WWTBAM Bored

I have to say I was tremendously shocked that the single best explanation of the recent spate of insurance policy nonrenewals came, of all places, from Fox News:

http://www.foxnews.com/opinion/2013/11/ ... companies/

Key portion:

The fact is if you are one of the estimated 2 million Americans whose health insurance plans may have been cancelled this month, you should not be blaming President Obama or the Affordable Care Act. You should be blaming your insurance company because they have not been providing you with coverage that meets the minimum basic standards for health care.

Let me put it more bluntly: your insurance companies have been taking advantage of you and the Affordable Care Act puts in place consumer protection and tells them to stop abusing people. The government did not “force” insurance companies to cancel their own substandard policies.The insurance companies chose to do that rather than do what is right and bring the policies up to code. This would be like saying the government “forces” chemical companies to dispose of toxic waste safely rather than dumping it in the river.

silverscreenselect wrote:I have to say I was tremendously shocked that the single best explanation of the recent spate of insurance policy nonrenewals came, of all places, from Fox News:

http://www.foxnews.com/opinion/2013/11/ ... companies/

Key portion:

The fact is if you are one of the estimated 2 million Americans whose health insurance plans may have been cancelled this month, you should not be blaming President Obama or the Affordable Care Act. You should be blaming your insurance company because they have not been providing you with coverage that meets the minimum basic standards for health care.

Let me put it more bluntly: your insurance companies have been taking advantage of you and the Affordable Care Act puts in place consumer protection and tells them to stop abusing people. The government did not “force” insurance companies to cancel their own substandard policies.The insurance companies chose to do that rather than do what is right and bring the policies up to code. This would be like saying the government “forces” chemical companies to dispose of toxic waste safely rather than dumping it in the river.

Except that the quote comes from Juan Williams, one of Fox's few liberals, who is blathering the latest "Let's blame somebody else" messages from the White House. To pass a law that hamstrings insurance companies and through further regulations make it impossible/illegal for them to "grandfather" existing policies, and then to blame them for the cancellations is outrageous and morally corrupt. I believe that small business group policies will be the next for cancellation. Those were given a one-year exemption by the President (no doubt intended to delay additional bad news until after the next round of elections), but some small groups already are starting to receive their own cancellation letters.

BTW, I have noticed that you like to refer to reports of cancelled policies as "anecdotes" or "anecdotal evidence." So far, there have been as many as 1.5 million such "anecdotes," according to most reports. How many anecdotes does it take for you to consider these individual reports -- many in the form of anguished cries -- to constitute fact?

ultra Liberal Juan Williams wrote:You should be blaming your insurance company because they have not been providing you with coverage that meets the minimum basic standards for health care.

Let me put it more bluntly: your insurance companies have been taking advantage of you and the Affordable Care Act puts in place consumer protection and tells them to stop abusing people.

Yeah, right. Not providing (nor charging for) prenatal and maternity care for a single male or post-menapusal couple is abuse but forcing such folks to have to pay for such coverage is not.

Most people who were happy with their plans who are getting them cancelled were happy BECAUSE they were not paying for things they did not want nor need, BY CHOICE. Why would someone be happy with plan that charged them $100/month more for contraception or maternity care when they could not possibly get pregnant?

Nice try Obama. But your lies are coming home to roost!

BackInTex wrote:

ultra Liberal Juan Williams wrote:You should be blaming your insurance company because they have not been providing you with coverage that meets the minimum basic standards for health care.

Let me put it more bluntly: your insurance companies have been taking advantage of you and the Affordable Care Act puts in place consumer protection and tells them to stop abusing people.

Yeah, right. Not providing (nor charging for) prenatal and maternity care for a single male or post-menapusal couple is abuse but forcing such folks to have to pay for such coverage is not.

Most people who were happy with their plans who are getting them cancelled were happy BECAUSE they were not paying for things they did not want nor need, BY CHOICE. Why would someone be happy with plan that charged them $100/month more for contraception or maternity care when they could not possibly get pregnant?

Nice try Obama. But your lies are coming home to roost!

Did anyone ever offer plans to women that didn't cover, say, prostate surgery? --Bob

Bob78164 wrote:

BackInTex wrote:

ultra Liberal Juan Williams wrote:You should be blaming your insurance company because they have not been providing you with coverage that meets the minimum basic standards for health care.

Let me put it more bluntly: your insurance companies have been taking advantage of you and the Affordable Care Act puts in place consumer protection and tells them to stop abusing people.

Yeah, right. Not providing (nor charging for) prenatal and maternity care for a single male or post-menapusal couple is abuse but forcing such folks to have to pay for such coverage is not.

Most people who were happy with their plans who are getting them cancelled were happy BECAUSE they were not paying for things they did not want nor need, BY CHOICE. Why would someone be happy with plan that charged them $100/month more for contraception or maternity care when they could not possibly get pregnant?

Nice try Obama. But your lies are coming home to roost!

Did anyone ever offer plans to women that didn't cover, say, prostate surgery? --Bob

I don't know but I would imagine if a woman tried to file a claim it would be denied. So yes, the policies did not cover prostate issues for women.

BackInTex wrote:

Bob78164 wrote:

BackInTex wrote:
Yeah, right. Not providing (nor charging for) prenatal and maternity care for a single male or post-menapusal couple is abuse but forcing such folks to have to pay for such coverage is not.

Most people who were happy with their plans who are getting them cancelled were happy BECAUSE they were not paying for things they did not want nor need, BY CHOICE. Why would someone be happy with plan that charged them $100/month more for contraception or maternity care when they could not possibly get pregnant?

Nice try Obama. But your lies are coming home to roost!

Did anyone ever offer plans to women that didn't cover, say, prostate surgery? --Bob

I don't know but I would imagine if a woman tried to file a claim it would be denied. So yes, the policies did not cover prostate issues for women.

Which policies are you talking about?

Are you aware that there are some women that do have prostates?

The parsing and patronization of this whole fiasco is stunning. Obama lied, you kow he did, and whether he knew he was lying is immaterial. It amounts to gross stupidity on the positive side and venality on the real side. It's incredibly saddening that the UNINSURED didn't get affordably insured and the insured got UNINSURED. Ironic that.

Bob Juch wrote: Which policies are you talking about?

Are you aware that there are some women that do have prostates?

Then they certainly should get a policy that covers it, if they want.

Bob Juch wrote:

BackInTex wrote:

Bob78164 wrote:Did anyone ever offer plans to women that didn't cover, say, prostate surgery? --Bob

I don't know but I would imagine if a woman tried to file a claim it would be denied. So yes, the policies did not cover prostate issues for women.

Which policies are you talking about?

Are you aware that there are some women that do have prostates?

I thought about putting up a picture of Ann Coulter, but that's way too predictable. I have to be more whimsical, so I'll put up a picture of this woman instead:

silvercamaro wrote: To pass a law that hamstrings insurance companies and through further regulations make it impossible/illegal for them to "grandfather" existing policies, and then to blame them for the cancellations is outrageous and morally corrupt.

Obama was not honest in this, but neither are the insurance companies. They could have grandfathered in the policies that existed in 2010 had they chosen to do so but they didn't. That was their decision, not Obama's. The public was probably not all that aware of what policies could and could not be grandfathered but insurance companies were very aware of it. They changed deductibles and copays, offered to switch people to "cheaper" policies, discontinued unprofitable policies, and in some cases got out of markets altogether, and they were fully aware of the effect these changes would have.

Although BiT is upset about the thought of paying for maternity coverage, the main reason that many of these plans were noncompliant had nothing to do with maternity coverage and everything to do with other features they were lacking, such as hospital care, pharmacy benefits, rehabilitative services, or in some cases strict annual limits. In addition, anyone having group insurance to which HIPAA applied was covered by HIPAA's nondiscrimination requirements. Employers could purchase a plan that excluded maternity benefits, but the plan would have to exclude maternity benefits for all their employees, which in most cases made this a non-issue.

The sad fact is that a lot of people don't really know what their insurance does and does not cover until they find out something's not covered when they attempt to file a claim for it (at which point it's too late to do anything about it). Plus, even those people who really are genuinely happy with their existing coverage had absolutely no guarantee that they would continue to have that coverage (or anything comparable) available in the future. Insurance companies leave states, in which case all their policies are nonrenewed. They discontinue policies, in which case those people have to find other coverage. They change policies by jacking up premiums, deductibles, or copays, in which case people have to bite the bullet or find other coverage. The main reason they make these changes is because the policies weren't profitable (i.e., they were charging too little), which may explain why people were "happy" with them. When the insurance companies raise their rates to an actuarially supportable level, people aren't so happy.

It's clear that many people are being nonrenewed. Insurance companies are blaming Obamacare for what is in a lot of cases a business decision to shut down less profitable policies and try to shunt patients into more profitable policies. By the way, Obamacare has made this more difficult for employers to do. Before, HIPAA required insurers to offer a discontinued policyowner replacement coverage, but the replacement policies were often, as here, more expensive. However, if an individual say Aetna policyowner had his policy discontinued and didn't like any of the replacement policies Aetna had to offer, he would have to be accepted by another insurer if he wanted to change coverage (which means a lot of people with pre-existing conditions were effectively locked in).

The biggest problem Obamacare now faces is the admitted mess of the website. It prevents people from enrolling, but it also makes it far more difficult for people to get accurate information about what's available, at what actual price, and what it actually covers and does not cover.

A more balanced view of the nonrenewals from an insurance professional:

http://www.benefitspro.com/2013/11/05/g ... =100284624

The biggest problem Obamacare now faces is the admitted mess of the website

Let me fix that for you. The biggest problem Obamacare now faces is that it is (and always was) completely unsustainable and being run by people who don't care that it's unsustainable. Because they want it to fail so they can get to something even more unsustainable: single payer.

flockofseagulls104 wrote:Because they want it to fail so they can get to something even more unsustainable: single payer.

Tell that to people in Great Britain.

flockofseagulls104 wrote:

The biggest problem Obamacare now faces is the admitted mess of the website

Let me fix that for you. The biggest problem Obamacare now faces is that it is (and always was) completely unsustainable and being run by people who don't care that it's unsustainable. Because they want it to fail so they can get to something even more unsustainable: single payer.

I want it to succeed so we can get to single payer. I think success with the ACA will eventually bring about the next step.

silverscreenselect wrote:

flockofseagulls104 wrote:Because they want it to fail so they can get to something even more unsustainable: single payer.

Tell that to people in Great Britain.

Great Britain is different. As I understand it, in England physicians are government employees. I don't want that. I think Canada is a true single-payer system.

What I do want is Medicare-for-all. Contrary to flock's predictions, Medicare works pretty damn well. I don't want to have to wait more than another decade before I can benefit from it. But largely thanks to Joe Lieberman, I will. --Bob

and Canada could improve on its system in several ways first and foremost would be the establishment of a prescription drug program. Because prescription drugs are not covered under health care plans unless you are a senior, on welfare or in a hospital people go to the more expensive ER where they can get a small amount of free medication. This has the spill over effect of clogging up hospitals and taking doctors to treat minor ailments. A second improvement would be to require as is the case here most times a Primary Care Physician to look after dyd to day needs.
Quite often the working poor, a group you often hear referenced here forego medications because of the cost. I remember the drug plan I had when I was there I was reimbursed for 90% of drug costs but had to upfront the money. This was I am sure a hardship for some.

themanintheseersuckersuit wrote:http://www.propublica.org/article/loyal ... -obamacare

Brilliant.

I just took the first level they were offered and proced it at Cigna.AZ
This looks about the same

Annual Individual Deductible (medical/pharmacy are integrated) $2,750
Annual Family Deductible $5,500
Individual OOP maximum $6,350
Family OOP maximum $12,700
Coinsurance You pay 20% after deductible
Primary Care Physician $30 Copay
Specialist Physician $60 Copay
Office Related Services You pay 20% after deductible
Preventive Care for All Ages You pay 0%, deductible waived
Facility Services (Inpatient Room and Board, Lab & X-ray, Operating Room, etc.) You pay 20% after deductible
Physician Services You pay 20% after deductible
Lab, X-ray and Ultrasound You pay 20% after deductible
Imaging - CT/PET and MRI You pay 20% after deductible
Cardiac & Pulmonary Rehabilitation
Short Term Rehabilitative Therapy You pay 20% after deductible
Outpatient Surgery - Facility You pay 20% after deductible
Outpatient Surgery - Physicians Services You pay 20% after deductible
Emergency & Urgent Care
In Network
Emergency Room Services You pay 20% after deductible
Urgent Care You pay $75, deductible waived
Ambulance You pay 20% after deductible
Skilled Nursing Facility You pay 20% after the deductible.
Home Health You pay 20% after deductible
Hospice You pay 20% after deductible
Durable Medical Equipment You pay 20% after deductible
Inpatient Mental Health You pay 20% after deductible
Outpatient Mental Health You pay 20% after deductible
Prescription Drugs
Tier 1 - Retail Preferred Generic You pay $4, deductible waived
Tier 2 - Retail Non-Preferred Generic You pay $15, deductible waived
Tier 3 - Retail Preferred Brand You pay $45, deductible waived
Tier 4 - Retail Non-preferred Brand You pay 50% after deductible
Tier 5 - Retail Specialty You pay 40% after deductible
Tier 1 - Home Delivery Preferred Generic You pay $10, deductible waived
Tier 2 - Home Delivery Non-Preferred Generic You pay $37, deductible waived
Tier 3 - Home Delivery Preferred Brand You pay $112, deductible waived
Tier 4 - Home Delivery Non-Preferred Brand You pay 50% after deductible
Tier 5 - Home Delivery Specialty You pay 30% after deductible

All for the princely sum of \wait for it

Spoiler

$246 per person a month

themanintheseersuckersuit wrote:http://www.propublica.org/article/loyal ... -obamacare

I see nothing in his current plan that would have required cancellation. Kaiser is full of shit. I had them when I lived there in 2003; they're the worst insurance I ever had.

Bob78164 wrote:

silverscreenselect wrote:

flockofseagulls104 wrote:Because they want it to fail so they can get to something even more unsustainable: single payer.

Tell that to people in Great Britain.

Great Britain is different. As I understand it, in England physicians are government employees. I don't want that. I think Canada is a true single-payer system.

What I do want is Medicare-for-all. Contrary to flock's predictions, Medicare works pretty damn well. I don't want to have to wait more than another decade before I can benefit from it. But largely thanks to Joe Lieberman, I will. --Bob

Medicare works pretty damn well.

The only problem is that it is financially unsustainable.

As Margaret Thatcher said, "The only problem with socialism is that eventually you run out of other people's money." She didn't agree with Paul Krugman either.
Bob, you seem like an intelligent guy. Can you not see that at some point with everyone feeding out of the public trough, it will eventually run dry and everyone will suffer?

We have no copays-I'll have to run down all of the OOPs etc. Most preventive is 100% before deductible, etc. Deductible is 3000 individual, 6000 family, with the employer paying first either 1500 or 3000 depending on if you're a one person or a more than one person. After deductible everything covered is 100%.

macrae1234 wrote:I just took the first level they were offered and proced it at Cigna.AZ
This looks about the same

Annual Individual Deductible (medical/pharmacy are integrated) $2,750
Annual Family Deductible $5,500
Individual OOP maximum $6,350
Family OOP maximum $12,700
Coinsurance You pay 20% after deductible
Primary Care Physician $30 Copay
Specialist Physician $60 Copay
Office Related Services You pay 20% after deductible
Preventive Care for All Ages You pay 0%, deductible waived
Facility Services (Inpatient Room and Board, Lab & X-ray, Operating Room, etc.) You pay 20% after deductible
Physician Services You pay 20% after deductible
Lab, X-ray and Ultrasound You pay 20% after deductible
Imaging - CT/PET and MRI You pay 20% after deductible
Cardiac & Pulmonary Rehabilitation
Short Term Rehabilitative Therapy You pay 20% after deductible
Outpatient Surgery - Facility You pay 20% after deductible
Outpatient Surgery - Physicians Services You pay 20% after deductible
Emergency & Urgent Care
In Network
Emergency Room Services You pay 20% after deductible
Urgent Care You pay $75, deductible waived
Ambulance You pay 20% after deductible
Skilled Nursing Facility You pay 20% after the deductible.
Home Health You pay 20% after deductible
Hospice You pay 20% after deductible
Durable Medical Equipment You pay 20% after deductible
Inpatient Mental Health You pay 20% after deductible
Outpatient Mental Health You pay 20% after deductible
Prescription Drugs
Tier 1 - Retail Preferred Generic You pay $4, deductible waived
Tier 2 - Retail Non-Preferred Generic You pay $15, deductible waived
Tier 3 - Retail Preferred Brand You pay $45, deductible waived
Tier 4 - Retail Non-preferred Brand You pay 50% after deductible
Tier 5 - Retail Specialty You pay 40% after deductible
Tier 1 - Home Delivery Preferred Generic You pay $10, deductible waived
Tier 2 - Home Delivery Non-Preferred Generic You pay $37, deductible waived
Tier 3 - Home Delivery Preferred Brand You pay $112, deductible waived
Tier 4 - Home Delivery Non-Preferred Brand You pay 50% after deductible
Tier 5 - Home Delivery Specialty You pay 30% after deductible

All for the princely sum of \wait for it

Spoiler

$246 per person a month

Price is more than mine, actually. $492 compared to $360ish for 2.

Bob Juch wrote:

themanintheseersuckersuit wrote:http://www.propublica.org/article/loyal ... -obamacare

I see nothing in his current plan that would have required cancellation. Kaiser is full of shit. I had them when I lived there in 2003; they're the worst insurance I ever had.

A number of consumer rights groups have made the same claim... that some of these cancellations are an attempt by insurers to purge less profitable policies and replace them with more profitable policies and avoid the blame by laying it at the feet of Obamacare. Under HIPAA, insurers can't arbitrarily cancel individuals because they have a bad health record, but they can cancel entire policies. I would expect that in states like California, we'll see these insurers called to account for what they've done.

President Obama spoke about the ACA at Temple Emanu-El in Dallas today, which no doubt caused many people here to wonder what a Muslim was doing at a Jewish synagogue.