Obamacare - AKA Walking Dead Update...largest provider UnitedHealthcare thinking of dropping out.

[ksen]

Such as:

In October 15, the Obama administration significantly downgraded its estimate of how many people will enroll in exchange plans next year. The administration now expects only 10 million exchange enrollees at the end of 2016. Charles Gaba, a statistical expert who closely tracks Affordable Care Act (ACA) enrollment and who made fairly accurate projections for 2014 and 2015, is somewhat more optimistic. He projects enrollment at 12.2 million people by the end of next year.

These low estimates should rock the health policy community. The Congressional Budget Office only four months ago projected there would be 20 million exchange enrollees next year. This CBO estimate was 3 million people fewer than its estimate issued just after the 2012 Supreme Court case that preserved the law and 1 million fewer than its March 2010 estimate, produced days before the law was passed by the House of Representatives.

CBO’s early projection of 2016 exchange enrollment was actually lower than predictions by other experts who modeled the ACA. The table below shows 2010 projections for 2016 from the RAND Corporation, the Office of the Chief Actuary at the Centers for Medicare and Medicaid Services, and the Urban Institute.

What fun building the welfare state, no?

http://www.forbes.com/sites/theapot...ining-plummeting-obamacare-enrollment-part-i/

I, for one, am shocked that predictions made 6 years into the future sometimes don't pan out.

 

[T.G.G. Moogly]

...a constant reminder of one of the largest failures in American social policy since...well, since ever.

Yes. No affordable healthcare for tens of millions of citizens in a western democracy is a failure of gigantic proportions.

 

[Trausti]

...a constant reminder of one of the largest failures in American social policy since...well, since ever.

Yes. No affordable healthcare for tens of millions of citizens in a western democracy is a failure of gigantic proportions.

Affordable for whom? Do you appreciate that the reason the ACA is failing is because the plans are so unaffordable and lousy that many people choose not to buy them?

 

[Loren Pechtel]

I don't see how the ACA can survive the next administration, Democrat or Republican. It was truly horrible legislation, which with its higher deductibles and higher premiums makes health insurance completely worthless for the private payer. Gruber's "stupid" Americans may still champion the monstrosity, but to the rest of us this abscess needs to be popped.

The number of people signing up says it's not worthless.

It's a lot more expensive than insurance through work because you don't have the premium subsidy from your employer.

 

[untermensche]

Yes. No affordable healthcare for tens of millions of citizens in a western democracy is a failure of gigantic proportions.

Affordable for whom? Do you appreciate that the reason the ACA is failing is because the plans are so unaffordable and lousy that many people choose not to buy them?

The poorness of the plans can't be blamed on the ACA. The plans have been getting progressively poorer for decades. It has a lot to do with the rising costs of healthcare, something the ACA does not address.

Replace these corporate plans with Medicare for all and the nation will save money and coverage for most will improve.

But it is good to see the right has finally learned that the corporate insurance plans have been getting more expensive and providing less.

 

[RavenSky]

Yes. No affordable healthcare for tens of millions of citizens in a western democracy is a failure of gigantic proportions.

Affordable for whom? Do you appreciate that the reason the ACA is failing is because the plans are so unaffordable and lousy that many people choose not to buy them?

balony.

The plans are quite affordable - far far far more affordable than direct private health insurance. And what is even more important is that people with pre-existing conditions cannot be denied coverage.

You know what would be even more affordable (if that is really your complaint)? UHC Medicare for all.

 

[SimpleDon]

There is a yawning chasm between what I have mused, and what you think I have predicted...even wider that Obamacare's promises/predictions and its actual results. Nope, I have not predicted its 'collapse', but I did predict its programmatic blunder and failures (which is an entirely different set of benchmarks). Moreover, while many aspects of ACA are clearly illegal, I have never predicted it would (would not) be overturned by the Supreme Court (I was well aware of the Court's political aims often being more important than the law).

So to assume that Obamacare will collapse is to assume that those who manage the program are moored to the actual approved law. However, it is now clear that neither HHS nor the Supremes are going to let that trifle endanger their pet. Hence, I fully expect HHS to illegally funnel billions to the insurance companies (or waive many service or co-payment limits) to keep the dead walking.

No one is going to dissuade the emperor from parading his birthday suit, but we can delight in making fun of his delusions of fashion. No?

Such as:

In October 15, the Obama administration significantly downgraded its estimate of how many people will enroll in exchange plans next year. The administration now expects only 10 million exchange enrollees at the end of 2016. Charles Gaba, a statistical expert who closely tracks Affordable Care Act (ACA) enrollment and who made fairly accurate projections for 2014 and 2015, is somewhat more optimistic. He projects enrollment at 12.2 million people by the end of next year.

These low estimates should rock the health policy community. The Congressional Budget Office only four months ago projected there would be 20 million exchange enrollees next year. This CBO estimate was 3 million people fewer than its estimate issued just after the 2012 Supreme Court case that preserved the law and 1 million fewer than its March 2010 estimate, produced days before the law was passed by the House of Representatives.

CBO’s early projection of 2016 exchange enrollment was actually lower than predictions by other experts who modeled the ACA. The table below shows 2010 projections for 2016 from the RAND Corporation, the Office of the Chief Actuary at the Centers for Medicare and Medicaid Services, and the Urban Institute.

What fun building the welfare state, no?

http://www.forbes.com/sites/theapot...ining-plummeting-obamacare-enrollment-part-i/

So you don't predict the collapse of Obamacare but you would welcome the collapse of Obamacare? This is a relatively minor difference.

As I said, the legislation is an unmitigated disaster, since it relies on the inefficient private for profit insurance companies to provide something that they never provided in the past, affordable coverage when they are at risk. Just the kind of idiotic free market crap you expect from a conservative think tank like the Heritage Foundation. This is absolutely the worse way to pay for medical care. It is the most expensive way to provide this health care.

And yes, it is designed to pump billions of dollars into the coffers of the for profit insurance companies. And this is not so much a result of their ability to provide this coverage efficiently but more a reflection of their ability to make Harold and Louise commercials to lie to people and to scare them to death about their health care.

Which brings us to this question. Since you don't support this conservative idea of how to provide the country with what it needs, high quality, low cost, widely available health care, how would you propose to do it?

At least now you understand why the ACA had to be so detailed, to prevent some future administration from using any regulation writing authority to rewrite regulations to rewrite the intent of the law. As the Bush the lesser administration tried to do with the EPA laws, which were reversed by the US Supreme Court.

 

[maxparrish]

Such as:

What fun building the welfare state, no?

http://www.forbes.com/sites/theapot...ining-plummeting-obamacare-enrollment-part-i/

I, for one, am shocked that predictions made 6 years into the future sometimes don't pan out.

Well there's a bit of win-win goal post shifting. A few years ago supporters were crowing that in spite of a rough start, meeting the target numbers showed success. But now that the program's numbers are falling way short of the target, it's "oh you can't predict the future and they didn't matter anyway".

My my. There is an epidemic of either situational amnesia or situational ethics, no?

 

[maxparrish]

Affordable for whom? Do you appreciate that the reason the ACA is failing is because the plans are so unaffordable and lousy that many people choose not to buy them?

balony.

The plans are quite affordable - far far far more affordable than direct private health insurance. And what is even more important is that people with pre-existing conditions cannot be denied coverage.

You know what would be even more affordable (if that is really your complaint)? UHC Medicare for all.

Ravensky, Trausti,

"Baloney"? Trausti is correct, it has made insurance more affordable for some, by making it less affordable for others. It shouldn't be a surprise, the program was structured to lower costs for the unhealthy and oldest, paid by penalizing the younger and healthier. The general result has been a large rise in health insurance premiums and deductions, mitigated by subsidy for some.

A recent NBER working paper by three economists - Mark Pauly, Adam Leive, Scott Harrington - demonstrates what should have been obvious to the "liberal" policy mavens

We find that the average financial burden will increase for all income levels once insured. Subsidy-eligible persons with incomes below 250 percent of the poverty threshold likely experience welfare improvements that offset the higher financial burden, depending on assumptions about risk aversion and the value of additional consumption of medical care. However, even under the most optimistic assumptions, close to half of the formerly uninsured (especially those with higher incomes) experience both higher financial burden and lower estimated welfare; indicating a positive “price of responsibility” for complying with the individual mandate. The percentage of the sample with estimated welfare increases is close to matching observed take-up rates by the previously uninsured in the exchanges.

http://www.nber.org/papers/w21565#fromrss

In short: “Persons with low incomes may fare better after the ACA, but those formerly uninsured at higher incomes not in poor health consistently are worse off.”

Now who would feel warm and fuzzy over a plan to punish the lower middle class person earning as little as $29,500 (250% of threshold)?

 

[ZiprHead]

The reality is that Obamacare is an imperfect system, but it’s workable — and it’s working.

As untermensche said, if they don't like ACA (a CONSERVATIVE REPUBLICAN plan), then they can vote in UHC via Medicare for all. Until then, they can kiss my ass or pay for my daughter's health care out of their own fucking pockets.

I like this quote better.:
"But are we looking at the beginnings of a death spiral? Some people are indeed saying that, but as far as I can tell, they’re all people who have been predicting disaster every step of the way, and will still be predicting imminent collapse a decade from now."

Seems far more apropos to our Max.

 

[Trausti]

The poorness of the plans can't be blamed on the ACA.

But they can. The bench plank of the ACA is that those who could afford private insurance before are forced to subsidize everyone else by paying higher premiums and deductibles now. Enough healthy must pay into the risk poor to support the unhealthy; otherwise, the risk pool collapses. Yet, one the reasons the ACA plans are so expenses - with ridiculous deductibles - is due to the government mandating you buy insurance you don't want and will never use. Say, a single adult male paying for maternity leave and pediatric dental. To argue that the ACA is not responsibility for the explosion of deductibles and costs is very misinformed. Take this example:

A 40-year-old bronze plan customer who paid an average of almost $261 per month in 2015 is now looking at an average price of nearly $290 per month.

And bronze plans have, as a rule, the highest deductibles, which people must personally pay before their plan covers their medical expenses. The 2016 average deductible for a family that does not receive assistance for out-of-pocket costs is $11,601, HealthPocket said.

"These are not inexpensive investments," Coleman said.

http://www.cnbc.com/2015/11/02/obamacare-prices-increase-for-those-who-dont-get-subsidies.html

If you have a >$11K deductible on top of increased monthly premiums, what is the point of having the insurance at all? Remember, you can't be denied coverage based on a pre-existing condition. To a good number of people it is much better just to save the money instead of throwing it away on an overpriced plan. If catastrophe strikes, well, then get a plan. Don't play the sucker before that, though. Of course, if too many people realize this, the ACA will crumble under its own weight.

 

[untermensche]

But they can. The bench plank of the ACA is that those who could afford private insurance before are forced to subsidize everyone else by paying higher premiums and deductibles now. Enough healthy must pay into the risk poor to support the unhealthy; otherwise, the risk pool collapses. Yet, one the reasons the ACA plans are so expenses - with ridiculous deductibles - is due to the government mandating you buy insurance you don't want and will never use. Say, a single adult male paying for maternity leave and pediatric dental. To argue that the ACA is not responsibility for the explosion of deductibles and costs is very misinformed. Take this example:

A 40-year-old bronze plan customer who paid an average of almost $261 per month in 2015 is now looking at an average price of nearly $290 per month.

And bronze plans have, as a rule, the highest deductibles, which people must personally pay before their plan covers their medical expenses. The 2016 average deductible for a family that does not receive assistance for out-of-pocket costs is $11,601, HealthPocket said.

"These are not inexpensive investments," Coleman said.

http://www.cnbc.com/2015/11/02/obamacare-prices-increase-for-those-who-dont-get-subsidies.html

If you have a >$11K deductible on top of increased monthly premiums, what is the point of having the insurance at all? Remember, you can't be denied coverage based on a pre-existing condition. To a good number of people it is much better just to save the money instead of throwing it away on an overpriced plan. If catastrophe strikes, well, then get a plan. Don't play the sucker before that, though. Of course, if too many people realize this, the ACA will crumble under its own weight.

The corporate plans have been getting more expensive and proving less for a long time.

The ACA didn't stop that.

That is all.

But it is good to see some have come on board and understand how the corporate system provides less for more money.

 

[laughing dog]

Let me get this straight. Insurance companies wanted the ACA and now they don't? Maybe the problem was listening to the insurance companies.

 

[Loren Pechtel]

What fun building the welfare state, no?

http://www.forbes.com/sites/theapot...ining-plummeting-obamacare-enrollment-part-i/

I had a thought here: This proves nothing. To show a change you need both the estimate and the margin of error of the estimate.

Among other things the estimates of the uninsurable population before the ACA were 10-15 million. That says there's a fair amount of inaccuracy--that same level of inaccuracy in the numbers behind the estimates would leave this shift in the range of simply improving the data as time goes on and not contradicting the original estimate at all.

 

[Loren Pechtel]

But they can. The bench plank of the ACA is that those who could afford private insurance before are forced to subsidize everyone else by paying higher premiums and deductibles now. Enough healthy must pay into the risk poor to support the unhealthy; otherwise, the risk pool collapses. Yet, one the reasons the ACA plans are so expenses - with ridiculous deductibles - is due to the government mandating you buy insurance you don't want and will never use. Say, a single adult male paying for maternity leave and pediatric dental. To argue that the ACA is not responsibility for the explosion of deductibles and costs is very misinformed. Take this example:

A 40-year-old bronze plan customer who paid an average of almost $261 per month in 2015 is now looking at an average price of nearly $290 per month.

And bronze plans have, as a rule, the highest deductibles, which people must personally pay before their plan covers their medical expenses. The 2016 average deductible for a family that does not receive assistance for out-of-pocket costs is $11,601, HealthPocket said.

"These are not inexpensive investments," Coleman said.

http://www.cnbc.com/2015/11/02/obamacare-prices-increase-for-those-who-dont-get-subsidies.html

If you have a >$11K deductible on top of increased monthly premiums, what is the point of having the insurance at all? Remember, you can't be denied coverage based on a pre-existing condition. To a good number of people it is much better just to save the money instead of throwing it away on an overpriced plan. If catastrophe strikes, well, then get a plan. Don't play the sucker before that, though. Of course, if too many people realize this, the ACA will crumble under its own weight.

Saying the deductible is $11k is a deliberate attempt to make things look worse than they are.

$11k seems reasonable for the family deductible of a bronze plan--but note that the individual deductible will be half that. It's unlikely that two people in the family will run up high medical bills.

As for catastrophe striking--that's why the limited sign-up windows. Unless your timing is just right you're not going to be able to do that and even if you can you'll still be facing whatever initial bills. For a young, healthy person those initial bills are likely most of the total bill.

 

[maxparrish]

So, it seems that the exchanges are not getting the many young and/or healthy folks they thought would obey under threat of a fine. (What's wrong with our citizens, do they need to be flogged by government overseers for their own good? )

But it also seems they projected far too many unsubsidized enrollees.

The really generous subsidies are for those who earn less than 200% of FPL who select the silver plan (most non subsidized higher earners feel they can only afford bronze plans).

Both out-of-pocket payments and premiums are mostly paid by other consumers and taxpayers. And because the cost-sharing subsidy drops in major steps, the silver plan coverage is much more attractive for people earning just below 200% of the FPL than for people earning just above 200% of the FPL (i.e. the perverse incentive is that its better to earn less, up to a point).

Naturally, folks who have others pay for most of their plans find ACA worth their contribution. Hence, last March the data shows that for the 37 states using federal exchanges, 70 percent had incomes below 200 percent and just 2 percent had incomes above 400 percent. Most recently, in September, HHS showed that 84% of the 9.9 million people enrolled in exchange plans throughout the country as of June 30 were receiving advance premium tax credits.

The complete failure to account for actual distribution is exemplified in one of many similar estimates:

In theory, this should create adverse selection and could induce a death spiral, especially after the reinsurance and risk corridor programs expire after 2015. But even as ACA co-ops continue to collapse and premiums escalate, rest assured Congress or the Administration will (regardless of legalities) keep it on subsidized life support.

There is nothing so permanent as a government program that sends out checks of other people's money (ask the many generations of farmers from the 1930s to 2015).

 

[T.G.G. Moogly]

If catastrophe strikes, well, then get a plan.

Where? Without the ACA you'd be denied coverage for the very conditions you now need coverage for.

 

[dismal]

I don't see how the ACA can survive the next administration, Democrat or Republican. It was truly horrible legislation, which with its higher deductibles and higher premiums makes health insurance completely worthless for the private payer. Gruber's "stupid" Americans may still champion the monstrosity, but to the rest of us this abscess needs to be popped.

The number of people signing up says it's not worthless.

It's a lot more expensive than insurance through work because you don't have the premium subsidy from your employer.

It was never going to be a challenge to get people with preexisting conditions to sign up, or people for whom it was heavily subsidized/free. Where this seems to be failing is in getting much of anyone else.

The idea that obamacare is a success because people took free stuff is setting the bar incredibly low. The question is whether the billions that have been spent and the time spent due to the disruptions this law caused have produced enough meaningfully better health outcomes to justify it.

 

[dismal]

If catastrophe strikes, well, then get a plan.

Where? Without the ACA you'd be denied coverage for the very conditions you now need coverage for.

I believe he's talking about why you would not buy insurance with this law in place. It creates a strong incentive not to buy.

Not a surprise either as this was widely discussed among the sane and math-capable years ago.

 

[Kusa]

I can't wait til Trump eviscerates obamacare.