Obamacare

[busterb]

I really don't understand all this crap. But I pay about $99 bucks a month for medicare. Also folks who make $80,000.00 pay the same. Hey I get about, now 18,000. So I never use mine, because I'm a vet. WHERE does my part go????

[Lamplighter]

NY Times
ROBERT PEAR
November 20, 2012

Administration Defines Benefits That Must Be Offered Under the Health Law

WASHINGTON — The Obama administration took a big step on Tuesday
to carry out the new health care law by defining “essential health benefits”
that must be offered to most Americans and by allowing employers to offer
much bigger financial rewards to employees who quit smoking or adopt other healthy behaviors.<snip>

Under the rules, insurers cannot deny coverage or charge higher
premiums to people because they are sick or have been ill.
They also cannot charge women more than men, as many now do.<snip>

The rules lay out 10 broad categories of essential health benefits,
but allow each state to specify the benefits within those categories,
at least for 2014 and 2015. <snip>

The rules limit insurers’ ability to charge higher premiums based on age.
Under the rules, the rate for a 63-year-old could not be more than
three times the rate for a 21-year-old.
Many states now allow ratios of five to one or more, the administration said.<snip>

The rules also give employers new freedom to reward employees who participate
in workplace wellness programs intended to help them lower blood pressure,
lose weight or reduce cholesterol levels. <snip>

The rules include several provisions to prevent discrimination against employees.
Employers must, for example, allow workers to qualify for rewards in other ways
if it would be “unreasonably difficult” for them to meet a particular standard.<snip>

The new law seeks to protect consumers by limiting what they must
pay for health care before insurers begin to pay.
In the small-group market, these deductibles are limited to $2,000 for individuals
and $4,000 for family coverage.
<snip>

[classicman]

insurers cannot deny coverage or charge higher
premiums to people because they are sick or have been ill.

They also cannot charge women more than men

The rules limit insurers’ ability to charge higher premiums based on age

.

On the face this seems great, but in reality, those who were paying less will be paying more to compensate.
Women historically paid more because they used more. Maternity coverage, for example.
Those who are sick used it more also when compared to those who were not. And also older people typically had more AND more expensive treatments than their younger healthier counterparts.
The gross cost will remain the same, now those who were healthier will pay more to compensate for the lost premiums because of this.
Its like car insurance - Should the person with 5 accidents and 2 DUI's pay the same as the person with a clean record?

[Lamplighter]

Those who are sick used it more also when compared to those who were not.

Maybe we should debate this some more.

[glatt]

I don't think the gross costs will remain the same. I think the gross costs will go down.

If you have no money and no health insurance now and are having a health crisis, you go to the ER and get treated there. You can't pay the bill, so the rest of us pay for it with higher hospital prices. Under Obamacare, you will have health insurance and go to a doctor instead. Maybe even sooner, where you will get it treated for a lower cost. Gross costs will go down.

Plus, getting people paying into the system who have not been in the system before will be an extra source of revenue. It's not a bad thing to have everyone paying in. Sure, for that healthy 27 year old, it will seem like a waste of money, but what they are buying is the promise that they will be taken care of when they get older and are sick. It's kind of like a forced savings account (where your money is given to other people now and then later, other people's money is given to you.)

[orthodoc]

Originally Posted by glatt

If you have no money and no health insurance now and are having a health crisis, you go to the ER and get treated there. You can't pay the bill, so the rest of us pay for it with higher hospital prices. Under Obamacare, you will have health insurance and go to a doctor instead. Maybe even sooner, where you will get it treated for a lower cost. Gross costs will go down.

You're assuming certain behaviors (i.e. people who have health insurance will go to the doctor instead of using the ER for non-urgent problems), but many people prefer the ER for reasons I'd rather not get into. Unfortunately, costs will go down only if there's a penalty for using the ER when you could have gone to the doctor, and penalizing people for ER use is a tough political sell. More often, the hospital and/or doctors get penalized when people use the ER inappropriately. That saves money (if person A turns up five times in seven days and his/her insurance refuses to pay for more than the first visit) but results in hospitals closing ERs wherever possible.

(The disincentive in Ontario ERs is that in an urban center you'll typically wait 12+ hours or more to be seen. That's good for filtering out those who ought to go to an Urgent Care; not so good for those who are urgently/emergently sick. But I digress.)

[Happy Monkey]

Originally Posted by orthodoc

Unfortunately, costs will go down only if there's a penalty for using the ER when you could have gone to the doctor, and penalizing people for ER use is a tough political sell.

There is a penalty for doing that. It's much more expensive. What other penalty would you be talking about?

[Clodfobble]

Originally Posted by classicman

Its like car insurance - Should the person with 5 accidents and 2 DUI's pay the same as the person with a clean record?

But in that analogy, it's the health problems that are due to irresponsible choices (poor driving) that should be the determining factor, not whether someone is a woman, or old (which would be more like getting hit when it's not your fault.) So smokers and the obese should be paying more for health insurance in that scenario, not the old lady.

[classicman]

So smokers and the obese should be paying more for health insurance in that scenario, not the old lady.

Agreed, but they won't be.

[Stormieweather]

Originally Posted by classicman

Agreed, but they won't be.

Actually, they have been.

As a former smoker and former obese individual who pays for insurance, I can testify to this. I no longer smoke, drink, or am obese, and my costs have gone down.

Insurance penalized

[classicman]

If you have no money and no health insurance now and are having a health crisis, you go to the ER and get treated there. You can't pay the bill, so the rest of us pay for it with higher hospital prices. Under Obamacare, you will have health insurance and go to a doctor instead. Maybe even sooner, where you will get it treated for a lower cost. Gross costs will go down.

In theory, yes. We shall see.

[glatt]

Yeah. We won't know if Obamacare works until it's fully phased in in 2018. That's a hell of a long time to wait.

[Lamplighter]

Another POV ...

If Obamacare is successful, the cost of Medicare may go down.

If Obamacare is not successful and the Republicans have their way
with Medicare (and other entitlements), there will be a lot of hurt to go around... not just $.

[classicman]

We won't know if Obamacare works until it's fully phased in in 2018. That's a hell of a long time to wait.

Thats two presidential elections away and it will likely look very different than it does today by then.

[classicman]

"If Obamacare is successful, the cost of Medicare may go down."

"If Obamacare is not successful, the cost of Medicare may go up."