The Goat Pen

eCat wrote:It takes a foreign government to show the people who the real scumbags are

Well said. Although I would have swapped "sworn enemy" for foreign government.

And to say pre-obamacare healthcare was the good ol' days is ridiculous. My agents and I sold BCBS for 25+ years and the premium increases in the individual market had become unsustainable, especially for people over 50. Burdensome deductibles and out-of-pocket expenses started many years ahead of the ACA. 60 million uninsured was a pretty good clue that health insurance was too expensive for a large chunk of the population.

Bottom line: our employer-based healthcare system sucks and no other developed country does it our way. Our medical outcomes are worse than our allies yet we pay more to receive less. The ACA is hugely flawed but it's currently the best way forward in a bad situation. Eventually all these old dickweeds in Congress will die off and we'll finally have a universal healthcare system that provides basic Medicare for all, while allowing the well-heeled to buy all the up-coverage they desire.

Congress may not have been able to pass AHCA but they had no trouble exempting themselves just in case.

bluetick wrote:And to say pre-obamacare healthcare was the good ol' days is ridiculous.

I never said that, never implied that. But for millions of America -much more so than the 24M who are now insured under this benevolent plan of my tax dollars, its disingenuous to compare this apples to apples. The idea of a high deductible for a comprehensive family plan was virtually unheard of pre Obama. Now its the norm. Most people now have a catastrophic plan masquerading as a major medical plan because they have to pick up all the incidentals.

What the financially challenged can't get however is that the current plan has no incentive to lower health care costs. Its a blank check to the health care industry using the insurance companies as middle men.

Obama and the democrats lied to the American people to get it to pass - had he/they told the truth - to the American people and congress it wouldn't have passed it - and that isn't up for debate-and if the democrats were held accountable for what they've done by putting in a stop gap health care system that is unsustainable - forced to subsidize the American people AND the insurance companies - every one that supported it would be out of a job.

Obama may have lied to you, but my premiums went down 25% when the ACA became law. People 50-65 got immediate savings, and the 3x-ceiling over 20-something's rates have kept older citizens' rates relatively stable. Did you notice how hard the AARP sought to block the GOP bills? Eliminating the cap on senior rates would have meant a triple or quadruple rate increase...holy shit. Blue hairs noticed, you bet. You've seen the town halls..

Just one part of why these republican bills were ringing up 17-20% polling numbers. The part near and dear to my ownself.

I've been trying to figure out how best to respond to a Republican Senate that failed to repeal and replace Obamacare after 8 years of promises to do so. I think the problem is that the dozen or so who voted against various versions of R&R think they will get still get reelected back home in Maine or wherever, so they don't care. And the GOP senators who DID vote for R&R are telling themselves, "I voted for it. My constituents can't hold me accountable for the hold outs. Those holdouts are not my fault and not my problem: My constituents will reelect me, and all of the same Senators who voted like me. That will be enough for us to keep the Senate, and all will be well." So they don't care either.

So the solution is to make the holdouts BE the problem of the Republican Senate - a major huge BFD problem of every last Senator with an R next to his/her name. In my early Army days, if the sergeants couldn't get compliance from one incredibly stupid private, they would punish ALL of us. When private X made the same screwup several times, those of us who had not screwed up were punished while private x was unpunished. What we called a "blanket party" quickly followed, where the rest of us kicked private x's ass in the middle of the night. It was amazingly effective. Private x got with the program, and the group punishments stopped.

So I think the GOP base should apply a similar group punishment to all their senators. They should say, "If you can't get all the Senator Dipwad's to vote for repeal and replace, I am not going to vote for you either. You and McConnell had better figure out a way to get all those Senator Dipwad's to get with the program, then you can kiss your fancy office, and committee chairmanships, and your Senatorial golf club, etc. goodbye. You figure it out. Maybe move the offices of the holdouts into the Senate washroom next to the toilet that is broken and will never be fixed. Stuff like that. You figure it out."

It would be amazing how persuasive the whole caucus could be against their sellout colleagues. They just need to be part openly motivated.

bluetick wrote:Obama may have lied to you, but my premiums went down 25% when the ACA became law. People 50-65 got immediate savings, and the 3x-ceiling over 20-something's rates have kept older citizens' rates relatively stable. Did you notice how hard the AARP sought to block the GOP bills? Eliminating the cap on senior rates would have meant a triple or quadruple rate increase...holy shit. Blue hairs noticed, you bet. You've seen the town halls..

Just one part of why these republican bills were ringing up 17-20% polling numbers. The part near and dear to my ownself.

how did it go down for you? Did you buy your health insurance thru the .gov website marketplace?

I'd like to know the details of the 25% savings.

And while I don't mean to disparage the elderly..... This is primarily people on fixed incomes and government supplied medical care, correct? So are they upset because their subsidies are going down? Obamacare is a giant Medicare expansion. Of course the AARP is against repealing it. When have they ever been against any government expansion that results in Seniors getting more subsidies from the government?

90% of Americans get their insurance thru their job or the government so the remaining 10% get it thru the marketplace. Of that 10%, 85% of those get it subsidized in some form by the federal government.

So that leaves the people who buy insurance thru the marketplace that isn't subsidized or buy insurance directly at 3%

interesting read from Forbes. A pretty good explanation of why Obamacare is going to fail unless the government continues to throw out huge amounts of money to keep insurance companies from having significant losses.
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Two scholars at the renowned Brookings Institution, Loren Adler and Paul Ginsburg, have published an analysis finding that “average premiums in the individual market actually dropped significantly upon implementation of the ACA [Affordable Care Act].” This contrasts with a plethora of evidence, including a rigorous 2014 Brookings study, showing that the ACA significantly increased premiums. In this post, I discuss methodological concerns with the Adler and Ginsburg approach as well as evidence that leads most scholars to reach a very different conclusion.

While I will discuss the relevant evidence of the ACA’s effect on premiums in depth, there are three data points worth emphasizing. First, unlike Adler and Ginsburg's approach, Brookings 2014 study used actual data and found that “enrollment-weighted premiums in the individual health insurance market increased by 24.4 percent beyond what they would have had they simply followed…trends.” Second, S&P Global Institute found that average individual market medical costs increased substantially between 2013 and 2015, up an estimated 69%. Third, 2014 insurer data shows that premiums for individual market Qualified Health Plans (QHPs), ACA-compliant plans certified to be sold on exchanges, were much higher than premiums for individual market non-QHPs, mostly plans in existence before 2014 that did not comply with the ACA. Relative to non-QHPs, insurers collected more than $1,000 per enrollee in higher premiums and more than $2,300 in higher premium revenue per enrollee in 2014 after accounting for large premium subsidy programs for their QHPs.

Adler and Ginsburg do not discuss this previous research, and their analysis also fails to account for other crucial factors. They do not account appropriately for substantial subsidies insurers received to discount individual market ACA plan premiums. They also do not consider the trend in medical claims costs, which is presumably a better measure of the ACA’s effect on the individual market thus far given both the large subsidies and large losses insurers have incurred selling ACA plans. Instead, most of their analysis relies upon crude back-of-the-envelope estimates for the average individual market premium in 2009 as well as well as for an annual growth rate to inflate their 2009 premium estimate.

Finally, it is worth noting that if Adler and Ginsburg were correct in their analysis, we would expect to see very different results than have occurred. If, as they claim, the ACA was delivering better coverage at lower cost, the exchanges would have attracted a wider cross-section of enrollees and more insurers would be looking to enter these markets. Instead we see adverse selection in the individual market, with spiraling premiums, sizeable insurer exits, and enrollees generally attracted to ACA plans only if they are either highly subsidized or relatively old or unhealthy.

Ample Evidence Shows Average Premiums and Spending Exploded After ACA Implementation in 2014

While it is important to look at data for several years after 2013 to assess the impact of the ACA, comparing individual market premiums in 2013 with those in 2014—the year its key changes took effect—provides an approximation of the initial change. The Manhattan Institute compared the average of the five least expensive pre-ACA plans in 2013 with the least expensive plans available on exchanges in 2014. Manhattan’s researchers adjusted the pre-ACA plan premiums upward to account for the population facing surcharges or denied coverage because of a pre-existing condition. Manhattan estimated that the average state individual market premium increased 41% between 2013 and 2014. A county-level analysis suggested that premiums increased by 49%.

The 2014 Brookings study on this same subject by Amanda Kowalski—and unaddressed by Adler and Ginsburg—used actual pre-ACA individual market premium data, finding that “[a]cross all states, from before the reform to the first half of 2014, enrollment-weighted premiums in the individual health insurance market increased by 24.4 percent beyond what they would have had they simply followed state-level seasonally adjusted trends.” According to Kowalski, the Manhattan Institute estimates are higher likely because they were not enrollment-weighted, and individuals in areas with high premiums likely selected cheaper plans.

Economists at the University of Pennsylvania, also using actual pre-ACA individual market data, estimated that the total expected price of individual market coverage (premiums plus out-of-pocket payments) increased by 14% to 28% as a result of the ACA. According to their findings, “the pre-ACA average premium was lower than the lowest silver plan premium.” Penn’s economists also estimated that plans in the individual market before the ACA had similar actuarial value to silver plans, not an average actuarial value that was 10 percentage points less (and 17% less) than assumed by Adler and Ginsburg. Importantly, all of these studies compare gross premiums before and after the ACA without accounting for subsidies that lowered ACA plan premiums.

Perhaps the most striking visual data that suggest Adler and Ginsburg’s conclusions are wrong is an S&P Global Institute analysis of individual market per member per month (PMPM) costs from May. The figure below from the S&P report shows trends in PMPM costs for the individual and employer-provided markets. The ACA is responsible for the huge spike, clearly shown in the figure, in the individual market PMPM costs, which by early 2015 exceeded PMPM costs in the employer markets.

The data shows a huge increase in PMPM costs in the individual market between 2013 and 2015. According to S&P, PMPM costs increased 38% between 2013 and 2014, and another 23% between 2014 and 2015. The two-year increase (69%) is the product of the two single-year increases.


The comparable PMPM cost increase in the employer market, which the ACA affected much less, amounted to about 11%. Assuming an 11% increase would have happened in the individual market absent the ACA, a very rough initial guess would be that the ACA increased individual market PMPM costs by about 58% between 2013 and 2015. As previously noted, premiums did not increase by this full 58% because of insurers’ large losses and the large subsidies they received.

It is worth noting that the individual market includes both ACA-compliant plans as well as non-ACA-compliant plans. If only ACA-compliant plans were included in the post-2013 data, the spike would likely be much larger.

Brookings Comparison Fails to Account for Important Subsidy Program that Reduced ACA Premiums

In their analysis, Adler and Ginsburg fail to account for the ACA’s reinsurance program—a program that allowed insurers to reduce premiums since it compensated them for a large share of the cost of their most expensive enrollees. In an April Mercatus working paper I coauthored, we computed that net reinsurance payments paid by government to insurers selling individual market QHPs totaled about 20.4% of gross premiums. Therefore, regardless of the other problems with Adler and Ginsburg’s methodology, just accounting for reinsurance payments negates their central finding that “2014 premiums in the ACA market were 10-21 percent lower than 2013 individual market premiums.”

In addition to the need to account for government subsidy programs, it is also important to consider that insurers incurred substantial losses in both 2014 and 2015, which I have estimated, after accounting for reinsurance, averaged about $400 per enrollee in 2014 and about $1,000 per enrollee in 2015. The fact that ACA plan premiums have been much too low to cover insurer expenses is another reason that it is problematic to compare face value premiums of ACA plans with pre-ACA individual market plans.

................................

Adler and Ginsburg argue that the ACA both improved coverage and lowered costs. If true, the exchanges would undoubtedly be more successful than they are. Thus far, the result is significantly worse than expected, with far fewer enrollees—particularly younger and healthier enrollees—than projected, and substantial market instability. Another Brookings Institution scholar, Stuart Butler, recognizes the problem, writing just two weeks ago that “the ACA might be more appropriately labeled the ‘Medicaid Expansion Act’” because “enrollment in the ACA exchanges has been disappointing, with an estimated 10 million fewer people enrolled compared with earlier expectations.”

The new Brookings study does not mention the numerous studies, including the rigorous 2014 Brookings study, that come to opposite conclusions, does not use actual pre-ACA individual market data, does not consider the huge increase in the cost of medical claims in the individual market after 2013, and makes a number of questionable methodological choices. The authors arrive at a different conclusion than most scholars who have examined the effect of the ACA on health insurance premiums. Most scholars and analysts conclude that, particularly when fully accounting for the various government subsidies for individual insurance coverage, the ACA significantly increased individual market premiums.

that last line is just basic economics.

you have a government entity printing money to give to the masses for the single purpose of spending it on healthcare in the marketplace. On top of that they have no resources to competitively shop for the cheapest services/goods in that marketplace and worse they have no incentive to do so. They are dumping money into the marketplace AND driving demand based on the regulatory policies of the federal government that tells them for this money they are entitled to certain procedures, services and wellness care.

and this is supposed to result in savings for Americans?

whenever a liberal makes a snide remark about science or religion to a conservative, its good to remind them they have no concept whatsoever of basic economic principles.

and finally, from Money magazine less than a year ago...

Since 2010, the percentage of Americans with a generally unfavorable view of the health care reform law has consistently outnumbered those with a favorable view of Obamacare, according to the Kaiser Health Tracking Poll. It's just not clear what the sizable anti-Obamacare faction would prefer as an alternative.

" In my early Army days, if the sergeants couldn't get compliance from one incredibly stupid private, they would punish ALL of us."

Man, I bet you were unpopular...

I was on the receiving end of a blanket party once. For snoring. I deserved it. I have always been a terrible snorer. And yes, that made me very unpopular.

Funny how some things never change...

90% of Americans get their insurance thru their job or the government so the remaining 10% get it thru the marketplace. Of that 10%, 85% of those get it subsidized in some form by the federal government.--used to be 90 % --12000 employers dropped insurance including home depot and walgreens among others thanks to obamacare

"how did it go down for you? Did you buy your health insurance thru the .gov website marketplace?

I'd like to know the details of the 25% savings." yes tic do tell--you must be the entitlement king

there seems to be no shortage of people to provide their own example of how they save money on health care under Obamacare

but given the percentages, given the number of people that went from a catastrophic plan to the mandated major medical plan and assuming no one has the balls to say they saved money because they got a subsidy or medicare expansion using our tax dollars, the number of people who actually saved money in the plan has to be acutely small - and the reality is a notable percentage of them were probably over insured or getting ripped off in a horrible plan.

And of those who did see a decrease, we find out the government was paying on average $400 to $1000 per person to cover the insurance losses.

whenever a liberal makes a snide remark about science or religion to a conservative, its good to remind them they have no concept whatsoever of basic economic principles.

So true. Very few Democrat politicians have ever had a private sector job in their entire lives. The free market is a concept that is as alien and disturbing to them as God.

Professor Tiger wrote:

whenever a liberal makes a snide remark about science or religion to a conservative, its good to remind them they have no concept whatsoever of basic economic principles.

So true. Very few Democrat politicians have ever had a private sector job in their entire lives. The free market is a concept that is as alien and disturbing to them as God.

I'm not sure many GOP have either - and while they may claim small government and fiscal conservatism, the reality is many GOP and GOP supporters do like big government, they just like their version of big government

like spending an additional $4b on the F-35 Jet Fighter which may turn out to be the biggest albatross in Military history.

a side bar to this

just read that in the past 2 decades, thru taxes and subsidies, the American public has paid over $400 billion to telecoms and cable providers to create a high speed internet infrastructure that was never delivered.

In the early 80's they had the ability to create a 45mbps network (think my terminology is complete) and by now with the money paid to them they should have had nationwide coverage for a 1000mbps network which we don't even have in the major cities.

"I'm not sure many GOP have either - and while they may claim small government and fiscal conservatism, the reality is many GOP and GOP supporters do like big government, they just like their version of big government"

Ya think?

crashcourse wrote:"how did it go down for you? Did you buy your health insurance thru the .gov website marketplace?

I'd like to know the details of the 25% savings." yes tic do tell--you must be the entitlement king

I am the co-owner of an insurance agency. I reaped the commissions from the BCBS group policy for our company, but I was still paying through the nose for my portion of the premium, even with high OOP and deductibles. And the policy we had excluded some key preventive care stuff, including colonoscopies which I was in need of. And full disclosure: the ACA immediately effected broker commissions nationwide, so my advantage as commission agent evaporated. So it made sense to check the alternative.

I got a bronze plan on the marketplace, again with BCBS. Same high OOP and deductibles, but preventive care under the ACA wasn't subjected to the deductible so my 3k colonoscopy cost me zilch, and my monthly premiums were indeed 25%+ less. The 3x cap we older insureds have benefited from is a real thing. My current premium is barely more than my pre-ACA rate.

There are charts that show a non-subsidized male age 60 currently paying 9k/yr seeing his premium go to 16k/yr after the GOP bill. I don't want to be that guy.

"just read that in the past 2 decades, thru taxes and subsidies, the American public has paid over $400 billion to telecoms and cable providers to create a high speed internet infrastructure that was never delivered."

That's just the tip of the iceberg that is our federal "government"...

hedge wrote:"just read that in the past 2 decades, thru taxes and subsidies, the American public has paid over $400 billion to telecoms and cable providers to create a high speed internet infrastructure that was never delivered."

That's just the tip of the iceberg that is our federal "government"...

every package that Amazon ships is subsidized to the tune of about $1.16 due to them taking advantage of a non compete clause the federal government stipulated to keep the post office from competing with USP and Fed Ex