Final Word on Obamacare: Cheaper than Expected

[Sbane]

The most interesting thing, and I learned about this a few weeks ago while perusing through healthcare.gov, is that there is an option for high deductible plans but only for young people (the way it should be). The amount of scaremongering by Republicans, and the ineptitude of the Obama administration in selling Obamacare is astounding.

[Sbane]

I think Torie's argument was that the program wouldn't be sustainable because premiums would rise for younger, richer, healthier people. These people could still get coverage when they got sick so there's no incentive for them to purchase health insurance, taking valuable premium dollars out of the plans.

I disagree because most people aren't rational enough to do that, but the idea that premiums would decrease on average doesn't contradict Torie's argument. (Unless I'm missing something, in which case, please correct me)

The issue I keep harping on is that Torie has posted editorials that pick data to claim that premiums are soaring for young people because of Obamacare and asks people to challenge them, and so this keeps coming back as in issue.

You're right that how open enrollment works in Obamacare (I think there's a window each year--no insurance sales desk at the hospital) is also a point of contention.

This is another issue. If you do get afflicted by some disease, it's not like you can get insurance for it immediately. And if it something that requires hospitalization, you are f'ed. And going forward there will be easy ways of discouraging this behavior even further by only offering guaranteed issue for those who have a history of having health insurance for the last 5 years or so. They could even start it during the next enrollment period by only offering guaranteed issue to those who had insurance during 2014 or got an exemption due to income.

I mean, this is what should happen but it won't because the Republicans won't allow it. They are after destroying Obamacare and sending us back to the mess of a system there was before. They have no ideas, all they want is Obama's signature achievement destroyed for political reasons.

[Sbane]

Harry you still don't understand gap insurance, but this conversation is too caustic for me to be able to continue with you given your penchant for personal insults. Thanks.

So you buy gap insurance but it doesn't cover the reason why you actually bought that insurance (obviously I am sure you realize no insurance company is going to cover a pre-existing condition outside of Obamacare). How is that helpful?

[Sbane]

And going to the emergency room and not paying your bill, if you can afford health insurance, is absolutely irresponsible behavior that should be punished. Like I mentioned before, these people should not get guaranteed issue if they did not make any effort to buy insurance or receive some sort of waiver due to income or some other hardship. They should be left to die on the streets as far as I am concerned.

[Sbane]

And going to the emergency room and not paying your bill, if you can afford health insurance, is absolutely irresponsible behavior that should be punished. Like I mentioned before, these people should not get guaranteed issue if they did not make any effort to buy insurance or receive some sort of waiver due to income or some other hardship. They should be left to die on the streets as far as I am concerned.

So you want to run a health insurance and income check before you bring anyone in for emergencies? Well if your aim is for people to be left to die in the streets, that's exactly what you'll get then.

Meh, denying them guaranteed issue is enough as it will ruin them financially. They should take personal responsibility for their actions. If you can afford to pay for insurance, and you don't due to either ideology or just plain selfishness since you can get free care at the ER and then sign up for Obamacare later, that behavior should be punished. Since you can apply for a waiver from health insurance due to hardship, there is really no excuse.

[Sbane]

That sounds a bit like a catastophic plan you may buy outside the exchange. I suspect it will be cheaper. I wonder though, if at least the big insurance companies will offer such products. The insurance companies have an interest in ensuring the exchanges work. If you look at their websites, they seem to be heavily promoting it. In any case, there is a easy fix for this. Change the law so that if you want guaranteed issue insurance in the future, you need to buy plans within the exchange. And of course exempt employer plans and medicaid/medicare. Only apply this to people who buy individual plans outside the exchange.

[Sbane]

That sounds a bit like a catastophic plan you may buy outside the exchange. I suspect it will be cheaper. I wonder though, if at least the big insurance companies will offer such products. The insurance companies have an interest in ensuring the exchanges work. If you look at their websites, they seem to be heavily promoting it. In any case, there is a easy fix for this. Change the law so that if you want guaranteed issue insurance in the future, you need to buy plans within the exchange. And of course exempt employer plans and medicaid/medicare. Only apply this to people who buy individual plans outside the exchange.

What's so awful about buying individual plans outside the exchange that you need to penalize them by denying them coverage in the future?

And where do people get the idea that the ER is free?

Because if you have community rating, it requires the healthy members of the community to support the sickly. So they pay more than their actuarial risk. Now, if they do not want to be a part of that program, then they should not get benefitted by that community when they get sick. They are not being penalized. That is a gamble they took and they should live with the risks that it comes with.

[Sbane]

Huh, that is something I did not know either. If no health plan, whether they are on the exchange or not, can discriminate based on pre-existing conditions, then it is game over for the pubbies. Sure, some half brained MBA students will likely not get insurance to prove a point, but most young people will (a lot are already covered under their parent's insurance during their healthiest years). A lot will get subsidized insurance and those who do not qualify due to income, will mostly be in healthcare, tech or finance/business. Outside the finance/business bunch (and even there the non-ideological ones who are a majority will understand what a risk not having insurance is), I see everyone basically getting health insurance. I don't see a mass of young people foregoing insurance, especially when it is subsidized and so easily accessible through a website. Game over. I hope Ted Cruz pisses his pants during his next Obamacare rant.

[Sbane]

Those sir are excellent questions, as to which I don't have the answer. The only thing with gap insurance, is that there will be no subsidy, so it might not be a better deal for lower income folks as has been noted, which might have the effect of improving the health quality of the pool insured, even if the premiums cannot be varied based on pre-existing conditions. Is it really the case that no medical insurance can be sold anywhere in the US now, that varies premiums based on pre-existing conditions, be it Lloyd's of London or anyone else?

I don't understand this idea of getting health insurance from Lloyd's on London.  Does Lloyd's of London have a presence in the US health insurance market and the appropriate license to sell health insurance?  Don't they need to have relationships with providers and the infrastructure to process claims?  Does any doctor, hospital or provider in the United States accept just any random health insurance plan? 

It would have to be direct reimbursement of claims to the patient, which no insurance company worth it's salt would be willing to do. A health insurance company needs to be able to adjudicate claims on the spot, which would not be possible with llyods. They would just have to blindly pay whatever the patient claims. Sure, if your local Bluecross chapter sold it, that would be a different issue. But they likely can't sell plans like this....meaning game over.

[Sbane]

No one's buying anything from Lloyd's. The real question is how many healthy people will just forgo insurance altogether.

[Sbane]

Yeah, I think ignorance and apathy (especially among the young whom Obamacare needs to sign up for it to be successful) will be more of a problem than people figuring out ways to game the system.