Obamacare ruled unconstitutional by US federal judge...

[Raising Heel]

1. Missed that note on the graph. Isn’t it representative in general or rate growth?

Probably, although I can't say for certain without researching it (which I'm not going to do).

2. Didn’t they short change the CO-OPs making it harder to sure up the exchanges?

Co-ops are non-governmental, non-insurance issuers on the exchanges. They make up a very small subset of exchange business, with only about 150,000 enrollees. Most co-ops have failed because their premiums were too low, benefits were too generous, and they were ill-equipped to be competitive in markets dominated by larger for-profit insurers. They were further harmed by the risk corridor shortfall and risk adjustment payment issues, but I'd hardly characterize that as some nefarious conservative strategy.

 

[NoleSoup4U]

There are four insurers and five HMOs in Florida selling ACA plans for 2019 (list). Generally speaking, the HMOs will have less robust benefit designs and "narrow" networks. The latter means you'll have fewer choices when selecting a doctor, but the tradeoff is that HMOs typically have lower premiums.

The best thing to do is use the healthcare.gov website to determine which plans are sold in your area. Today is the last day you can enroll* so you have to hurry.

* In case anyone thought yesterday's ruling wasn't politically motivated.

I thought we were talking about non-ACA plans. I have no interest in getting Florida Blue or any other garbage plan on the exchange.

 

[NoleSoup4U]

That's the point. I have no issues. I'm simply saying you do a lot of talking about things you obviously know little about.

Fine, tell me what they are and tell me why I'm wrong then. Just making blanket statements isn't proving your point to anyone, unless you don't care about proving a point, in which case...PARTY ON, DUDE!!!

 

[toophly1124]

PARTY ON, DUDE!!!

Garth. Party on, Garth!

 

[Raising Heel]

Whoops, missed one.

3. I meant collusion in the sense that no one is lowering costs or looking to innovate.

Not true at all. The industry is going through one of the most radical transformations in history, spurred largely by ideas embodied in the ACA. Commercial insurers are moving away from fee-for-service reimbursement and adopting many of the same value-based care and alternative payment models first enacted by the ACA in an attempt to lower costs and improve quality.

There are literally hundreds of different examples. A couple that are prevalent among governmental and private insurers include financial penalties for hospitals whose patients are readmitted and for hospitals whose patients develop infections (surgical or otherwise) while in the hospitals' care. Also, insurers are encouraging providers to lower costs by implementing Shared Savings programs, in which both parties share any savings generated by successfully reducing the costs of care.

 

[Raising Heel]

I thought we were talking about non-ACA plans. I have no interest in getting Florida Blue or any other garbage plan on the exchange.

Color me confused. The poast below makes it sound like you're complaining about physicians not accepting ACA plans issued on the exchange. You even said you had to pay for the ACA policy.

Hardly anyone takes it. I had it and it was almost impossible to find a GP, and forget about it if I needed a specialist. I had to drive one or two towns over to find anyone who would accept the insurance. I might as well had Medicaid, except that I had to pay for the ACA policy.

If you had individual insurance that a doctor wouldn't accept, that's another issue entirely. You can use that same list I linked to visit each insurer's website to shop for plans. Or go through a broker, who can provide a comparison of several different insurers' plans for you.

 

[ticket2ride04]

Probably, although I can't say for certain without researching it (which I'm not going to do).

Co-ops are non-governmental, non-insurance issuers on the exchanges. They make up a very small subset of exchange business, with only about 150,000 enrollees. Most co-ops have failed because their premiums were too low, benefits were too generous, and they were ill-equipped to be competitive in markets dominated by larger for-profit insurers. They were further harmed by the risk corridor shortfall and risk adjustment payment issues, but I'd hardly characterize that as some nefarious conservative strategy.

Why am I thinking the Republicans shorted the exchanges? I could have sworn I heard that reported. What am I confusing here?

 

[NoleSoup4U]

Color me confused. The poast below makes it sound like you're complaining about physicians not accepting ACA plans issued on the exchange. You even said you had to pay for the ACA policy.


If you had individual insurance that a doctor wouldn't accept, that's another issue entirely. You can use that same list I linked to visit each insurer's website to shop for plans. Or go through a broker, who can provide a comparison of several different insurers' plans for you.

I had Florida Blue and there were only a few doctors in my area who would take it. I also had to travel to the next town to see specialists. It was a mess that I didn't have with my individual plan before it was canceled. Then my premium skyrocketed in 2017 so I just said "eff it" and didn't renew. It went up, even more, this year according to my mother who had the plan as well. She just rode it out till she could get Medicare. I wasn't so lucky.

 

[NoleSoup4U]

Why am I thinking the Republicans shorted the exchanges? I could have sworn I heard that reported. What am I confusing here?

You heard it because I heard it as well. I also heard that it wasn't true.

 

[ticket2ride04]

I had Florida Blue and there were only a few doctors in my area who would take it. I also had to travel to the next town to see specialists. It was a mess that I didn't have with my individual plan before it was canceled. Then my premium skyrocketed in 2017 so I just said "eff it" and didn't renew. It went up, even more, this year according to my mother who had the plan as well. She just rode it out till she could get Medicare. I wasn't so lucky.

What plan did you have before? What were the premiums?

Did your plan price explode after you got sick?

 

[NoleSoup4U]

Whoops, missed one.
Not true at all. The industry is going through one of the most radical transformations in history, spurred largely by ideas embodied in the ACA. Commercial insurers are moving away from fee-for-service reimbursement and adopting many of the same value-based care and alternative payment models first enacted by the ACA in an attempt to lower costs and improve quality.

There are literally hundreds of different examples. A couple that are prevalent among governmental and private insurers include financial penalties for hospitals whose patients are readmitted and for hospitals whose patients develop infections (surgical or otherwise) while in the hospitals' care. Also, insurers are encouraging providers to lower costs by implementing Shared Savings programs, in which both parties share any savings generated by successfully reducing the costs of care.

Does that being readmitted into the hospital only have to do with policies, or with the hospitals themselves? I ask because I was discharged this summer, only to have to call the EMTs again a day and a half later. They had discharged me while I still had internal bleeding, probably because I didn't have insurance. That's what almost killed me. My hemoglobin level was at 45% of what it should have been (5.8 out of 13) when I was readmitted. They told me the only reason I didn't have a heart attack or stroke out was that I was young enough to handle it.

 

[NoleSoup4U]

What plan did you have before? What were the premiums?

Did your plan price explode after you got sick?

No, it was always going up faster, but it really started going crazy back in 2017 (it almost doubled in 2017 and then again in 2018). Of course I was a full time student then too, so I couldn't get any subsidies because I was showing no income. I don't know if I could have afforded it even with the subsidies at that point. I got sick over this summer. The only other thing I've ever been admitted for was surgery to remove my appendix 20 years ago.

 

[Raising Heel]

Why am I thinking the Republicans shorted the exchanges? I could have sworn I heard that reported. What am I confusing here?

You heard it because I heard it as well. I also heard that it wasn't true.

You're probably thinking of the Trump administration's decision to end funding for Cost Sharing Reduction (CSR) payments. That caused a 14% increase to ACA premiums from Blue Cross/Blue Shield of North Carolina. The elimination of the Individual Mandate added another 4% to BCBSNC rates. There's no question Republicans are trying to sabotage the ACA, but they're harming constituents in the process.

 

[ticket2ride04]

You're probably thinking of the Trump administration's decision to end funding for Cost Sharing Reduction (CSR) payments. That caused a 14% increase to ACA premiums from Blue Cross/Blue Shield of North Carolina. The elimination of the Individual Mandate added another 4% to BCBSNC rates. There's no question Republicans are trying to sabotage the ACA, but they're harming constituents in the process.

That’s what I was thinking of. Thank you.

And wow

“This is the first individual market rate decrease in Blue Cross NC history and will benefit people across North Carolina. We’re moving in the right direction, but even with a lower rate, premiums are still too high – particularly for those who don’t get a subsidy,” said Dr. Patrick Conway, President and CEO of Blue Cross NC. “With more certainty from Washington, rates would be 15 percent or more lower. We must address both market instability and the rising price of health care.”

 

[Raising Heel]

I had Florida Blue and there were only a few doctors in my area who would take it. I also had to travel to the next town to see specialists.

That seems weird but I don't know how prevalent it is. Payments to doctors and other providers for ACA patients are negotiated just like any other contract. The rates are typically discounted from what they'd receive for treating a patient with commercial insurance, but unless the provider sucks at negotiating, ACA patients should still provide them with positive margins. They should definitely be more profitable than Medicare and Medicaid patients, who don't reimburse providers enough to cover costs.

 

[NoleSoup4U]

That seems weird but I don't know how prevalent it is. Payments to doctors and other providers for ACA patients are negotiated just like any other contract. The rates are typically discounted from what they'd receive for treating a patient with commercial insurance, but unless the provider sucks at negotiating, ACA patients should still provide them with positive margins. They should definitely be more profitable than Medicare and Medicaid patients, who don't reimburse providers enough to cover costs.

It might not be prevalent everywhere. All I can speak to is my own experience. I had to change doctors, unfortunately. In all actuality, I think I only saw my actual doctor once. I always dealt with a nurse practitioner. It was just a terrible experience.

 

[NoleSoup4U]

You're probably thinking of the Trump administration's decision to end funding for Cost Sharing Reduction (CSR) payments. That caused a 14% increase to ACA premiums from Blue Cross/Blue Shield of North Carolina. The elimination of the Individual Mandate added another 4% to BCBSNC rates. There's no question Republicans are trying to sabotage the ACA, but they're harming constituents in the process.

I've heard people make claims that Republicans defunded the ACA while Obama was in office, but I've never seen any evidence to that.

 

[Raising Heel]

Does that being readmitted into the hospital only have to do with policies, or with the hospitals themselves? I ask because I was discharged this summer, only to have to call the EMTs again a day and a half later. They had discharged me while I still had internal bleeding, probably because I didn't have insurance. That's what almost killed me. My hemoglobin level was at 45% of what it should have been (5.8 out of 13) when I was readmitted. They told me the only reason I didn't have a heart attack or stroke out was that I was young enough to handle it.

Readmission penalties vary by payer and provider. Florida Blue and Hospital X may negotiate a contract that looks different than one negotiated by Cigna and Hospital Y. Your situation definitely sounds like one that would meet most readmission penalty criteria, although it's typically determined by a numerator/denominator calculation.

For example, Florida Blue and Hospital X sign a contract saying readmissions must be less than 12%. If Hospital X discharges 1,000 Florida Blue patients, readmission of 120 or more of those patients would trigger the penalty. Or more likely, it would disqualify Hospital X from any financial reward since it's typically only Medicare that imposes payment penalties. Said another way, Medicare uses a stick while commercial insurers dangle a carrot.

 

[NoleSoup4U]

Readmission penalties vary by payer and provider. Florida Blue and Hospital X may negotiate a contract that looks different than one negotiated by Cigna and Hospital Y. Your situation definitely sounds like one that would meet most readmission penalty criteria, although it's typically determined by a numerator/denominator calculation.

For example, Florida Blue and Hospital X sign a contract saying readmissions must be less than 12%. If Hospital X discharges 1,000 Florida Blue patients, readmission of 120 or more of those patients would trigger the penalty. Or more likely, it would disqualify Hospital X from any financial reward since it's typically only Medicare that imposes payment penalties. Said another way, Medicare uses a stick while commercial insurers dangle a carrot.

Gotcha. I was uninsured when it happened, so I wouldn't fall under that. I was just a little upset when they discharged me while I was still bleeding internally.

 

[Raising Heel]

That’s what I was thinking of. Thank you.

And wow

“This is the first individual market rate decrease in Blue Cross NC history and will benefit people across North Carolina. We’re moving in the right direction, but even with a lower rate, premiums are still too high – particularly for those who don’t get a subsidy,” said Dr. Patrick Conway, President and CEO of Blue Cross NC. “With more certainty from Washington, rates would be 15 percent or more lower. We must address both market instability and the rising price of health care.”

Patrick Conway came to BCBSNC from the Centers for Medicare and Medicaid Innovation. There couldn't be a better example of commercial insurers adopting policies first enacted by CMS (The Centers for Medicare and Medicaid Services).

 

[Raising Heel]

I've heard people make claims that Republicans defunded the ACA while Obama was in office, but I've never seen any evidence to that.

"Defunded" sounds intentionally vague, since there are a number of channels through which the federal government provides funding for various aspects of the ACA.

 

[Raising Heel]

Gotcha. I was uninsured when it happened, so I wouldn't fall under that. I was just a little upset when they discharged me while I was still bleeding internally.

Well sure, lol. Glad to hear you pulled through okay.

In case you didn't already know, emergency rooms are legally obligated to treat patients regardless of their insurance or ability to pay. But yes, if you're admitted for a longer stay and don't have insurance, they're going to try to get you out of there as soon as possible. It raises some ethical issues for sure. Your case was unconscionable and sounds like grounds for a lawsuit (and I'm not "that guy" who looks for reasons to sue).

 

[ticket2ride04]

Well sure, lol. Glad to hear you pulled through okay.

In case you didn't already know, emergency rooms are legally obligated to treat patients regardless of their insurance or ability to pay. But yes, if you're admitted for a longer stay and don't have insurance, they're going to try to get you out of there as soon as possible. It raises some ethical issues for sure. Your case was unconscionable and sounds like grounds for a lawsuit (and I'm not "that guy" who looks for reasons to sue).

Medical lawsuits are extremely hard to win. I have some first hand experience with this.

 

[NoleSoup4U]

Well sure, lol. Glad to hear you pulled through okay.

In case you didn't already know, emergency rooms are legally obligated to treat patients regardless of their insurance or ability to pay. But yes, if you're admitted for a longer stay and don't have insurance, they're going to try to get you out of there as soon as possible. It raises some ethical issues for sure. Your case was unconscionable and sounds like grounds for a lawsuit (and I'm not "that guy" who looks for reasons to sue).

I understood why they did it. They discharged me because I was doing better and they couldn't find anything wrong with me. They discharged me the second time and still didn't know what was wrong. My blood level was at 7.1 the day they let me go. It might have been the scariest night I've ever had. If I would have had another issue I probably wouldn't be posting on this board right now.

 

[Hark_The_Sound_2010]

In case you didn't already know, emergency rooms are legally obligated to treat patients regardless of their insurance or ability to pay

If we fixed that, I’m sure we could really lower some healthcare costs.

 

[tarheel0910]

If we fixed that, I’m sure we could really lower some healthcare costs.

Fixed that? So if someone is in need of urgent medical care, the emergency room should just let them die in the parking lot?

 

[strummingram]

Fixed that? So if someone is in need of urgent medical care, the emergency room should just let them die in the parking lot?

It will take us back to the 1940s or 50s when blacks were not allowed in white hospitals. MAGA

 

[Hark_The_Sound_2010]

Fixed that? So if someone is in need of urgent medical care, the emergency room should just let them die in the parking lot?

I’m just presenting it as an option to cut healthcare costs.

 

[strummingram]

I’m just presenting it as an option to cut healthcare costs.

At least it would cut through that feigned altruism that American politicians and preachers love to wave.

 

[grillheel]

Fixed that? So if someone is in need of urgent medical care, the emergency room should just let them die in the parking lot?

The problem is the amazing number of people that use the ER as their primary care provider.

 

[strummingram]

The problem is the amazing number of people that use the ER as their primary care provider.

What is the amazing number? Any idea?

 

[tarheel0910]

The problem is the amazing number of people that use the ER as their primary care provider.

Then those people need to get sent to an urgent care. It wouldn't take much to coordinate that.

 

[tarheel0910]

I’m just presenting it as an option to cut healthcare costs.

That's not a realistic option though, but you already know that.

 

[Grayhead]

What is the amazing number? Any idea?

Because the ER should never be an option to be checked for a snotty nose, nagging cough, or a bump on your finger. Some abuse the whole not turning anyone away. It's called "EMERGENCY ROOM" for a reason.

 

[grillheel]

What is the amazing number? Any idea?

Sorry I used the word amazing. A quick google review estimated ER overuse costs $38 billion annually and that figure was from several years ago.

 

[ticket2ride04]

Sorry I used the word amazing. A quick google review estimated ER overuse costs $38 billion annually and that figure was from several years ago.

Still not a small number.

I always laugh at the horror stories people use when thet talk about an ER experience in Canada or England. It’s not like we have an amazing ER situation over here.

The whole medical system is so broken.