Post by Ephemeral on Oct 31, 2013 9:47:46 GMT -6
A few things to remember. You can make your own value judgments on whether these are positives or not.
The law requires a medical loss ratio for insurance companies. It's 80 percent now, and transitions to 85 percent soon. That means 80 cents of every dollar an insurance company takes in must be paid out in claims or it must rebate the overage to policy holders. That means for now, 20 cents on the dollar are for operations expenses and profit, and that moves to 15 cents. The reality is that for-profit insurers (not BCBS and the like) will struggle going forward.
The reasons why the costs are escalating is because of the removal of: a) pre-existing conditions; b) lifetime limits on coverage; c) expansion of dependent coverage to age 26; and d) and expansion of benefits. More people are being covered, but not necessarily a whole lot more people are paying. That doesn't take into account the subsidies, which is spread among the pool.
Some say the answer is to allow insurance companies to sell across state lines. I'm a Republican and a conservative, and I'll tell you that in reality it won't work. Out of state insurers can't effectively set up networks and operate profitably. The other issue is, apart from ACA, is that states have differing laws on mandated coverages -- autism, chiropractic services, prostate testing, diabetes, etc. If a state wants to go beyond ACA coverage and another doesn't, how do you reconcile? It goes back to the original issue, no insurance company wants to play by different set of rules. Georgia tried it, and no company would play in the market to provide additional choices.
Now for the sermon. We'll never get this under control because we don't have the discipline to make it work.
If we were serious, we would:
1. Kick the 22-26s off their parents coverage.
2. Mandate coverage for all adults.
3. Do it on the state level where networks are more easily established, more local supervision.
4. Strenuously Incentivize less use of health care/Strenuously disincentivize more use (higher deductibles, much higher co-pays, etc.)
5. More like catastrophic coverage, rather than a maintenance system.
6. Retain no pre-existing conditions from ACA.
So, Jet, you're saying there is no solution, because we don't have the will to do it? I have no problem with state by state reforms, but I suspect some states will do nothing (including Alabama) because the well served are in control. I know someone with a lien on her house (here in Montgomery) because she couldn't pay her hospital bill fast enough. She, being self-employed, thought she could not afford health insurance and then got seriously ill. She is a divorced mother of two.
I remember when I was little (I am older than most of you), I was the first to have health insurance in my family--through my public school at the cost of less than ten dollars for a year. We didn't go to the doctor often, and my parents wondered if that policy would be a waste of money. My, how times have changed!
When I came back to work for the state after a break in service, I tried to opt out of the individual state coverage because I was covered by my husband's health insurance. I was not allowed to do that; had to have it. We have not had to pay a cent for the out-patient surgery I had in Birmingham this summer. Quite a contrast from what happened to my friend, who had at the time of her illness had no insurance. She does now.
I think, if nothing else, the ACA has caused some serious discussion, and I thank the Pres for having the courage to take it on. I don't expect it will remain long in its current configuration. Something must be done about health care costs, however; small hospitals are closing in areas that really need to be served, and there are people who need healthcare that can't afford it.
