News & Current Events
bill_coley — 2017-10-02T11:28:48-04:00 — #21
The CBO doesn't have to have anything to do with the insurance companies to predict - quite reasonably and rationally - that those companies will raise premiums if they don't receive CSR payments, which function as subsidies to offset claims costs. If they don't receive the subsidies, insurers have to make up that lost revenue somehow; they do so via increased premiums.
And I remind you, David, that every source I consulted on this matter offered the same conclusion: Without CSR payments, insurers raise premiums to make up for the lost revenue. Please offer a link to a source that concludes insurers aren't affected in this manner by lost CSR payments.
I "would have to be living under a rock not to know that"...
What people living under rocks know or don't know about the conditions needed for a profitable business is not marketing's concern. The purpose of marketing the health exchanges is both to inform people of their existence and services, and to persuade eligible persons - in the example I raised, otherwise uninsured younger, healthier persons - to participate in them.
As I'm sure you know, stable insurance markets require the involvement of people who pay premiums, but don't make claims. If only the more at-risk or less healthy buy insurance, costs will far exceed income, and the market will collapse. Younger, healthier people, as a group, tend to buy less health insurance because they believe their needs for such coverage are less. Marketing is needed, NOT to remind younger, healthier people that insurers need their premiums to make a profit(!) but to persuade them to take an action they don't otherwise want to take: buy health insurance.
And that's why CSR payments are so important. The CSRs subsidize part of those high premium costs, thereby reducing the cost paid by insurance customers, making insurance more affordable and increasing the chances that people will purchase coverage.
It's a hard sell, no doubt. But that doesn't mean we don't try.
Bottom Line: Any serious expansion of the number of people with health insurance - in other words, any serious reduction in the number of people who use ERs as their primary care physicians - will require the participation of people whose healthcare needs, as a group, produce more premium revenue than claims costs. Hence, we must market to the younger and healthier.
So why not reduce the OE to a week, or a day?
I acknowledge that I didn't know what "adverse selection" was, so I looked it up. If the sources I checked are correct, then "reducing the risk adverse selection" basically means insuring people whose projected claims experience will put less pressure on premiums because those people, as a group, will be in better health and hence file fewer, less costly claims. Given that summary, I don't understand how a shortened OE reduces the risk of adverse selection. Please explain.
We should seek to increase enrollment because it's the right thing to do, because more insured is a better outcome than fewer insured.
Everyone acknowledges that there are problems with the ACA's exchanges. There are serious proposals on the table to strengthen the core structure of the program. A GOP Congress, however, is unlikely to give serious consideration to those proposals.
As for deregulation of the insurance industry, you and I will disagree. I think it's a recipe for disaster, but I think we should follow the example of most other advanced countries in the world and provide coverage for all through a single payer system (if you want a Google search challenge, try to find a reputable authority that deems the U.S. healthcare system as anything close to the best in the world! THIS SET OF RANKINGS, for example, puts us 32nd).... As I said, we disagree.
And I still hope you'll respond to the request I made at the end of my previous post:
david_taylor_jr — 2017-10-02T12:16:15-04:00 — #22
I meant you would have to live under a rock to not know about the ACA, how it works, and the need for everyone to sign up. Face it, socialism fails. AGAIN.
And who pays for that Bill? It's not sustainable.
It's a hard sell because it is a bad idea.
Why should I have to pay for someone elses healthcare?
Sure. So example:
Someone doesn't have a pre-existing condition on November 1st and therefore doesn't want insurance from the ACA exchange. However, on December, let's say 29th, they develop or are diagnosed with a condition that is now pre-existing. Because they would now want to sign up the become adverse selection. They are a risk to the insurance company. But by them not beign able to sign up for a year, that is less risk to the carrier and allows them to make money that will cover that person next year.
Remember, the purpose of insurance IS NOT to insure pre-existing conditions. That's why you can't wreck your car, go buy insurance and expect it to cover the wreck.
No Bill, the socialist experemint failed.
Single payer does not work. Waiting lines, terrible care, horrible coverage. It doesn't work.
As far as deregulation...how would it be a disaster? The short term insurance field does great because it isn't as regulated. Prices are LOW, coverage is GREAT.
bill_coley — 2017-10-02T13:07:23-04:00 — #23
I doubt seriously that everyone not living under rocks knows how the ACA works (for example, what percentage of people knows the ACA covers only a small percentage of Americans?) It's a complicated system, not quickly understood.
And the fact that people know how it works and that they should sign up does not assure that they WILL sign up - and that's especially true for younger, healthier people who don't think they need it, and don't understand their role in making insurance accessible and affordable to everyone.
Then why are SO MANY countries that have a "socialist" healthcare system ahead of us in almost every ranking of the quality of nations' healthcare systems?
Who pays when an uninsured person uses an ER to obtain medical care?
You don't think you help pay for Medicaid services in your state? You don't think your payroll taxes underwrite others' Medicare coverage? You don't think you pay when uninsured persons use ERs to get care?
And who SHOULD pay for someone else's healthcare if that someone else can't afford insurance or the cost of care itself? Do you advocate that those who can't pay for their own care not receive care? If not, then who should pay for their care?
So how SHOULD the person in your example get care once diagnosed, and who should pay for that care, particularly if he or she can't afford it or the high risk pool premiums that I think you're advocating?
Then why are there so many single-payer system nations ahead of the US in nearly every ranking of nations' healthcare systems?
And by the way, the idea that there are long lines and terrible coverage in single payer systems, according to most studies of those systems and most of the people served by them, is not true. One study from many years ago, for example, found that 0.5% of 18,000 Canadians surveyed had accessed healthcare in the US during the previous 12 months. Another study found that 41% of Canadians received same- or next day appointments when they were sick, compared to 48% of Americans. Not a drastic difference, in my view.
And for the third time I will ask you to cite one action the Trump administration has taken to increase ACA enrollment.
david_taylor_jr — 2017-10-02T13:28:47-04:00 — #24
Marketing doesn't do that either....
That's not the question Bill.
Oh no I do think that, I would get rid of both of those programs.
Ultimately yes. It goes a lot deeper than that but yes.
bill_coley — 2017-10-02T14:16:22-04:00 — #25
No outcome is guaranteed, but targeted marketing whose purpose is to inform and persuade the younger, healthier community DOES have the potential of helping them understand their need for insurance and their role in making insurance accessible and affordable to everyone. That's what marketing does! It tries to persuade people to change their behavior/spending/etc.
Both Spain and Finland have single payer systems, and both rank above the US in the rankings to which I linked in a previous post.
The United Kingdom has a hybrid system, but most care is publicly provided and paid for by taxation. The UK also ranks above the US in the rankings.
You asked for one. I gave you three.
Who pays for the person who uses an ER as his or her primary care physician IS at least one of the questions when your question was...
The person who uses ERs often does so because he or she doesn't have insurance, and hence sticks the hospital with large, unpaid costs. So that ER patient is the "someone else" in your question.
This is a helpful revelation for our understanding your vision for healthcare in this country. Thanks.
And that in some or fashion you believe people who can't pay for their own care should not get care is also a helpful revelation of your vision. Thanks again.
For the fourth and final time I will ask you to cite one action the Trump administration has taken to increase ACA enrollment.
david_taylor_jr — 2017-10-02T15:12:05-04:00 — #26
I didn't see those link....where are they?
There should be consequences for not paying your ER bill just like every other bill out there.
That is not what I said. I think that is where the church needs to step in.
I actually did answer your question and asked why would they want to put more people in a program with terrible rates, care, and coverage?
david_taylor_jr — 2017-10-02T16:07:58-04:00 — #27
@bill_coley and others who are interested in the healthcare.gov downtime....
I just received an email from healthcare.gov that says these are "potential" downtimes, not guaranteed downtimes. Nothing to see here everyone, move along.
bill_coley — 2017-10-02T17:40:02-04:00 — #28
This change in policy might display the power of public pressure!
We first learned of the planned shutdowns via a tweet from Phil Galewitz, after his participation in an HHS webinar. Notice, no mention of "potential" shutdowns.
When pressed on the matter, HHS released this statement; notice again, no mention of "potential" shutdowns...
Maintenance outages are regularly scheduled on HealthCare.gov every year during open enrollment. This year is no different. The maintenance schedule was provided in advance this year in order to accommodate requests from certified application assisters. System downtime is planned for the lowest-traffic time periods on HealthCare.gov including Sunday evenings and overnight.
So in my view, David, there obviously WAS "something to see here"... until HHS realized how transparent was their effort to damage this year's ACA enrollment, and so changed the shutdown times to "potential" ones.
References to "consequences" do not answer the question I asked: Who pays for the person who uses an ER as his or her primary care physician? Whether there are "consequences" for needing medical care when you can't afford to pay for it doesn't help you pay for it when you need it but can't afford it.
When I asked whether you believe a person who cannot afford medical care should not receive care, you answered...
Which I summarized this way...
My summary sounds pretty accurate to me.
And how do you propose that the church "step in" to help pay for the medical care of the millions of Americans still un- and under insured?
Because the ACA is part of the healthcare policy of the United States, and it is the sworn duty of the HHS to implement that policy until it is changed.
And remember my request for an example of an action the administration has taken to increase ACA enrollment came in response to our exchange about a trio of administration actions, all of which seem intended to reduce the results of this year's enrollment period:
- Reduced marketing expenditures by 90%
- Shortened the open enrollment period by 50%
- Cut the website's up time by more than 6%
It's not the job of HHS to make ACA enrollment for difficult or more unlikely. Yet each of those actions does exactly that.
gao_lu — 2017-10-02T18:43:55-04:00 — #29
This is not my area of expertise and not really even of interest as I don't live in the US, but maybe someone can answer my naive question. Why invest tons of taxpayer dollars in a proven bad system that is going away?
david_taylor_jr — 2017-10-02T21:19:48-04:00 — #30
You know they also did this under Obama right? It used to be six months, then it got shortened to three so don't act like this is specific to Trump.
Because liberals are stubborn.
alex_vaughn — 2017-10-02T21:42:07-04:00 — #31
It takes one to know one. The Republican House over the last seven years have attempted to repeal, cripple, or defund the Obamacare 54 times. Now, the Senate has voted numerous times on various bills attempting to repeal the same. It is clear that the Republicans never had a reasonable plan to replace, improve or repeal Obamacare. What's more they've completely ignored the regular order of the Senate.
It is thus clear that Republican officials are like a bird running into a window repeatedly.
P.S. Additional examples of liberal progressives being stubborn include: 13-15th Ammendments, Liquor outlawed (18th Ammend), and Women's Suffrage(19th).
bill_coley — 2017-10-02T22:32:31-04:00 — #32
As you may well know, David, the change from a six month open enrollment period for coverage in year 2014, to a ninety day OE period for all succeeding years was known from the beginning of the program. Look at THIS AARP summary published in 2013; notice the section titled "What about in future years?"
Why was the first year of enrollment held open twice as long as succeeding years? Probably because going into the 2014 OE period, NO ONE was already enrolled; EVERYONE had to go through the entire plan selection process. In succeeding years, lots of enrollees would make no changes to their coverage, and need less time to re-up than were they to start from scratch.
To my knowledge, the Obama administration never planned a second reduction in the OE period, and certainly would not do so now, given the importance of increasing market sizes to assist in efforts to shore up the exchanges.
And remember, David, it's not just the OE period cut that's at issue here; it's the "coincidence" of three Trump administration actions ALL which have the effect of hampering the ACA's chances of success:
- The OE period reduction
- The cut in the marketing budget
- The increase in the healthcare.gov website's downtime
Any one of those MIGHT be understood as a benign - if also misguided - quest for system efficiency. But all three? In the same year? The intention is clear: The Trump administration wants the ACA to fail and is taking active measures to promote that failure.
I accept that you believe that would be a good - probably inevitable - outcome. I don't. I believe the ACA is the law of the land, that people with healthcare needs are at the other end of the administration's failure quest, and that the president needs to order his HHS to do everything possible to support the ACA and the people who rely on it while it is the law.
Another powerful argument, David. Well written. Thoughtfully executed. Deceptively compelling. Thanks.
david_taylor_jr — 2017-10-03T08:57:34-04:00 — #33
I can't argue with that.
Because the Democrats are so in favor of regular order? Please....
The point is they also did the same thing so not sure why you are harping on that.
That is factually not true. Only individuals who did not have a certified plan had to do this.
This actually helps stabilize the markets by reducing adverse selection as previously stated.
Which also happened in the Obama years. It is potential down time. Could be five minutes, they are just being transparent about it.
Once again, they shouldn't be marketing it in the first place. Waste of money.
Just like Obama should have enforced immigration laws? Double standard? Hmmmm.....
bill_coley — 2017-10-03T09:48:17-04:00 — #34
The ACA was passed after months and months and months of hearings, negotiations, and amendments from BOTH sides. A telling summary of the differences between the legislative processes used to pass the ACA and the GOP's "repeal and replace" alternatives can be found HERE, an article from which I now quote...
In June and July 2009, with Democrats in charge, the Senate health committee spent nearly 60 hours over 13 days marking up the bill that became the Affordable Care Act. That September and October, the Senate Finance Committee worked on the legislation for eight days — its longest markup in two decades. It considered more than 130 amendments and held 79 roll-call votes.
The full Senate debated the health care bill for 25 straight days before passing it on Dec. 24, 2009.
When houses of Congress hold hearings, call witnesses, consider amendments (from both sides of the political aisle!) and take months to consider legislation, I believe they call it "regular order."
Oh, and in 2009 the Senate passed the ACA with 60 votes - more of that "regular order" - and not via the reconciliation process used this year by the GOP.
So as for your argument that the Democrats "are so in favor of regular order," David, where the ACA and its GOP alternatives are concerned, as you would say, "Please!..."
I am "harping on that" because what the Obama administration did NOT do was to reduce the OE period beyond what the ACA called for. The cut from 180 to 90 days was codified in the law from the beginning, as was the expectation that the OE period would then remain at 90 days. So it's not correct to say "they also did the same thing."
Yes. Those whose insurance didn't meet ACA standards and wasn't grandfathered into acceptance, had to enroll. Recall that a principal target of the ACA was the uninsured, none of whom would have had a "certified plan." But I take your point, so I modify my point to say that the number of people eligible/required to enroll in the initial OE period was substantially higher - by eight million - than the number of people eligible in succeeding years.
As I've noted multiples times in our exchange, explanations of the action's intended purposes do not change the fact that when take it's taken in concert with the two other actions I identified, the administration's intentions are clear.
The Obama administration did NOT reduce the OE period beyond what was called for in the ACA.
The Trump administration apparently did not start calling the extended down times "potential" until public pressure compelled them to. Since I can't find ANY official reference to such "potential" down times, please provide a link to the administration's use of that adjective. Especially helpful would be a link to a use made when the administration FIRST announced the increased down times. (Recall the tweet from Phil Galewitz after the HHS webinar that announced the down time increases)
So are you arguing in favor of double standards, or against them? Do you OPPOSE how, in your view, the Obama administration selectively implemented immigration laws? And you now APPROVE of the Trump administration's selective implementation of the ACA? Is THAT what you mean by a "double standard"?
david_taylor_jr — 2017-10-03T11:18:59-04:00 — #35
I'm talking about as of late....
They had a super majority Bill, not exactly comparing Apples with Apples here...
That's your opinion.
Doesn't change the facts.
Everything I have received from HC.gov has been "potential". I can't provide you a link as it isn't for public consumption and needs an agent/broker password.
No, I am saying you can't have it both ways.
bill_coley — 2017-10-03T12:57:26-04:00 — #36
I thought we were talking about passing healthcare reform via regular order. The Democrats did. The Republicans didn't.
And is it your view that their having a "super majority" moved the Democrats in 2009 to hold all those hearings and consider all those amendments, something the GOP didn't do? (recall that committee hearings and amendment processes are also part of "regular order")
Please cite for me one assertion in my "opinion" that "what the Obama administration did NOT do was to reduce the OE period beyond what the ACA called for" which is not factually correct.
Well, surely, David, the Trump administration hasn't been telling you one thing about these "potential" down times and the rest of us something else! Surely you can provide a link to an official administration PUBLIC statement that repeats the basic message you have received about the down times only being "potential."
And you're saying you can't have it both ways, either?
david_taylor_jr — 2017-10-03T13:09:59-04:00 — #37
No we were talking about regular order in general.
You do realize the Republicans had hearings as well, right?
I don't have any links for you Bill, I'm sorry. Can you show me something from healthcare.gov that says what you say it does? Preferably something more official than a tweet? Something more official than a biased slate.com article that reads more into the statement that what is there? Notice that the quote was from an anonymous source with no citation given, no official link.
david_taylor_jr — 2017-10-03T13:11:14-04:00 — #38
How have I tried to have it both ways Bill? I acknowledge that the administration, including Obama, has the right to not enforce parts of the law. However, Obama took it way further than that and did things that were not within his authority. Show me how the Trump Administration is doing that?
bill_coley — 2017-10-03T13:52:47-04:00 — #39
How many hearings were held, and how many witnesses testified at those hearings, David?
The CMS official spoke on the condition of anonymity; so there is no link to the statement. And the only reason we know about the increase in Sunday down times is that a participant in the HHS webinar passed along the information HHS provided in a webinar. A simple Google search produced countless reprints of the tweet's content (if not always its attribution).
Notice that HHS has not denied the accuracy of the information passed along.
And whether the down times are only "potential" down times distracts from the fact that the Trump administration has added to the time the system might be down. According to the U.S. Digital Service, last year healthcare.gov was up 99.99% of the time. That's not likley to happen this year.
I was wrong to take us off course and far afield with my question about double standards. That's fodder for another time and another thread/forum.
david_taylor_jr — 2017-10-03T14:19:23-04:00 — #40
How is that relevant?
Right so you are basing all of this off of one tweet who may or may not have left out the part about potential....
You are confusing two different things here. 99.99% of uptime doesn't mean 99.99% usable to the public. Even maintainence periods are counted in uptime with web standards. Not sure if you knew that. Downtime only means that the actual server itself is unreachable with no messages of downtime etc...
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