HHS in 2010: 40-67% of those with individual insurance won't be able to keep it

[7,052,770]

http://touch.latimes.com/#section/-1/article/p2p-77990231/

More and more it seems like these anti-Obamacare stories are bunk, peddled by journalists who aren't doing their jobs and don't know what they're talking about, insurance companies who want their customers to buy more expensive plans, and irresponsible/ignorant people who aren't willing to actually find out what their options are.

And intentional distortions by the more and more desperate Right to stomp out obamacare before it causes millions of people to permanently flip to the Democratic side

[Torie]

For some reason, the moral hazard issue vis a vis folks with skeletal plans does not get mentioned enough. One can have a debate about what the minimum level of coverage should be, but there clearly does need to be a minimum. It may well be that Obamacare got the balance wrong here (choice on the one hand, moral hazard on the other), but it got the overall concept right. As many have pointed out, one would think that the moral hazard issue would be one that those on the Right would be particularly sensitive to, but no, not this time - for obvious reasons.

[Link]

For some reason, the moral hazard issue vis a vis folks with skeletal plans does not get mentioned enough. One can have a debate about what the minimum level of coverage should be, but there clearly does need to be a minimum. It may well be that Obamacare got the balance wrong here (choice on the one hand, moral hazard on the other), but it got the overall concept right. As many have pointed out, one would think that the moral hazard issue would be one that those on the Right would be particularly sensitive to, but no, not this time - for obvious reasons.

^This.

I am no expert and I haven't done much research on Obamacare.  I figure I'm going to wait a couple of months for stuff to settle down before I go to the website... Like I do with every tech roll out.  I doubt Obamacare is perfect.  That is statistically impossible.

Insurance in a general sense is pretty basic.  You take in premiums, invest the money, and pay out claims.  What's left over is your profit... If you are a profit generating entity.  If you know the size and frequency of the claims, which I do, then you know, Obamacare or not, something is fishy about two olds allegedly on a plan for $257/month.  If they are high net worth individuals that are doing a kind of self insurance then yeah that makes sense.  But for the average family leaving themselves potentially exposed to $20,000 is dangerous.

[muon2]

Sue's pretty savvy with this stuff, so I'm surprised she wouldn't have checked the online options. I'll let you know what other relevant facts I find.

It's hard doing a true comparison since I don't know any of the other specifics of her plan, but I'm always suspicious when a newspaper article talks about skyrocketing premiums without doing a basic check on a publicly available site to see if there are any alternatives available.

To be fair, she may not have checked the exchange because Illinois requires the use of healthcare.gov, which is still pretty wonky.

She found the quote you cited, but then she had to go to the Blue Cross of IL website and enter all her specifics to sign up for the silver plan. When she did that it comes up $444.80/mo and $6000. deductible (she doesn't qualify for a subsidy). Something doesn't seem to be working accurately at healthcare.gov if that's the real cost.

[🐒Gods of Prosperity🔱🐲💸]

What also happened here is that Obama tried to keep this promise by grandfathering in plans people belonged to before 2011, but the insurance companies gamed it by switching millions of people into "new, better" plans after that date and then using that as an excuse to drop them.

What happened is that routine, minor changes of the sort that people tend to make to their insurance year to year were interpreted as precluding grandfathered policies thanks to the decision of HHS.

and they did the same thing with group plans, and predicted a similar result:

You must be logged in to read this quote.

http://www.forbes.com/sites/theapothecary/2013/10/31/obama-officials-in-2010-93-million-americans-will-be-unable-to-keep-their-health-plans-under-obamacare/

[muon2]

In a conversation this morning I ran across another 60+ woman who is having a similar experience to the case I described earlier. This case involves a widow, who's husband left enough in a nest egg for her to make too much to qualify for a subsidy. She has a different insurance company than the first case but like the other case the set of choices means a doubling of premiums or deductible. She also needs follow up surgery for work done three years ago, which was scheduled and covered on her current plan. However, it appears that new basic coverage through her insurer or the exchange won't cover that or allow her to keep her same doctor. She'll be forced to a higher level of coverage with greater expense to her.

[Brittain33]

Muon, interesting. If she doesn't qualify for subsidy, her income must be $70,000 a year or more, no? How much of that is annual interest from the nest egg (meaning a principal well over $1 million) and how much is his Social Security?

Definitionally, if she is not qualifying for subsidy, the "great expense" is within her range for the small number of years until she turns 65 and qualifies for Medicare.

This seems like a rather exceptional case that we can take at face value given the caveats that she can afford the hike in costs and it will only affect her until age 65, and then weigh against the millions and millions of people unable to buy individual insurance under the old regime because of cost, preexisting conditions, and failed markets who now enjoy meaningful health insurance.

[muon2]

Muon, interesting. If she doesn't qualify for subsidy, her income must be $70,000 a year or more, no? How much of that is annual interest from the nest egg (meaning a principal well over $1 million) and how much is his Social Security?

Definitionally, if she is not qualifying for subsidy, the "great expense" is within her range for the small number of years until she turns 65 and qualifies for Medicare.

This seems like a rather exceptional case that we can take at face value given the caveats that she can afford the hike in costs and it will only affect her until age 65, and then weigh against the millions and millions of people unable to buy individual insurance under the old regime because of cost, preexisting conditions, and failed markets who now enjoy meaningful health insurance.

What made this interesting to me was that this was was the second woman I spoke to within a week around 60 who faced this sort of increase in cost for a reduction in the benefits that mattered to them. They did get new benefits that were not part of there old plan (both mentioned that they now would have to have pregnancy care at 60). But both are pretty savvy selectors of insurance and had worked to put together the policy that best covered their risk.

What I glean from this limited sample is that the few-sizes fit all approach of the exchange means that many people who have some understanding of their risk can no longer deploy that knowledge. They must pay for coverage that can not possibly be needed, but can't select coverage that they do need with buying even more features they don't want. This is a stark contrast to our normal experience with insurance, including online insurance where you can layer on different levels of coverage in different areas to design a custom policy.

[opebo]

Muon, interesting. If she doesn't qualify for subsidy, her income must be $70,000 a year or more, no? How much of that is annual interest from the nest egg (meaning a principal well over $1 million) and how much is his Social Security?

Definitionally, if she is not qualifying for subsidy, the "great expense" is within her range for the small number of years until she turns 65 and qualifies for Medicare.

This seems like a rather exceptional case that we can take at face value given the caveats that she can afford the hike in costs and it will only affect her until age 65, and then weigh against the millions and millions of people unable to buy individual insurance under the old regime because of cost, preexisting conditions, and failed markets who now enjoy meaningful health insurance.

What made this interesting to me was that this was was the second woman I spoke to within a week around 60 who faced this sort of increase in cost for a reduction in the benefits that mattered to them. They did get new benefits that were not part of there old plan (both mentioned that they now would have to have pregnancy care at 60). But both are pretty savvy selectors of insurance and had worked to put together the policy that best covered their risk.

What I glean from this limited sample is that the few-sizes fit all approach of the exchange means that many people who have some understanding of their risk can no longer deploy that knowledge. They must pay for coverage that can not possibly be needed, but can't select coverage that they do need with buying even more features they don't want. This is a stark contrast to our normal experience with insurance, including online insurance where you can layer on different levels of coverage in different areas to design a custom policy.

But again, isn't the real improvement that in fact one actually has coverage (that is, payouts mandated by government) rather than just the farcical pretense of care that 'private insurance' provides?

[jaichind]

Muon, interesting. If she doesn't qualify for subsidy, her income must be $70,000 a year or more, no? How much of that is annual interest from the nest egg (meaning a principal well over $1 million) and how much is his Social Security?

Definitionally, if she is not qualifying for subsidy, the "great expense" is within her range for the small number of years until she turns 65 and qualifies for Medicare.

This seems like a rather exceptional case that we can take at face value given the caveats that she can afford the hike in costs and it will only affect her until age 65, and then weigh against the millions and millions of people unable to buy individual insurance under the old regime because of cost, preexisting conditions, and failed markets who now enjoy meaningful health insurance.

To qualify for subsidies ones MAGI has to be less than 400% of FPL which is $45,960.  In this case perhaps she lives in a high cost area like the Greater NYC area so a MAGI of around $50K does not leave her with much money left for medical insurance. 

[Brittain33]

Good point, my mistake is that I've applied a number for a family of 4 to an individual with a lower threshold.

Muon, interesting. If she doesn't qualify for subsidy, her income must be $70,000 a year or more, no? How much of that is annual interest from the nest egg (meaning a principal well over $1 million) and how much is his Social Security?

Definitionally, if she is not qualifying for subsidy, the "great expense" is within her range for the small number of years until she turns 65 and qualifies for Medicare.

This seems like a rather exceptional case that we can take at face value given the caveats that she can afford the hike in costs and it will only affect her until age 65, and then weigh against the millions and millions of people unable to buy individual insurance under the old regime because of cost, preexisting conditions, and failed markets who now enjoy meaningful health insurance.

To qualify for subsidies ones MAGI has to be less than 400% of FPL which is $45,960.  In this case perhaps she lives in a high cost area like the Greater NYC area so a MAGI of around $50K does not leave her with much money left for medical insurance. 

[Torie]

Muon, interesting. If she doesn't qualify for subsidy, her income must be $70,000 a year or more, no? How much of that is annual interest from the nest egg (meaning a principal well over $1 million) and how much is his Social Security?

Definitionally, if she is not qualifying for subsidy, the "great expense" is within her range for the small number of years until she turns 65 and qualifies for Medicare.

This seems like a rather exceptional case that we can take at face value given the caveats that she can afford the hike in costs and it will only affect her until age 65, and then weigh against the millions and millions of people unable to buy individual insurance under the old regime because of cost, preexisting conditions, and failed markets who now enjoy meaningful health insurance.

What made this interesting to me was that this was was the second woman I spoke to within a week around 60 who faced this sort of increase in cost for a reduction in the benefits that mattered to them. They did get new benefits that were not part of there old plan (both mentioned that they now would have to have pregnancy care at 60). But both are pretty savvy selectors of insurance and had worked to put together the policy that best covered their risk.

What I glean from this limited sample is that the few-sizes fit all approach of the exchange means that many people who have some understanding of their risk can no longer deploy that knowledge. They must pay for coverage that can not possibly be needed, but can't select coverage that they do need with buying even more features they don't want. This is a stark contrast to our normal experience with insurance, including online insurance where you can layer on different levels of coverage in different areas to design a custom policy.

That is because cross subsidies are hidden away within the premium and mandatory coverage structure of the ACA. Without that, the books would show a much bigger "deficit" for implementation of the ACA. Extending coverage to millions of people who cannot afford it, and the ACA's authors belief that some  should not pay as much as the real cost of their insurance for reasons not based on income (e.g., because they are old, have pre-existing uninsured conditions), does not come for free. But then, you already knew all of this. Now more, a lot more, are finding out about it in a hurry.

[Brittain33]

An excellent point made during the Congressional hearings is that new plans have consumer protections that the previous individual plans/Ameriplan-style benefits did not. The insurance plan that the 60+ woman has, if described accurately, certainly is a loser for the insurance company, and what is common among people who've been reporting plans lost is that her surgery that she believes to be "covered" may have incurred other costs, or complications, that would not have been covered at all, or a technicality could have caused them to drop insurance, with no recourse for her. She is a beneficiary of inefficient underwriting causing harm to the investors in the company or we don't have all the information about the policy's real worth; I assume a mix of both.

It is beyond question that a large number of people satisfied with their low-cost insurance have never made claims on it that could trigger ejection or denial that would have made them unsatisfied, the same way many homeowners are satisfied with their home insurance policy because they have never experienced a Katrina or Sandy, or even a break-in, and found out what they were really getting.

That said, in a country of several hundred million served by a diversity of insurance companies, I do believe that there are some people who will find that they are paying more for a plan with protections, some of which they don't need (hat tip to the pregnancy treatment) but others they had no idea they were lacking (the ejection from the planning, surprise costs.) A majority of these people will be able to afford the switch, but not without some cost.  

I do see uncomfortable shades of the discussion of muon's vote on another issue where the rare prospect of an unintended outcome (fraud in applying for a marriage license) is cited to justify denying benefits to a large number of people as the law intended, without weighing both the unintended harm and the benefit. I believe that if we are to govern a diverse, wealthy country with a range of views, it's not realistic to only make policy around the exceptions when the loss is not a grave constitutional infringement, i.e. the right to have a cheap, potentially defective insurance policy yielding to the requirement to by a more expensive, but banned-from-dumping-charges-on-the-public-purse approved policy. This is the same debate we have over auto safety, zoning laws, and many other policies, and America survives.

[Torie]

Yes, one must balance the moral hazard issue with the concept of choice, Brittain33 (it is highly problematical that the ACA has the right balance here vis a vis dealing with actual moral hazards versus choice, but one can debate that), but no moral hazard is being mitigated by requiring men to have pregnancy coverage or abortion coverage or birth control coverage or whatever. So that just becomes a cross subsidy (one of many embedded in the ACA regulatory system itself rather than just using tax dollars via the medicaid system), rather than requiring more coverage that it is deemed prudent to require -prudent because otherwise, one might be wiped out financially because of inadequate coverage, and/or be a burden to the taxpayers, by just not paying the medical bills at all, while still getting treated.

[muon2]

But what I find troubling in this is that despite the fact that it would be straightforward to create a price tree for any number of add-ons to the basic bronze package, the ACA chooses to create a very few specific bundles for offer to the public. I presume that the ACA was fiscally designed to assume that if everyone ended up with bronze the numbers would work. Therefore each separate feature above and beyond the basic minimum could have been set with its own price.  Other areas of insurance do this perfectly well as did health insurance pre-ACA.

I get that not everyone wants to get into the weeds of the details and will accept a bundled policy in exchange for their lack of knowledge. I don't get why the same system needs to create disincentives for those who are willing to put in the effort to determine their personal needs.

I'm not sure why some of you are characterizing the policies of the two cases as defective or deficient. I've taken the time to review the details with the individuals and I find nothing deficient in their current coverage. Their plans were appropriate to meet their medical needs and prevent them from being financially wiped out in the event of unexpected ill health. It appear that either of their plans could have been easily assembled from a basic bronze with selective additions of coverage appropriate to their situation in life. The data and technology are there to do this.

[Brittain33]

I'm sorry, are men required to get pregnancy coverage? Do men's policies cover obstetrician vistis, etc.? Speak more about that. Or is this just about the costs of pregnancy not accruing 100% to women per surcharges, but being shared among the pool of all people?

[Link]

I get that not everyone wants to get into the weeds of the details and will accept a bundled policy in exchange for their lack of knowledge. I don't get why the same system needs to create disincentives for those who are willing to put in the effort to determine their personal needs.

The website signed up like 6 people out of a nation 0f $330+ million on day one.  And now you want to make things even more complicated?  let's straighten out the current mess before we layer other moving parts on it.

The law can be changed and improved.  I'm not really getting bent out of shape about a millionaire having to kick in a little more dough for their surgery.  Particularly when they are over the age of 60 and going to be on medicare soon.  Less than five years of paying whatever isn't going to kill this woman.

[7,052,770]

I'm sorry, are men required to get pregnancy coverage? Do men's policies cover obstetrician vistis, etc.? Speak more about that. Or is this just about the costs of pregnancy not accruing 100% to women per surcharges, but being shared among the pool of all people?

Overall, it's cheaper to just have "covered services" for everyone, not let everyone pick and choose what they want and what they don't want.  And remember, one of the most well-publicized pieces of Obamacare is that men and women cannot be charged different rates.  And as far as maternity coverage for olds goes, the fact that they don't get pregnant is reflected in age rating.

[muon2]

I get that not everyone wants to get into the weeds of the details and will accept a bundled policy in exchange for their lack of knowledge. I don't get why the same system needs to create disincentives for those who are willing to put in the effort to determine their personal needs.

The website signed up like 6 people out of a nation 0f $330+ million on day one.  And now you want to make things even more complicated?  let's straighten out the current mess before we layer other moving parts on it.

The law can be changed and improved.  I'm not really getting bent out of shape about a millionaire having to kick in a little more dough for their surgery.  Particularly when they are over the age of 60 and going to be on medicare soon.  Less than five years of paying whatever isn't going to kill this woman.

One of the cases I'm describing here is a former Democratic congressional staffer who was a strong proponent of the ACA at its passage. Hardly a 1%er. I don't see why she should pay double because the Feds couldn't emulate any of the number of online insurance engines that already exist.

[Link]

One of the cases I'm describing here is a former Democratic congressional staffer who was a strong proponent of the ACA at its passage. Hardly a 1%er. I don't see why she should pay double because the Feds couldn't emulate any of the number of online insurance engines that already exist.

I think the situation is complex and we are operating in an information vacuum.  I am willing to say there is a lot I don't know.  But what I do know was there was a lengthy period where Republicans could have helped shape this thing and they chose not to.  In fact they chose to obstruct, sue, defund, and basically destroy it.  Are you at all surprised after such a process the final product is less than ideal in some instances?

I am going to wait for the website to get fixed and substantial numbers for people to sign up.  I am going to wait for a solid amount of objective data instead of a drip, drip, drip of anecdotal stories.  I've been burned too many times on the internet where people go off on a long discussions and some critical piece of information was left out intentionally or unintentionally.

[muon2]

One of the cases I'm describing here is a former Democratic congressional staffer who was a strong proponent of the ACA at its passage. Hardly a 1%er. I don't see why she should pay double because the Feds couldn't emulate any of the number of online insurance engines that already exist.

I think the situation is complex and we are operating in an information vacuum.  I am willing to say there is a lot I don't know.  But what I do know was there was a lengthy period where Republicans could have helped shape this thing and they chose not to.  In fact they chose to obstruct, sue, defund, and basically destroy it.  Are you at all surprised after such a process the final product is less than ideal in some instances?

I am going to wait for the website to get fixed and substantial numbers for people to sign up.  I am going to wait for a solid amount of objective data instead of a drip, drip, drip of anecdotal stories.  I've been burned too many times on the internet where people go off on a long discussions and some critical piece of information was left out intentionally or unintentionally.

I support your decision to wait for more data, and I'm not totally surprised at the product produced by this process. Most of my surprise is at what happened technologically given the resources available. I and many other Pubs were willing to work with a plan like Wyden's at the beginning of 2009. Unfortunately Obama characterized that as "too radical" despite its bipartisan support.

[Brittain33]

I support your decision to wait for more data, and I'm not totally surprised at the product produced by this process. Most of my surprise is at what happened technologically given the resources available. I and many other Pubs were willing to work with a plan like Wyden's at the beginning of 2009. Unfortunately Obama characterized that as "too radical" despite its bipartisan support.

No U.S. Senators were willing to work on a bipartisan plan or any plan for healthcare in 2009-2010, as shown by the lack of results or proposals from the bipartisan "gang" which negotiated through much of 2008. Robert Bennett did support the Wyden plan and is no longer a U.S. Senator as a result.

Given the pressure on U.S. Senators to conform and be whipped to filibuster on issues of major importance to the President (the stimulus, health care, immigration reform, and all judicial nominations) the dynamics of the Senate under current leadership foreclose compromise. It's unfortunate that your instincts and initiatives would not bear any fruit in the Senate, and it's inconceivable that a Republican U.S. senator could behave as you suggest.

[Torie]

I'm sorry, are men required to get pregnancy coverage? Do men's policies cover obstetrician vistis, etc.? Speak more about that. Or is this just about the costs of pregnancy not accruing 100% to women per surcharges, but being shared among the pool of all people?

Don't know, but what I heard was the former - all the policies read the same, and not based on gender as it were. But economically, to the extent true, it does not make any difference either way. It's a cross subsidy. Again, we can do away with the cross subsidies, and just give folks subsidies based on means. Everyone will still have the means to purchase insurance with some "bronze plan" (as Muon2 puts it) minimal level of coverage.

No doubt the Pubs get more of the blame here for the mess, but both parties really have egg on their faces. The Pubs to the extent of my knowledge were AWOL about the notion of getting everyone insured, and getting past the moral hazard problem, and giving folks the subsidies that they needed one way or the other to purchase bronze plans based on means. Rather, if I recall correctly, there were just into making insurance more affordable and portable, and did not get much into the subsidy business. Maybe some did (offering some subsidies - I don't think any went the universal coverage route), and no doubt the Wyden Plan had some subsidy component. But I am not sure if the Wyden Plan got there as to meeting all the basics above, and why the Dems, as Mike puts it, thought it "too radical," (is that really true, and who said that on the Dem side, or were other reasons in play?), and if someone could outline the basics of that approach to refresh my memory, that would be appreciated.

[muon2]

I support your decision to wait for more data, and I'm not totally surprised at the product produced by this process. Most of my surprise is at what happened technologically given the resources available. I and many other Pubs were willing to work with a plan like Wyden's at the beginning of 2009. Unfortunately Obama characterized that as "too radical" despite its bipartisan support.

No U.S. Senators were willing to work on a bipartisan plan or any plan for healthcare in 2009-2010, as shown by the lack of results or proposals from the bipartisan "gang" which negotiated through much of 2008. Robert Bennett did support the Wyden plan and is no longer a U.S. Senator as a result.

Given the pressure on U.S. Senators to conform and be whipped to filibuster on issues of major importance to the President (the stimulus, health care, immigration reform, and all judicial nominations) the dynamics of the Senate under current leadership foreclose compromise. It's unfortunate that your instincts and initiatives would not bear any fruit in the Senate, and it's inconceivable that a Republican U.S. senator could behave as you suggest.

The difference is between where the US Senate was in Mar 2009 vs Aug 2009. There was a willingness to work on a compromise in the spring and Alexander, Crapo and Graham were also on Wyden's bill. Furthermore, Corker, Grassley and Gregg had been cosponsors of the same bill the year before Obama took office.

Because the bill would completely remove any employer-based insurance, meaning no negotiable health care in contracts, the unions lobbied hard against it in the spring of '09 and the president sided with the unions on the issue of employer-based health care. Conservative opposition was building against an individual mandate, but it was really during the August recess that the Tea Party push-back in member town hall meetings moved the GOP away from any compromise position.

[Link]

Van Jones and Politifact have some interesting information...



So apparently it is only the extreme minority of individual policy holders that keep their policy for more than two years.  And individual policy holders are a minority compared to empoyer policies and medicare and medicaid.  This looks like the Catholic birth control thing.  People want to make vast changes to national policy to accommodate a tiny minority of people.