It's not ONLY the subsidized plans they are complaining about, just the worst ones. A couple of issues with subsidized plans: 1) Premiums are not getting paid. I don't remember what the number was, but there was a surprisingly high percentage of people who signed up and then never paid the premiums. An even larger percentage that just don't maintain the coverage through the whole year. There was an internal discussion I got to sit in on where the speaker explained how even if the plan cost $1 a month, the internal studies showed there was a high chance they wouldn't pay it for the full year. 2) As an extension of #1, what a lot of people do is get these plans and then go rack up big claims right away and then don't pay for the premium. Under ACA, the insurance company has to pick up that claim even if the member doesn't pay, for the first 30 days and the provider has to eat it for the next. (exact amount of days may differ) This put serious cost burdens onto both insurance companies and hospitals. 3) As an extension of #2, a lot of hospitals refused to participate in the new networks because they didn't want to be exposed to that potential risk. 4) People who buy on the exchange have proven to be sicker than the traditional population AND, perhaps because of lack of insurance experience, utilize traditional wellness and PCP a lot less than expected, instead opting for emergent care at high rates. 5) The risk re-insurance that was built into ACA has proven to be completely inadequate and there have been no steps taken by the government to shore that up. 6) The government has rejected rate increases that would stabilize the marketplace despite seeing hard evidence of the losses. This was already a falsehood. Not in year one, but really starting last year almost every plan in the country available for individual purchase was a reduced network. In Houston they were laughable. The insurance companies are making money right now largely by re-purposing themselves. Most have pushed hard to sell dental, vision, life insurance, etc. and have also begun to purchase free standing urgent care centers as a way to both make profit and reduce the reliance on emergency rooms. Here in Houston we have at least three major urgent care chains that are owned by insurance companies without you realizing it. However, the individual marketplace is a total disaster. To be fair, the insurance companies never expected them to be "profitable." The hope was that losses would be small enough that they would justify the investment in the increased membership and there was a belief that losses would subside as the years went on. Instead the opposite has happened; each quarter the losses rise.
Obamacare was built on a best case scenario, not a realistic scenario. You can look back and find posters staunchly supporting Obamacare based on theoretical numbers. CBO this. CBO that. Trend this. Trend that. Negotiate cost this. Negotiate costs that. There was nothing substantial in the promises. I dont find insurance companies greedy and evil as much as I find them unnecessary. The companies can only exist if they are making money. Its not them making money that I have a problem with as much as they have no desire to drive down costs or make things better.
I'm a proponent of single payer, but I also think we should allow people to buy into medicare for the cost of administration. If insurance companies can't compete with big inefficient government, then they shouldn't be in business. We also need to reform the FDA and the medical boards. We have a supply problem, and we aren't doing enough to increase the supply of quality medical care.
I have real doubts that a single payer will fix the rising cost problem, but I think it would help us with other issues. Our medical system has so many problems it is ridiculous.
Thanks for the insights. Reading your list, it feels like there could be a legislative fix to each of these problems. My intuition has always been that that the ACA could be tweaked to address problems, but it's not my industry so I'm reluctant to have firm opinions on what could be tweaked.
It is. However, our obesity rates and how we take care of end of life needs has to be taken care of first.
Well when you have 300 million customers you have insane pricing pressure. If you are a hospital and you refuse to work medicare what do you do. Why not just open medicare to all? It currently covers the sickest least desirable population pool. If everyone can sign up for it it can't make the pool much worse.
There are definitely fixes that could be used and most of the insurance companies have indicated as much. However, fixing aca is a total non starter in our current congressional makeup. Additionally, many states, Texas chief among them, have intentionally taken steps to make aca more painful for political reasons.
Given the rancor and the sabotaging Republicans were doing to the legislation, Pelosi was smart to want to pass the imperfect bill. She didn't like it, but she was applying the lessons Ted Kennedy brought from the Nixon negotiations: any bill is better than no bill. With the law on the books, the Democrats can work to improve the program while opponents would face more difficulty trying to repeal it. If Clinton wins, Pelosi might, in the end, get the public option she wanted in the ACA in the first place.
The bolded is what is most infuriating. Tea Baggers and their ilk make government as dysfunctional as possible so they can they can come back and tell us how much government sucks.
This is probably too much in the weeds for most people, but here is an example of the stupidity: The ACA requires small group insurance plans to be rated on community factors instead of traditional underwriting. As part of that they established the age bracket system (Humana used this already for groups under 10 employees) meaning each employee in a company and their spouses and dependents all have a "true" charge based on their age. The ACA then leaves it to each state to decide how to implement that. The insurance companies and professional groups all lobbied Texas to allow the insurance company to come up with a group "composite" rate. This is what most employees are familiar with; employee only, employee spouse, employee child, full family. The reason to want the composite is because it is a nightmare administratively for companies of decent size to have each employee and all of their dependents charged different rates. It is also problematic for employees and "punishes" employees with multiple kids or older employees. However, Texas refused to implement this method until the last possible date (two full years!) intentionally trying to make the ACA seem extra burdensome for small business. It worked. You talk to HR people who dealt with that type of invoice and they will tell you how much they hated it and they blame the ACA for it.
It's true that not everyone played along with the BS ACA but all that really did was hasten the demise of an ill conceived piece of legislation that never should have been passed in the first place. When you have to bribe members of your own party with pork for pet projects in order to get something passed, it's pretty clear it's trash.
We've had ~6 years now of being unable to improve the program because of political opposition. If Clinton wins but can't get at least the Senate to flip, we might have 8 more years of intransigence.
It's not the Senate. The Senate, despite the oft repeated McConnell claim, has expressed a willingness to work with the White House. What the Senate will NOT do on GOP leadership is throw their GOP members into the political gallows for issues that they know are DOA in the House. It's one thing to ask a Senator in a purple state to have the political courage to vote for something that will be unpopular with his base, it's another thing to ask him to do it when it will never even get a vote in the House.
is it your contention justtxyank that democratic states that fell in line are doing well under obamacare?
And how is Texas doing? Doubled down on having the most uninsured folks, a very obese population, and no actual plan for healthcare.... Brilliant. It's one thing to reject ACA, it's another to not even put up an alternative.
Yes I think if you read my posts you will find a great deal of enthusiasm for the ACA and a defense of democratic led states
