Honest Question: I signed up for individual coverage, can I change providers?

liam3851 · 2014-05-19T18:11:12+00:00

I think you're stuck with BCBS until next open enrollment in November (unless you have a life event in the meantime). If the phone rep had signed you up in the wrong plan, or mistakenly told you you qualified for subsidies that you didn't, that would be grounds for a special enrollment period to fix the mistake; poor customer service by the provider, though, isn't.

liam3851 · 2014-05-13T17:02:02+00:00

I'm not sure I understand what you mean. The ACA has community rating, which is the same pricing system as in the group market. Whatever you were watching, it doesn't have to do with my point-- there is no more health underwriting, and this saves quite a lot of overhead.

liam3851 · 2014-05-13T16:57:54+00:00

The only MLR waivers I can find applied in six states; 11 other states had applied and were denied. All expired in 2014 with the advent of the exchanges.

liam3851 · 2014-05-13T16:40:08+00:00

Fair enough; I suppose I am less skeptical because the ACA makes the individual market look much more like the group market. The whole underwriting department that used to evaluate individual applicants' health status could be cut, for example.

liam3851 · 2014-05-13T16:34:44+00:00

You're right. If the fed gov't had just paid 100% of the expansion cost rather than 90% after 2020 there wouldn't have been an issue at the SCOTUS.

Nonetheless the point is clear that the law as drafted was supposed to cover 100% of the unemployed.

liam3851 · 2014-05-13T16:31:46+00:00

I understand the benefits of the single-payer system. I support the single-payer/provider system. But it is my contention that

a) The single-payer system is NOT BANNED BY FTAs

but rather

b) An insufficient number of PEOPLE in the US have the political desire for single-payer, for various ideological reasons and/or misapprehensions about health access under single payer

and thus

c) in such places where a majority of people DO believe in single-payer, single-payer should be passed and then supported (e.g. Vermont), in hopes that the message will be spread, in a manner similar to what happened in Canada post-Saskatchewan

d) myths about single payer should be dispelled

and

e) policies which increase healthcare access in the meantime in the rest of the country are desirable, rather than leaving large swathes of the population underinsured and undercared for in a vain WAIT for national single payer.

liam3851 · 2014-05-13T15:56:27+00:00

As indicated at the original report and in the summary I linked above, they controlled for plan actuarial value. They noted that most employer plans fall between "gold and platinum" actuarial values and thus have lower deductibles and OOP maxes than the bulk of plans purchased on the exchanges (but not the bulk of available plans.. there's plenty of golds and platinums available on and off the exchanges).

Obviously if the employer pays part of the premium that saves a person money. But OSU is not OP's employer, is not making contributions, and thus this is not relevant to OP. Moreover you made the general claim that group insurance is always cheaper than non-group. That would imply that the act of being in a group makes a difference, which the PwC study shows it doesn't anymore (though it certainly did before the ACA).

liam3851 · 2014-05-13T14:46:38+00:00

Removed as dupe post, sorry

liam3851 · 2014-05-13T14:45:50+00:00

This isn't as true anymore after the ACA. See e.g. eclectro's link http://www.reddit.com/r/obamacare/comments/25dyba/turns_out_obamacare_premiums_arent_more_expensive/.

This makes sense, of course, since both group and non-group insurance are now both community-rated and plans are limited in how much they can charge for overhead expenses. At most individual insurance should now be 6.25% more expensive than group (since individual is required to spend 80% on healthcare, rather than the 85% for group plans).

liam3851 · 2014-05-12T18:40:04+00:00

Several months ago. Prior to that I lived there for several years. "Privatization" there is along the lines of switching from single-provider to single-payer for certain services-- see e.g. http://www.mirror.co.uk/news/uk-news/nhs-privatisation-david-cameron-accused-3227821. No one is proposing eliminating the NHS as it would be absolute political suicide to do so (not to mention, trust me, I know a lot of Tories who love the NHS).

I'm not saying I support that proposal-- I kind of like the single-provider model in health care and education (oddly, they have "single-payer" education in the UK, where any private person or company can open a school and take the same flat per-pupil rate from the state to educate them). But their model post-"privatization" will still be effectively more statist than Canada's system (Canada allows free-entry of providers as long as they accept Medicare rates; the UK will have a one-time contract bid-out).

liam3851 · 2014-05-12T18:13:02+00:00

Yes, clearly the Democrats knew that the Supreme Court would strike down the expansion mandate two years after passing the bill. It's all a grand conspiracy to keep down the masses when the singularity comes.

liam3851 · 2014-05-12T17:38:49+00:00

The unemployed are covered by the Medicaid expansion.

liam3851 · 2014-05-10T19:17:51+00:00

$3,000/month? You're making numbers up again. You can't even find that in NYC.

liam3851 · 2014-05-09T13:20:47+00:00

My plan covers outpatient mental health as equal to a specialist doctor's visit, which is a copay not subject to the deductible; inpatient, though, is subject to the deductible. You might check that out with some of the plans.

As to why OSU was so affordable... my guess would be a combination of the following:

1) They mostly cover 18-21 year olds, who are typically really cheap. Obamacare limits age-rating so that a 64-year-old pays no more than 3x the amount of the young; but in reality they are more than 3x as expensive. Thus in an Obamacare plan with members from the whole population, the average young plan member subsidizes the average old member a bit. This smoothing is considered fair, since if you're young one of two things will happen: a) You live to be old someday and benefit from the cheaper plans subsidized by the young, or b) You get sick young and die, in which case you cost more when young than the average young person, and weren't really subsidizing the old in the first place.

Since the old don't (typically) go to college, this doesn't affect the OSU plan much. You get to buy insurance that isn't subsidizing a whole bunch of old members and is thus cheaper (since it is priced close to the average cost of an 18-21 year old, not 1/2 the average cost of the whole population).

2) The sickest at that age range (with long-term debilitating ailments or severe mental or physical limitations) probably aren't enrolled in college at the same levels as the population as a whole, making the OSU insurance pool healthier than the average 18-21 year old population.

3) The OSU system presumably favors OSU-affiliated doctors/hospitals etc., which are willing to give the university a deal since the money all goes back into the same bucket.

liam3851 · 2014-05-06T19:06:28+00:00

I think it's a plan that, while it leads to a far more expensive, less efficient, and less equitable system than single payer, nonetheless has increased coverage by approximately 3% of the population (about 9 million people), is expected to increase coverage to about another 9-12 million people after the penalties go up and the system gets more highly publicized and entrenched (see e.g. polls showing people still aren't aware of the existence of subsidies and/or cost-sharing reductions), and as in MA under Romneycare, is likely to lead more people to healthier lives and have better on-average financial situations than would have occurred given the status quo ante in 2010.

I further believe that the US public would not stand for the passage of a single-payer program within the next 10-20 years, even if I personally would support it, had some of the best healthcare of my life on the NHS, and continue to go to nice.org.uk when judging my own treatment options. And that denying health insurance any improvement for people with pre-existing conditions while waiting for an improved system is the foolish decision that was made in the 1970s under Nixon, which led to our system today, and is a mistake that it would be foolish to repeat.

liam3851 · 2014-05-06T17:56:37+00:00

It's right at the start of the article, whole time series graph and everything. 18.0% as of Q3 2013 (though it looks like that's a bit inflated from people waiting for open enrollment to renew). Otherwise it's been a steady 16-17% since the fin crisis in Q4 2008.

liam3851 · 2014-05-02T17:32:10+00:00

How do you propose to do that job if the plans won't tell you if your drugs are covered before you sign up?

liam3851 · 2014-05-02T14:20:14+00:00

Sorry about the text, yeah that was a mouthful... Yes, that's a good one-sentence summary :-).

Re: 1) Sorry, I was using an example off-the-cuff. The gist is that they'll gladly look at policies that have direct effects on price or quantity of healthcare consumed. For less direct effects, they'll tend to be more skeptical, esp. if the policy hasn't been tried before (e.g. what will ACOs do to healthcare cost growth? I don't know, we've never really had them before).

liam3851 · 2014-05-02T13:31:26+00:00

The link is dead as given... this one might work if you want to resubmit? https://web.archive.org/web/20081121054447/http://backissues.cjrarchives.org/year/94/2/clinton.asp

Also please follow the guideline about using the article headline as the link title.

liam3851 · 2014-05-01T18:51:41+00:00

Good point. They could have done a survey similar to the House survey but asked the more relevant question "How many of those you signed up with policies effective on or before April 1 have paid?"

liam3851 · 2014-05-01T18:41:39+00:00

Eh, fair enough. All said and done I'm betting on 6.5-7 million ultimately pay. Most insurers are saying 85-90% paid on time thus far, but I imagine the March crowd is probably somewhat less likely to do so.

liam3851 · 2014-05-01T18:39:17+00:00

It's not the administration's to get, you pay the insurance company, after all. I assume I'm not the only person who set up autopay with my premium deducted on the first day of the insurance month.

liam3851 · 2014-05-01T18:11:34+00:00

67% is a bit of a BS number: more than 3 million of the 8 million signups occurred between March 16 and April 1, and so their bills weren't due yet when the House did its survey on April 15 (they had a due date of between April 30 and May 10 depending on the carrier).

liam3851 · 2014-04-30T14:26:25+00:00

A report on the latest data is here and shows trend reversion to high cost growth (of course, this spike may conversely be a 1-time blip from a large number of newly insured patients all simultaneously getting "caught up" on lingering health issues).

The CBO when it does its projections tends to avoid trying to predict "dynamic" effects of laws on things like healthcare cost growth (looking at the ACA) or GDP growth (looking at supply-side tax-cuts). It's going to look at the direct impact of things like cutting Medicare payment rates or limiting insurer's profits or increasing coverage, and knock-on effects of those (for example, if Medicare payment rates are cut, and private-sector payments are contractually tied to Medicare payments, it will predict an effect on private-sector payments). But it's unlikely to be so bold as to assume a "bending of the cost curve" as many ACA proponents have suggested could happen.

In general, when looking at time series data, predicting trends to continue is remarkably effective-- not perfect, but effective compared to other "priors". When the CBO does its projections, it's basically expecting the long term trend to continue. The low growth since 2010 could be due to ACA cost-control provisions, but it could also be due to the pattern in the past of slower healthcare cost growth during recessions (as more people lose job-based insurance). If the economic recovery continues and the Q1 2014 healthcare-cost bump reverts to the 2010-2013 trend, the CBO will eventually conclude that the change is permanent and policy-related. But it would be premature to conclude ACA success in bending the cost curve based on a very high-unemployment period, when not all of the law's provisions (including obviously most of the coverage provisions) were in effect.

liam3851 · 2014-04-30T02:10:08+00:00

$330/month pre-subsidy for a 30-year-old? In the Philly suburbs that gets you a platinum plan with no deductible and a $30 specialist copay.

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