if some of the shit should splash back on your people. It is not like people did not try and point out things like this would happen. Fuck 'em.
post #68 of 739
http://reason.com/blog/2013/05/22/the-obamacare-nightmare-scenario
Quote:
At a congressional hearing yesterday with Gary Cohen, the Health and Human Services official charged with managing the implementation of Obamacare, Republican legislators charged that Cohen’s agency may be improperly allowing some states to run “assister” programs that pay people to help individuals sign up for the health law’s coverage options. Republicans charged that HHS may not have the statutory authority to fund those programs in states running their own exchanges. That includes states like California, which plans to use a significant part of the $910 million it has received so far in federal implementation grants to pay 21,000 such assisters $58 for each person successfully enrolled in new Obamacare coverage.

To most observers, this probably looked like a strictly technical dispute over the rules governing Obamacare’s implementation funding. But at the heart of the dispute is something much larger—the growing liberal concern over what might be called the Obamacare Nightmare Scenario: that too few people, who are too sick, will sign up for coverage under the law, that premiums will rise in the exchanges, and that this will reinforce public skepticism of the law as an unworkable burden whose primary effect is to cause costs to rise.

You don’t need to read between the lines to see this fear creeping into the left’s conversations about the law.

You can see it in former White House health adviser Ezekiel Emanuel’s recent Wall Street Journal op-ed, which warned that enrollment efforts needed more attention, because there’s no certainty about how many people will sign up for coverage under the law. “This uncertainty,” he wrote, “could set off a negative reinforcing cycle that undermines the entire exchange system.”

You can see it in Kathleen Sebelius calls to insurers, to friendly foundations, and to tax prep organizations asking them to “support” Enroll America, a nonprofit that is practically an extension of the administration—it’s led by a former Obama administration health official, and its entire mission is to sign people up for the new health law.

You can see it in the anxiety over California’s enrollment promotion. As The L.A. Times reported last year, “federal officials have a lot riding on the California effort,” which will be “an important test” of Obamacare in the face of GOP opposition. But it all “depends on getting enough people — healthy and unhealthy, uninsured and insured — to enroll. If that doesn't happen, the state could lose billions in federal dollars and insurance premiums could soar.” The piece says that California authorities expect to enroll 2 million people in private insurance through the law, and describes the challenge of getting people to enroll as “daunting.”

Whitehouse.govThey’re right to worry. In part because, as Emanuel notes in his piece, this sort of enrollment push has never been tried at this scale. But also because a version of what they worry about—low enrollment, an unusually sick population, and spiraling costs—has happened before, in Obamacare’s first, smaller-scale attempt to expand coverage to the uninsured.

For the period between when the health law was passed and when its major coverage expansion kicked in, Obamacare set up a stopgap option for hard-to-insure individuals with troubled health history—the Preexisting Condition Insurance Plan (PCIP). The initial worry with this program, one I shared, was that it would go over budget as a result of high enrollment.

That concern was half right. Somewhere between 350,000 and 400,000 people were expected to enroll in the program. Instead, just 135,000 signed up—and then only after the administration went on an aggressive enrollment push. Yet even as The New York Times reported this week, even with far lower than expected enrollment, the cost of claims in the program has “far exceeded White House estimates, exhausting most of the $5 billion” the legislation provided to fund the program.

It wasn’t just that too few people signed up. It was that the people who did sign up were, on average, very sick. And thus, very expensive to cover.

Which left states with very costly programs helping very few people: Last year Alaska said that its PCIP would cost $10 million in 2012—and cover just 50 people. New Hampshire enrolled just 80 people in its program, but spent twice its allotted federal funding. California had the highest enrollment of any state in the nation, but per-beneficiary costs came in three times higher than expected.

And what is the administration doing in response? Cutting payment rates to providers in order to hold costs down.

This could be Obamacare’s future: Not a broad middle class benefit, but an expensive program with low enrollment that mainly covers the very sick and serves as a catalyst for driving doctor reimbursements down. Granted, this is far from the only possible future for the law, and far from the only way it could go wrong. But right now, I suspect, it's the disaster scenario that many liberal supporters of the health law fear the most.


TLDR: Not enough people signing up for Obamacare, so states might lose the bribes they are currently receiving to implement it. Those that are enrolling are very sick, and thus very expensive to cover.
post #69 of 739
I betchya the IRS did not hold up the paperwork for http://www.enrollamerica.org/
post #70 of 739
http://www.youtube.com/watch?v=pfTh6vIQBVg&


I hope whoever made that video gets into a drunk driving accident with a schoolbus.


EDIT - I posted the link, it won't let me embed it.
post #71 of 739
Not working
post #72 of 739
http://www.cnbc.com/id/100768749
Quote:
Cynthia Weidner, an executive at the benefits consultant HighRoads, agreed that the tax appeared to be having the intended effect. "The premise it's built upon is happening," she said, adding, "the consumer should continue to expect that their plan is going to be more expensive, and they will have less benefits. "

I have always known this was the underlying goal of the Affordable Care Act - "equalize, rather than improve" - I just never heard anyone (especially someone involved) cite this as the intended effect.
post #73 of 739
Quote:
Originally Posted by Piobaire View Post

I betchya the IRS did not hold up the paperwork for http://www.enrollamerica.org/

damn, I was gonna make that joke.
post #74 of 739
Quote:
Originally Posted by ChicagoRon View Post

http://www.cnbc.com/id/100768749
I have always known this was the underlying goal of the Affordable Care Act - "equalize, rather than improve" - I just never heard anyone (especially someone involved) cite this as the intended effect.

That seems almost deliberately out of context. They're talking about the Cadillac Plan tax, not all plans. They resulted in greatly expanded usage and no improvement in outcomes, so it's not unreasonable to levy some disincentives on them.
post #75 of 739
Quote:
Originally Posted by Gibonius View Post

That seems almost deliberately out of context. They're talking about the Cadillac Plan tax, not all plans. They resulted in greatly expanded usage and no improvement in outcomes, so it's not unreasonable to levy some disincentives on them.

First, what Ron said was completely on point in regards to "Cadillac" plans. The goal is to help push those well insured down to levels of what Dems would have called "under-insured" during the Bush administration. Did you read the impact this is going to have on a nurse aide?
Quote:
Starting this year, they have a combined deductible of $2,300, compared with just $500 before. And while she was eligible for a $1,400 hospital contribution to a savings account linked to the plan, the couple is now responsible for $6,600 a year in medical expenses, in contrast to a $3,000 limit on medical bills and $2,000 limit on pharmacy costs last year. She has had to drop out of school and take on additional jobs to pay for her husband's medicine.

Trust me, nurse aides make only about $15 an hour.

Also, "no improvement in outcomes?" Have some data for this? I mean, do you think people like the family illustrated are not going to cease being compliant with medication regimes? If this happens do you think overall utilization for these patient segments will not rise through need for tertiary care settings? Heaven knows I'm against over-utilization but this seems to me like it's going to cause more acute needs in these populations vs. less.

It's using a sledgehammer for a solution vs. a scalpel.
Edited by Piobaire - 5/29/13 at 12:50pm
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