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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 16th October 2017, 10:37 AM   #961
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Originally Posted by Puppycow View Post
I don't know that there is a specific executive order about ending subsidies. But the official White House spokesperson said it. Not everything involves an executive order from the president. It could be the secretary of HHS.
I'll try to keep an eye out for something that confirms this. It's been being talked about for a couple of years now, and it has pretty massive impacts.
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Old 16th October 2017, 10:40 AM   #962
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Originally Posted by Travis View Post
You do realize this will kill people, right?

Is being "correct" so much more important than saving lives?
It's not going to kill anyone.

And yes, actually, being just and legal IS more important than saving lives. Heck, it's feasible that some good samaritan could rob a bank and use all the money to pay the hospital bills of those in need. Still illegal, still unjust, still not excusable. It's feasible that the government could forcibly take ownership of everything in the US, and could confiscate the earnings of every citizen, then use that money to save lives. That doesn't make it okay.

The ends don't justify the means.
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Old 16th October 2017, 10:52 AM   #963
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Quote:
President Trump on Monday blasted ObamaCare, saying it is "dead" and "finished."

"ObamaCare is finished. It's dead. It's gone," Trump said during a Cabinet meeting.

"You shouldn't even mention it, it's gone. There is no such thing as ObamaCare anymore. It is a — and I said this years ago — it's a concept that couldn't have worked."

Trump added that in the law's "best days," it couldn't have worked.
The comments come after the White House announced last week that it would end key payments to insurers selling ObamaCare plans.
http://thehill.com/policy/healthcare...macare-anymore

HAHAHAHAHA!!!
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Old 16th October 2017, 10:53 AM   #964
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<unplugs tv> See? I told you that machine wouldn't work forever!
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Old 16th October 2017, 11:39 AM   #965
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Trump's breathless excitement over exclaiming the death of Obamacare reinforces my belief that his almost singular policy is the erasure of Obama from the National consciousness. Recklessly. To the detriment of the country. To the detriment of himself. Our new Ahab.
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Old 16th October 2017, 12:15 PM   #966
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What Trump is up to:
Quote:
His main strategy is trying to prevent healthy people from entering the normal insurance market. The administration has all but stopped advertising the Obamacare insurance exchanges, which serve people who don’t already have coverage. Absent this outreach, people who desperately need insurance — the sick — will dominate sign-ups, and prices will soar. Imagine if the life insurance market were dominated by people who’d already turned 80.
https://www.nytimes.com/2017/10/15/o...trumpcare.html

More:
https://www.nytimes.com/2017/10/12/u...T.nav=top-news
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Old 16th October 2017, 03:50 PM   #967
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Originally Posted by Bob001 View Post
Okay, I'm gonna quibble. YEs, Trump is busy trying to destroy ACA. Yes, he's going about it in a reckless and negligent way with no consideration to the harm being done in the process...

But this quote is absurd. The advertising that is funded by the government has had very little impact on the market. And insurers advertise for open enrollment too. The government no longer funding this specific type of advertising is NOT going to destroy the market and leave only the sick signing up. Seriously, this is a ridiculous claim.

There's plenty of other things that can AND SHOULD be attacked with respect to the current administration's handling of ACA. This is a distraction from that.
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Old 16th October 2017, 04:26 PM   #968
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Originally Posted by Argumemnon View Post
<unplugs tv grandma's ventilator> See? I told you that machine wouldn't work forever!
edited to be more apropos
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Old 16th October 2017, 04:51 PM   #969
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Originally Posted by Emily's Cat View Post
Okay, I'm gonna quibble. YEs, Trump is busy trying to destroy ACA. Yes, he's going about it in a reckless and negligent way with no consideration to the harm being done in the process...

But this quote is absurd. The advertising that is funded by the government has had very little impact on the market. And insurers advertise for open enrollment too. The government no longer funding this specific type of advertising is NOT going to destroy the market and leave only the sick signing up. Seriously, this is a ridiculous claim.

There's plenty of other things that can AND SHOULD be attacked with respect to the current administration's handling of ACA. This is a distraction from that.

The story sets out many of those things. Maybe this is a more representative quote:
Quote:
Last week, the administration took several steps to deprive people of health insurance. In doing so, it has both a short-term goal (have the federal government do less to help vulnerable citizens) and a long-term goal (sabotage Obamacare, so that Congress can more easily repeal the law).
https://www.nytimes.com/2017/10/15/o...trumpcare.html

And this:
https://www.nytimes.com/2017/10/12/u...T.nav=top-news

But I think you're making a big mistake if you think advertising doesn't matter, especially in the face of dishonest political claims that "Obamacare is broken." Telling people who don't have insurance what's available and how to get it is about as basic as you can get, especially when there is an enrollment deadline. Watch any hour of prime-time TV and count how many minutes are paid advertising. You wanna claim it's not effective?
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Old 16th October 2017, 05:44 PM   #970
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Originally Posted by Bob001 View Post
But I think you're making a big mistake if you think advertising doesn't matter, especially in the face of dishonest political claims that "Obamacare is broken." Telling people who don't have insurance what's available and how to get it is about as basic as you can get, especially when there is an enrollment deadline. Watch any hour of prime-time TV and count how many minutes are paid advertising. You wanna claim it's not effective?
I'm not saying that advertising doesn't matter. I'm saying that advertising paid for by the government is unnecessary.

Over the past several years, the government advertising has made no measurable difference in the volume of enrollments. The advertising was in a limited number of areas, and was quite expensive, and showed no actual increase in enrollments - it didn't generate lift. The insurers are advertising already, and will continue to do so - it's in their interests to bring in lower cost people, after all. The additional advertising in such a small footprint at such a large price is not a good use of funds.
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Old 16th October 2017, 06:11 PM   #971
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This is a very good observation paired with an excellent kicker.


Quote:
His single-minded obsession with dismantling the Affordable Care Act isn’t an impulse that stems from some deeply held right wing ideology, but from his primitive desire to brutalize Obama, the person, in the public square. He sees the steady progress he’s made rolling back Obama-era regulations and administrative action not as policy changes that will serve the public interest, or as legacy burnishing accomplishments in their own right, but as his most proximate means of needling a defenseless nemesis. Of owning Obama. Nay, of pwning him.

Perhaps Obama is highly insulted by all this pwnage. That’s the fantasy anyhow. But as in Moscow four years ago (allegedly) Trump hasn’t come around to the fact that the bed he’s befouling isn’t Obama’s anymore. It’s his. And, unfortunately, it’s ours, too.
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Old 17th October 2017, 10:33 AM   #972
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Originally Posted by Emily's Cat View Post
I'm not saying that advertising doesn't matter. I'm saying that advertising paid for by the government is unnecessary.

Over the past several years, the government advertising has made no measurable difference in the volume of enrollments. The advertising was in a limited number of areas, and was quite expensive, and showed no actual increase in enrollments - it didn't generate lift. The insurers are advertising already, and will continue to do so - it's in their interests to bring in lower cost people, after all. The additional advertising in such a small footprint at such a large price is not a good use of funds.

What's your evidence that government ads don't matter? How much have the insurance companies actually paid for expensive private advertising? Here's where we stand now:
Quote:
Here’s more cause for worry: The polling firm Hart Research Associates conducted a poll for Get America Covered and found that only 31 percent of customers insured through the ACA exchanges and 12 percent of the uninsured know when open enrollment starts. Worse, majorities of the insured (54 percent) and of the uninsured (59 percent) either believe Obamacare will be canceled in 2018 or say they’re unsure.
https://www.washingtonpost.com/blogs...s-malevolence/

If advertising is badly designed or misdirected, that's a separate issue that needs to be dealt with. But obviously, people need to know that health insurance is available and a deadline is looming. And Trump is doing everything he can to discourage them.
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Old 17th October 2017, 11:14 AM   #973
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Originally Posted by Bob001 View Post
... But obviously, people need to know that health insurance is available and a deadline is looming. And Trump is doing everything he can to discourage them.
Including telling them that Obamacare is DEAD, whether or not you were expecting those cancelled subsidies. I don't think advertising would help now.
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Old 17th October 2017, 11:24 AM   #974
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Originally Posted by WilliamSeger View Post
Including telling them that Obamacare is DEAD, whether or not you were expecting those cancelled subsidies. I don't think advertising would help now.
It's even worse, some of the ads that has been funded and released by the DHHS, involves horror stories of families whose lives are worse off because of ACA.

I'm not sure, but that has got to be the first time a department is actively trying to discourage US citizens from utilising their services. Imagine if the US Army ran recruiting ads along the line of "Be all that you can be after losing a limb or two".

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Old 17th October 2017, 02:03 PM   #975
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Lying and not paying the bills was a big part of Trump's business model. Now he is making government work just like his business.
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Old 17th October 2017, 03:36 PM   #976
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It ain't dead yet. Look on the bright side. Trump has declared ACA dead. When the inevitable "tweaks" to make it actually dead are sent to the Oval Office no one will be able to mention the subject because Trump declared ACA dead.


It will be like when the Allies stormed the Normandy beaches and no one wanted to wake Hitler! And, yes, I just compared Trump to Hitler.
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Old 30th October 2017, 06:51 AM   #977
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More ACA sabotage:
https://www.washingtonpost.com/natio...f98_story.html
https://www.washingtonpost.com/natio...=.98482d9021c3
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Old 30th October 2017, 10:05 AM   #978
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Originally Posted by Bob001 View Post
I'm not so sure the total number of enrollees will go down. The number of new sign ups should, because of the slashed advertising budget and scarce facilitators, but anyone who is already enrolled doesn't have to do anything. You get an email from your insurance company telling you what next years premium will be and if you agree you take no action, it automatically rolls over. If you want to shop for a new policy (or if your insurance company withdraws from the market) you have to return to the Exchange, but this is something you are already familiar with, it's not that much trouble.

The usual frequent emails from the Exchange have already started, I don't suppose that will change, they're cheap to send.
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Old 30th October 2017, 10:44 AM   #979
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Originally Posted by Marcus View Post
I'm not so sure the total number of enrollees will go down. The number of new sign ups should, because of the slashed advertising budget and scarce facilitators, but anyone who is already enrolled doesn't have to do anything. You get an email from your insurance company telling you what next years premium will be and if you agree you take no action, it automatically rolls over. If you want to shop for a new policy (or if your insurance company withdraws from the market) you have to return to the Exchange, but this is something you are already familiar with, it's not that much trouble.

The usual frequent emails from the Exchange have already started, I don't suppose that will change, they're cheap to send.

According to this, current enrollees will be auto re-upped before they have a chance to change if they want:
Quote:
Millions of Americans with insurance through the Affordable Care Act could find themselves locked into health plans they do not want for the coming year because of the Trump administration’s schedule for the enrollment season that starts in less than two weeks.
The complication arises when people who already have health plans under the law are automatically re-enrolled in the same plan. In the past, a few million consumers each year have been auto-
enrolled and then were sent government notices encouraging them to check whether they could find better or more affordable coverage.
This time, according to a federal document obtained by The Washington Post, the automatic enrollment will take place after it is too late to make any changes. Auto-enrollment will occur immediately after the last day of the ACA sign-up season, which the Trump administration has shortened, leaving the vast majority of such consumers stranded without any way to switch to a plan they might prefer.
https://www.washingtonpost.com/natio...=.98482d9021c3

Last edited by Bob001; 30th October 2017 at 10:54 AM.
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Old 30th October 2017, 11:06 AM   #980
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Originally Posted by Bob001 View Post
Okay, let's clear up some stuff with real information...

The shrinking open enrollment period is not new. It's been planned to shrink so that it is in alignment with Medicare open enrollment since the inception of ACA. In fact, in 2014, the enrollment period was artificially extended by an additional 2 months, and by 1 month in 2015. This year, after four years in practice, the enrollment period is down to 45 days. For comparison, Medicare Advantage has an enrollment period of 53 days.

Yes, there is likely to be a drop in enrollments this year. I wouldn't be at all surprised to see somewhere around a million people nationwide, although I don't give much credence to the loss being driven by Trump not extending the federal funding for advertising. The federal advertising was scheduled to sunset, by the terms of ACA. And it *should* be sunset in my opinion. The federally funded advertising was only operational in a handful of states, and was quite expensive. It also had minimal effect on actual enrollments in those states. The cost per acquisition was really high - a cost being borne by taxpayers.

The largest drivers of reduced enrollment, in my opinion, are due to two things: Reduced choice of insurers and increased prices. There were several counties in the US where no individual market options existed - there were no carriers at all. Additionally, there were many counties where there is only one carrier available, so there is no competition. Premiums for 2017 were expected to increase in a material way before Trump removed funding for the Cost Share Reduction (CSR) program... that removal has increased prices beyond what was already expected. Both of those are going to drive lower enrollment rates.

Regarding the other article...
Quote:
The complication arises when people who already have health plans under the law are automatically re-enrolled in the same plan. In the past, a few million consumers each year have been auto-
enrolled and then were sent government notices encouraging them to check whether they could find better or more affordable coverage.

This time, according to a federal document obtained by The Washington Post, the automatic enrollment will take place after it is too late to make any changes.
This is pretty much just outright narrative. So let me clear this up.

Current members are sent a letter in OCTOBER telling them exactly what is going to happen to their coverage: the changes to coverage, cost shares, and premiums are all identified. The details of the plan that they will be auto-enrolled in are included. This is a federal requirement. I know this, because my team is responsible for generating the data used to populate those notices .

Additionally, although the mapping is generally done in advance, the mapped plans aren't effective until the January 1 anyway. They never have been.

So the chief complaint of this article seems to be that people have to 1) read their mail and 2) make a decision before open enrollment ends. Which is what they are supposed to be doing anyway.

Quote:
It remains unclear whether consumers will be notified of when the automatic enrollment will take place
That right there ^^^ is blatant speculation for narrative emotional engineering. It's not a thing. I don't know why the author is "unclear" on the thing that every insurer is required to communicate to their policyholders, or that is easily available on the internet with only minimal googling skills, and that is actively being advertised by insurers all over the place. This isn't a black box. This author is busy fearmongering for no good reason.

http://lmgtfy.com/?q=health+insurance+open+enrollment
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Old 30th October 2017, 11:24 AM   #981
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Originally Posted by Emily's Cat View Post
Okay, let's clear up some stuff with real information...

The shrinking open enrollment period is not new. It's been planned to shrink so that it is in alignment with Medicare open enrollment since the inception of ACA. In fact, in 2014, the enrollment period was artificially extended by an additional 2 months, and by 1 month in 2015. This year, after four years in practice, the enrollment period is down to 45 days. For comparison, Medicare Advantage has an enrollment period of 53 days.
......

According to the link, the enrollment period was shortened prematurely.
Quote:
A narrowed enrollment window — from three months to 45 days — was planned by the Obama administration for the approximately three dozen states that rely on the federal insurance exchange. But the change was to have begun for 2019 coverage; instead, the Health and Human Services Department announced in April that it would take effect for the sign-up period starting Nov. 1.
With so much in flux, maintaining a longer enrollment period could only help people get coverage, and shortening it can only discourage people from signing up, which is Trump's goal, right? Is the goal to get consumers enrolled, or to shrink the program?
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Old 30th October 2017, 12:09 PM   #982
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Originally Posted by Bob001 View Post
According to the link, the enrollment period was shortened prematurely.
The link seems to be incorrect, at least according to the law:
https://www.law.cornell.edu/cfr/text/45/155.410
Quote:
(e)Annual open enrollment period.

(1) For the benefit year beginning on January 1, 2015, the annual open enrollment period begins on November 15, 2014, and extends through February 15, 2015.

(2) For the benefit years beginning on January 1, 2016 and January 1, 2017, the annual open enrollment period begins on November 1 of the calendar year preceding the benefit year, and extends through January 31 of the benefit year.

(3) For the benefit years beginning on or after January 1, 2018, the annual open enrollment period begins on November 1 and extends through December 15 of the calendar year preceding the benefit year.

Originally Posted by Bob001 View Post
With so much in flux, maintaining a longer enrollment period could only help people get coverage, and shortening it can only discourage people from signing up, which is Trump's goal, right? Is the goal to get consumers enrolled, or to shrink the program?
Meh. My observation has been that allowing open enrollment to extend into the effective year hasn't had any real effect on people's selections or decision-making. All it's done is encourage people to game the system.

I don't really care about Trump's goals. Most of his goals regarding ACA are stupid. But on the other hand, ACA is a pretty bad plan already. Accelerationism is idiotic... but ACA was never going to be long-term sustainable in its existing form anyway. So pretty much, it's going to suck.
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Old 30th October 2017, 01:20 PM   #983
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Originally Posted by Emily's Cat View Post
.....
Meh. My observation has been that allowing open enrollment to extend into the effective year hasn't had any real effect on people's selections or decision-making. All it's done is encourage people to game the system.
....
How does anybody "game the system?" They buy insurance or they don't. They qualify for a subsidy or they don't. The ACA is intended to make health insurance available to the small percentage of the population that doesn't get it from their employer, or from Medicare, Medicaid or the VA. It should be obvious that people without jobs, often because they have medical problems, are generally less sophisticated and more vulnerable than the rest of us. Providing information and assistance in understanding their options is an important and legitimate function -- and Trump has dramatically cut those services:
Quote:
In Indianapolis, the director of the state’s largest organization helping people find Affordable Care Act insurance had to lay off nine of 13 staff members last month because the federal government had just taken away more than 80 percent of the grant that paid for their work.

In Atlanta, festivalgoers at the annual Pride weekend in mid-October were mystified that members of Insure Georgia had a table set up, because they thought President Trump had gotten rid of the health-care law.

And across Ohio, residents starting to phone a call center for appointments with coaches to renew their coverage are being told that the service no longer exists and that, for help, they should go to a website, a hotline, an insurance broker, a county health department or — if all else fails — their member of Congress.
https://www.washingtonpost.com/natio...=.b6556458ec66

Note also that the original ACA plan was to expand Medicaid in every state, and for every state to establish its own insurance exchange. The states that did those things seem to have expanded coverage pretty successfully. If the ACA is hurting, it's largely because of the states that rejected it.
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Old 30th October 2017, 01:53 PM   #984
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Originally Posted by Bob001 View Post
According to this, current enrollees will be auto re-upped before they have a chance to change if they want:

https://www.washingtonpost.com/natio...=.98482d9021c3
Your link says the auto re-up will take place at the end of the enrollment season, which is Dec 15. I suppose someone could get caught out if they waited until the last second, and they somehow didn't know that they needed to shop for a new plan, if they wanted a new plan. I don't see it as a big factor though, at least not as big as Trump is hoping.
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Old 30th October 2017, 02:11 PM   #985
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Originally Posted by Marcus View Post
Your link says the auto re-up will take place at the end of the enrollment season, which is Dec 15. I suppose someone could get caught out if they waited until the last second, and they somehow didn't know that they needed to shop for a new plan, if they wanted a new plan. I don't see it as a big factor though, at least not as big as Trump is hoping.
I think the question is what are current enrollees being told? If they get a notice telling them "Your current coverage will be renewed automatically" vs. "Your current coverage will be renewed automatically unless you choose a different plan before Dec. 15. For information about all the plans available to you, go to...." the consumer gets a different picture. Information is everything, and it should be obvious that, even among people who are already covered, there has been a lot of confusion and misinformation.

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Old 30th October 2017, 02:22 PM   #986
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Originally Posted by Bob001 View Post
How does anybody "game the system?"
By not paying for their insurance in December, and not signing up for their next year's insurance to start until February or March. People are required to have insurance... but only for 10 out of 12 months. So they take the risk for two months to avoid the premiums, skip in at the last minute for effective dates, and essentially get a full year's coverage. Because if anything goes wrong in December or January, they can just be "late" on their premium payments.

Originally Posted by Bob001 View Post
Note also that the original ACA plan was to expand Medicaid in every state, and for every state to establish its own insurance exchange. The states that did those things seem to have expanded coverage pretty successfully. If the ACA is hurting, it's largely because of the states that rejected it.
No, not really. Washington expanded Medicaid and built their own exchange, and there were several counties that were going to be without any coverage at all. The WA OIC negotiated with a handful of carriers to get them to pick up those counties, but I believe a bit under half the counties in WA have only one carrier, and all but around 5 or 6 have only two choices.

It's not just states that didn't expand Medicaid that are having a tough time of it.
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Old 30th October 2017, 02:48 PM   #987
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Originally Posted by Emily's Cat View Post
By not paying for their insurance in December, and not signing up for their next year's insurance to start until February or March. People are required to have insurance... but only for 10 out of 12 months. So they take the risk for two months to avoid the premiums, skip in at the last minute for effective dates, and essentially get a full year's coverage. Because if anything goes wrong in December or January, they can just be "late" on their premium payments.
Who does that? What percentage of ACA consumers do that? And if that's a problem, how does is it solved by making it harder to get information?

Originally Posted by Emily's Cat View Post
....
No, not really. Washington expanded Medicaid and built their own exchange, and there were several counties that were going to be without any coverage at all. The WA OIC negotiated with a handful of carriers to get them to pick up those counties, but I believe a bit under half the counties in WA have only one carrier, and all but around 5 or 6 have only two choices.

It's not just states that didn't expand Medicaid that are having a tough time of it.
So before the ACA, what percentage of Washington residents did not have health coverage? And what is that percentage after it was fully implemented? If more people are covered, that's success, even if it's not perfection.

This county-based coverage has never made much sense and could be fixed administratively. If rural counties without a lot of customers could be left without carriers, the obvious solution is to create multi-county, regional or state-wide coverage groups. If the Republicans can promote selling insurance across state lines, with all the problems that would cause, it shouldn't be hard to get support for selling/buying across county lines.
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Old 30th October 2017, 02:59 PM   #988
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Originally Posted by Bob001 View Post
Who does that? What percentage of ACA consumers do that? And if that's a problem, how does is it solved by making it harder to get information?
About 5% of the policyholders in my company, last year. It was worse in prior years.

Presence or lack of information has nothing to do with this though. This is due to the length of the open enrollment period.

Originally Posted by Bob001 View Post
So before the ACA, what percentage of Washington residents did not have health coverage? And what is that percentage after it was fully implemented? If more people are covered, that's success, even if it's not perfection.
In WA, the size of the individual market has been pretty even at about 450K the whole time I've been involved... which is going on about 12 years now. ACA didn't increase the individual market. What changes in the uninsured market occurred were a result of expanded Medicaid... which is not affected by the lack of advertising, nor by the shortened open enrollment period.

The same can't necessarily be assumed for other states. WA already had fairly stringent community rating rules, with minimal ability for insurers to deny coverage, so the shift to ACA didn't have as much of an impact as it did elsewhere.

Originally Posted by Bob001 View Post
This county-based coverage has never made much sense and could be fixed administratively. If rural counties without a lot of customers could be left without carriers, the obvious solution is to create multi-county, regional or state-wide coverage groups. If the Republicans can promote selling insurance across state lines, with all the problems that would cause, it shouldn't be hard to get support for selling/buying across county lines.
Great idea. Now all you have to do is convince the hospitals that have monopoly power in those rural counties to bring their prices down to a reasonable level...

Let me know when you've sorted that, would you?
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Old 30th October 2017, 03:13 PM   #989
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Originally Posted by Bob001 View Post
I think the question is what are current enrollees being told? If they get a notice telling them "Your current coverage will be renewed automatically" vs. "Your current coverage will be renewed automatically unless you choose a different plan before Dec. 15. For information about all the plans available to you, go to...." the consumer gets a different picture. Information is everything, and it should be obvious that, even among people who are already covered, there has been a lot of confusion and misinformation.
I'm a current enrollee. Like EC says, they send you a packet with all the info. Also there is a constant bombardment of emails, I don't know if it will be the same this year, but I have gotten two already. They encourage you to shop for another policy, and tell you that your old policy will auto-up if you don't. Also you get communications from your insurance company.

Yes there has been confusion, and Trump is doing his best to sabotage the ACA, but I'm confident that by the time open enrollment starts on Wednesday few if any current enrollees will be unaware of their options. New enrollees are a different matter, I'm sure a number of them think that Obamacare is dead. Not.
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Old 30th October 2017, 03:28 PM   #990
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Originally Posted by Emily's Cat View Post
.....
Great idea. Now all you have to do is convince the hospitals that have monopoly power in those rural counties to bring their prices down to a reasonable level...

Let me know when you've sorted that, would you?
Why should they have monopoly power? Wouldn't expanding the coverage area to give consumers more choices reduce that monopoly power? Could they maintain unreasonable prices if consumers could get a better deal by traveling to other providers a little farther away?
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Old 30th October 2017, 03:34 PM   #991
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Originally Posted by Bob001 View Post
Why should they have monopoly power? Wouldn't expanding the coverage area to give consumers more choices reduce that monopoly power? Could they maintain unreasonable prices if consumers could get a better deal by traveling to other providers a little farther away?
Most rural areas only have one hospital to choose from. How much choice do you really think there is when the next closest hospital is 40 miles away, and you need surgery? Let alone for an emergency.

Honestly, the only people who have any sort of real 'choice' of hospitals and other major facilities are those who live in densely populated urban areas, and maybe some sprawl-filled suburbs.
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Old 30th October 2017, 03:43 PM   #992
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Originally Posted by Emily's Cat View Post
Most rural areas only have one hospital to choose from. How much choice do you really think there is when the next closest hospital is 40 miles away, and you need surgery? Let alone for an emergency.
.....
If it's elective surgery, maybe 40 miles or more isn't too far to travel for better service and/or a better price. People travel from all over the world to the Mayo Clinic, the Cleveland Clinic etc. At least expanding the coverage area would give consumers the choice, and the very existence of that choice might have an impact on the local providers.

It might also create an incentive for some of those farther-away hospitals to create free-standing emergency rooms and clinics in rural areas to compete with the monopoly provider.
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Old 30th October 2017, 03:51 PM   #993
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Originally Posted by Bob001 View Post
If it's elective surgery, maybe 40 miles or more isn't too far to travel for better service and/or a better price. People travel from all over the world to the Mayo Clinic, the Cleveland Clinic etc. At least expanding the coverage area would give consumers the choice, and the very existence of that choice might have an impact on the local providers.

It might also create an incentive for some of those farther-away hospitals to create free-standing emergency rooms and clinics in rural areas to compete with the monopoly provider.
I really think you're missing a key point here. Elective surgery, maybe, but that's stretching it. Even so, you've got to arrange for a significant amount more travel. Follow-up visits are going to pretty seriously interfere; instead of taking an hour or two off of work, you need to take a whole day. And of course, if you need an MRI or an X-ray, that's a whole day off work too.

I genuinely don't think you've given a lot of thought to how competition would work in health care.

How far are you willing to drive in order to get an X-ray? How much of a cost differential would you need to see in order to be willing to drive that far? How is that going to coordinate with your workday? What if you need someone to go with you?

Nah. We need to either nationalize the hospitals and make all doctors salaried... or the government needs to impose a quality-based fee structure on them.
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Old 30th October 2017, 03:52 PM   #994
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Old 30th October 2017, 04:14 PM   #995
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Originally Posted by Emily's Cat View Post
....
Nah. We need to either nationalize the hospitals and make all doctors salaried... or the government needs to impose a quality-based fee structure on them.
Universal single-payer would be the goal, although a nationalized health care system like the UK is just one model, and maybe not the best. Meanwhile, it should be possible for state regulators to do something about unreasonable hospital fees in rural areas. And if the insurers say "We'll pay you the same rates we pay University Hospital in Big City, but no more," what are they going to do? Only take self-paying patients? Shut down? Is everybody really intimidated by rural providers? I ask again, why wouldn't better insurance coverage create an incentive for alternative providers to offer services?
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Old 30th October 2017, 04:35 PM   #996
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Originally Posted by Bob001 View Post
Universal single-payer would be the goal, although a nationalized health care system like the UK is just one model, and maybe not the best. Meanwhile, it should be possible for state regulators to do something about unreasonable hospital fees in rural areas. And if the insurers say "We'll pay you the same rates we pay University Hospital in Big City, but no more," what are they going to do? Only take self-paying patients? Shut down? Is everybody really intimidated by rural providers? I ask again, why wouldn't better insurance coverage create an incentive for alternative providers to offer services?
State regulators don't regulate hospital fees. It's a bit of a gap.
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Old 1st November 2017, 12:38 PM   #997
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Originally Posted by Emily's Cat View Post
State regulators don't regulate hospital fees. It's a bit of a gap.
They might not set fees ("you can charge this much") but I suspect that unusual behavior regarding fees, billing etc. could have an impact on whether a provider maintains and renews its license.
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Old 1st November 2017, 02:23 PM   #998
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Originally Posted by Bob001 View Post
They might not set fees ("you can charge this much") but I suspect that unusual behavior regarding fees, billing etc. could have an impact on whether a provider maintains and renews its license.
Not to my knowledge, no. There is no legal requirement for providers to use reasonable pricing. Fraud might impact them, but high prices? Not really.
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Old 8th November 2017, 09:06 AM   #999
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