Well sure if you are going to force it on everyone. Depending on income and health many youth will opt for the penalty. Imagine if SS was voluntary these days. Almost the same premise, you gotta have the young's money or it wont come close to working.

10/2/2013 3:53:40 PM

taking the penalty for not having health insurance would be very dumb in the majority of cases

the individual mandate was invented by republicans as the free market solution to the free rider problem you are describing

[Edited on October 2, 2013 at 4:09 PM. Reason : .]

10/2/2013 4:05:32 PM

Quote :

"premiums should come down in the long run. "

I don't think they will, there's no incentive for them to. The biggest problem with the ACA is that it is largely the worst of both worlds. Individuals are now required by law to purchase insurance regardless of the actual cost of that insurance and for a certain subset of people who can't afford it (or who are arguably the most price sensitive) that purchase may be subsidized, diluting some of that price sensitivity. On the flip side of this, because everyone now has insurance, there is no need for providers (or the insurance companies for that matter) to care about the costs of the actual care, just what the insurance company will pay. And the insurance payment model already encourages inflation of medical costs because it's a lot like federal "use it or lose it" budgeting. It should now get even worse because there's no "cash only" customers anymore. So who's going to push for lower premiums? Obviously the people will cry out for them, but the people don't have a choice, they either pay or they get fined. The providers don't care. Maybe the government would push for it, but it's not like the insurance market is getting bigger, so the government won't have much choice either.

I would really like to be wrong, believe me I would, but like I said way back at the beginning of this debate, we either need to go all private or all socialized, but this continued half and half shit is just going to continue to make things a mess.

[Edited on October 2, 2013 at 4:17 PM. Reason : who]

10/2/2013 4:14:35 PM

it ads pay for performance requirements and makes the market more transparent for everyone, not just those receiving subsidies

i hate the ACA, but it will make it easier for consumers to purchase, compare, and switch insurance providers which should help premiums. it also spreads the risk which should reduce premiums in the long run.

10/2/2013 4:18:16 PM

Sure the pay for performance will be good in theory, but I'm less confident about how it works in practice. Don't get me wrong, little silos of care has been a problem for a long time;our great state has separate medicaid budgets for prescriptions and hospital visits, as a result, the prescription side would forgo an expensive medication that looks bad on their balance sheet even though without that medication, it is far more likely the patient will be in the hospital with a much larger cost and worse health outcome. My concern is whether the performance requirements encourage more ass covering and unnecessary zebra hunting when a horse is sufficient 90% of the time.

I don't see how this makes the market any more transparent than it was before. There's a website now where you can compare insurance quotes side by side? Great, those existed before. How much will setting your broken leg cost? How much will your hip surgery costs? I can walk into my dog's vet and get a quote good for 30 days for any procedure, down to the last penny (though perhaps with the caveat that if X happens, you will need to pay for Y). On the other hand, you would be lucky to get anything even close to that for anything short of perhaps a physical from your PCP, they'll all say "it depends on what your insurance company will pay for", and I don't see how the ACA changes that. Serious question is there some "pricing sheet" transparency thing in the ACA that requires providers to give real quotes now?

As for making it easier to switch, I don't see it. At least not for the majority of Americans. It probably will for those eligible for subsidies, but for the rest of America who has one family member eligible for company provided care at less than 9.5% of the household income, at best, it keeps everything the same as it was before since their employer care is still the best option paid with tax advantaged dollars. Never mind the hiking of the medical costs tax deduction threshold.

10/2/2013 4:46:34 PM

Quote :

"I don't see how this makes the market any more transparent than it was before. There's a website now where you can compare insurance quotes side by side? Great, those existed before."

you're being purposefully obtuse if you don't think that picking coverage based on what color metal it is is easier than trying to compare confusing policies for the average consumer.

10/2/2013 4:50:22 PM

Quote :

"the individual mandate was invented by republicans as the free market solution to the free rider problem you are describing"

Are you using this as an argument for ACA? From where I'm sitting, it's looking like Democrats got duped into supporting something that establishment Republicans have been pushing for a long time.

Quote :

"you're being purposefully obtuse if you don't think that picking coverage based on what color metal it is is easier than trying to compare confusing policies for the average consumer."

The average consumer is pretty damn stupid, so that's not saying a lot. The fact is that dividing plans into bronze/silver/gold/platinum doesn't give an accurate representation of which plan is best for that individual. The premium might be less with Bronze, but maybe you don't need a lot of coverage, so it's actually the best choice.

[Edited on October 2, 2013 at 5:40 PM. Reason : ]

10/2/2013 5:38:31 PM

Quote :

"it's looking like Democrats got duped into supporting something that establishment Republicans have been pushing for a long time."

That's pretty much what happened.

The democrats wanted the public option as a choice, but this was removed to placate the republicans early on.

We basically have the plan Newt Gingrirch himself once argued for under Clinton, written by insurance companies i'm sure.

Quote :

"you would be lucky to get anything even close to that for anything short of perhaps a physical from your PCP, they'll all say "it depends on what your insurance company will pay for""

This will most likely never change, unless we had a single-payer system.

Although it's possible you'd see more of this under ACA, since hospitals at least know they will be getting SOMETHING for everyone who comes in, rather than having to guess on if their next case is for charity or not.

[Edited on October 2, 2013 at 5:51 PM. Reason : ]

10/2/2013 5:48:27 PM

Disney World offers full-time jobs to 427 part-timers, so they qualify for health benefits

http://www.orlandosentinel.com/business/os-disney-health-care-part-time-workers-20131002,0,7412492.story

Walt Disney Co. is offering full-time positions to 427 part-time employees at Walt Disney World who worked enough hours in the past year to qualify for health benefits under the federal Affordable Care Act.

They seem to be the exception, but i just noticed the exchange has a place for small businesses to find coverage options for employees too.

10/2/2013 6:24:31 PM

Quote :

" Are you using this as an argument for ACA? From where I'm sitting, it's looking like Democrats got duped into supporting something that establishment Republicans have been pushing for a long time. "

Yes, I made an entire thread about how ACA is bullshit republican corporatist privatization garbage that's fundamentally not that different than our existing system as an argument for ACA.

I don't like or support ACA and never have. But I don't think its going to destroy america or let the Nazis win so I like making fun of people who do. Also, most people have no idea wtf it is.

10/2/2013 6:59:46 PM

Quote :

"But insurance isn't where the costs of healthcare come from. "

EHHHHHHHHHHHHHHH!!!! 100% incorrect. Insurance is the primary driver of healthcare costs. You just failed Economics 101

10/2/2013 8:01:02 PM

Has anyone that lives in NC and has employer subsidized insurance gotten their new rate options? I'm concerned about what's going to pop up.

If you have, what kind of increase / decrease are you seeing? Is your previous plan still offered?

10/3/2013 11:43:32 AM

our rates are not changing at all because of this, in fact our rates are guaranteed for 3 years

10/3/2013 11:50:25 AM

Quote :

"EHHHHHHHHHHHHHHH!!!! 100% incorrect. Insurance is the primary driver of healthcare costs. You just failed Economics 101"

lol @ anyone who believes this

10/3/2013 12:02:55 PM

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/02/obamacares-biggest-problem-right-now-isnt-glitches-its-traffic/

Quote :

"The White House says that most of the delays have been a product of overwhelming traffic. The main Web site for the federal marketplace, HealthCare.Gov, has tallied more than 4.7 million visits in the first 24 hours of open enrollment. Some of the Web developers I've spoken with who have walked me through some of the back-end error messages on the site generally agree that system overload is the big problem for those trying to sign up right now. "My opinion is that its probably 99 percent capacity right now and not glitches," Dan Katz, vice president for technology at contracting firm Inadev, and a former lead web developer at CareFirst BlueCross BlueShield. "Typically when you're doing capacity you're basing models on previous usage data. For the health insurance exchange, that doesn't exist.""

Blizzard, a company who's been running online games for over a decade, including the largest MMO in history, couldn't keep Diablo III running for a solid month after release. And they have plenty of experience and usage data, as well as some of the best developers and network engineers in the world. This shit isn't easy.

10/3/2013 1:25:34 PM

yeah but that was cause blizzard purposefully built capacity for standard usage instead of peak usage (which is im sure what they also did w/ healthcare.gov).

in blizzards case they did it cause there was no reason for them to spend the extra money when they could wait it out

in healthcare.gov's case they probably thought people wouldn't all slam it at once. which tbh would probably have been the case if the shutdown coverage hadn't reminded everyone about it non-stop. once people start giving up it will be fine and they'll just go in and do it later. really they should just have the high load page say "you have XXX days to get this done, so its fine if you come back later. "

10/3/2013 1:59:18 PM

Quote :

"Has anyone that lives in NC and has employer subsidized insurance gotten their new rate options? I'm concerned about what's going to pop up. If you have, what kind of increase / decrease are you seeing? Is your previous plan still offered?"

I just got that info today, and it's not good news. Company's total healthcare costs are going up $147 million this year, mostly from ACA related government costs. Everyone's premiums are going up 8-12% while at the same time copays and deductibles are getting more expensive as well. It's the worst change I've seen in my 5 years with this company.

10/4/2013 12:32:51 PM

Yes, but think of all the people you're helping!

10/4/2013 12:40:36 PM

My HDHP plan is the same price as last year.

[Edited on October 4, 2013 at 12:46 PM. Reason : anecdotal evidence!]

10/4/2013 12:45:28 PM

I mean, that sucks, but it's an exception not the rule. Employer health care costs have risen the past couple years, by ~4%, which is historically quite low. This year they are expected go up around 4.8%, which is still less than the 7% historical average. Overall, insurance premiums and health care costs in general have grown, but slower than usual since Obamacare was passed.

I will say, the employer mandate is probably the worst piece of policy in the entire law and needs to be either reworked or entirely revoked. For one, it only affects a tiny percentage of people in the first place, ~1% of US workers. Something like 95% of large employers already offer their full time employees health insurance. It also incentivises cutting hours, which has been the most publicized negative effect of the law. The added costs of reporting for companies, and the regulatory costs for the government just isn't worth the relatively small potential social benefits.

10/4/2013 12:52:13 PM

Quote :

"My HDHP plan is the same price as last year. [Edited on October 4, 2013 at 12:46 PM. Reason : anecdotal evidence!]"

I'm not saying everyone will be affected like my company. Just answering Wadhead's question.

10/4/2013 1:23:51 PM

more evidence:
A Staunch Republican Tries Obamacare ... And Discovers That It's Actually Pretty Awesome

Quote :

"Matthews' old Blue Cross plan cost $1,069 a month and had a $10,000 deductible. The plan he just bought on the Arkansas state exchange has a $0 premium (after the government subsidy he gets because of his low income level) and only a $750 deductible. It's also a "Silver" plan, which has much better benefits than the vastly more expensive "Bronze" plan he ditched. Mukherjee asked Matthews whether he had any advice for fellow Republicans now that he has learned that Obamacare actually isn't that bad. Here's what he had to say: “I would tell them to learn more about it before they start talking bad about it,” he noted. “Be more informed, get more information, take your time and study and not just go by just what you hear on one side or the other. Actually check the facts on it.” “I still am a very strong Republican, but this… I’m so happy that this came along,” he continued. “Our home is paid for, vehicle’s paid for, this is our expense that we have. We have more expense on medical care than everything else put together, so this is going to be a great help for us.” So maybe Republicans can learn to love Obamacare? Maybe sooner rather than later? So we can get our government open again? Read more: http://www.businessinsider.com/republican-likes-obamacare-2013-10#ixzz2gmCYWzt7"

its not surprising that a conservative loves the conservative ACA

10/4/2013 1:45:35 PM

Quote :

"I will say, the employer mandate is probably the worst piece of policy in the entire law and needs to be either reworked or entirely revoked. For one, it only affects a tiny percentage of people in the first place, ~1% of US workers. Something like 95% of large employers already offer their full time employees health insurance. It also incentivises cutting hours, which has been the most publicized negative effect of the law. The added costs of reporting for companies, and the regulatory costs for the government just isn't worth the relatively small potential social benefits. "

I agree, but i think the 1% is misleading.

It's not "full-time workers" that are affected, it's workers of 30+ hours. There's probably a lot of nuance here between students or youth working 30+ hours that are still under their parents, and adults working 30+ hours that are just being exploited by their employers.



It would be interesting to see what the stats are on changes in costs for people who buy there own.

And then there's this, from Fox News Opinion column:
http://www.foxnews.com/opinion/2013/09/30/five-reasons-americans-already-love-obamacare-plus-one-reason-why-theyre-gonna/

and this:
http://www.buzzfeed.com/andrewkaczynski/fox-news-reporter-rebukes-bill-oreillys-obamacare-criticism
"Fox News’ chief Washington correspondent James Rosen delivered a strong rebuke to Bill O’Reilly’s criticism that Obamacare wasn’t working, saying, “that’s not clear, Bill.” Rosen then launched a defense of the program saying historically it takes time to see if things work."

10/4/2013 2:18:07 PM

Quote :

"lol @ anyone who believes this"

I know. It's crazy to actually believe that what is happening is actually what is happening! You're looking at one link in a chain of cause and effect, ignoring all the others before it, and declaring "This one is the problem!" Yes, the cost at the provider is going up, but there are other things causing that, chief among them the insistence that we use the insurance model to pay for every last thing at the provider. To look at the provider and say "your greed is making everything so much more expensive!" is to ignore the fact that the providers aren't substantially pocketing any more money than they otherwise have. The economic mechanisms by which insurance is driving up costs at the provider are easily explainable by even the most casual student of economics and, well, by common sense.

Quote :

"its not surprising that a conservative loves the conservative ACA someone likes not paying anything for something"

10/4/2013 11:35:34 PM

Quote :

"I mean, that sucks, but it's an exception not the rule."

what the hell news are you reading? almost EVERYONE is pay at least double in healthcare because of obamacare (or maybe 30 percent more)

10/5/2013 1:11:54 PM

have you idiots not thought that maybe multiple parties are involved in the cost of healthcare, the two largest being medical providers and insurance companies?

10/5/2013 1:14:23 PM

why do you think it's the providers, though? They are being forced to raise costs due to insurance companies and medicare. Would you rather they kept their "prices" the same and just went out of business?

10/5/2013 9:20:06 PM

Quote :

"They are being forced to raise costs due to insurance companies and medicare. "

lol. where the hell did you get this from?

10/5/2013 9:46:03 PM

basic Common sense? When the overwhelming majority of your customers are getting a "discount", you have to increase your prices to make up for it.

10/5/2013 10:07:22 PM

In soviet russiaobamaland government forces you to buy a product as a condition of just being alive.

(no, doesn't fit the meme really but it is applicable.)

10/6/2013 12:28:15 AM

This seems perfect for insurance companies. I can think of no other corporate product where the populace is forced to buy it. Seems like a perfect business model for them.

My question is, are there any provisions in this bill that will keep the insurance companies from charging whatever they want? I realize that the markets and their competition are supposed to bring the price of premiums down, but what if they all decide to price fix? Yes that is illegal, but it happens.

10/6/2013 8:46:46 AM

I would hope someone would realize if they were price fixing.

10/6/2013 9:38:30 AM

The exchanges are the free market solution, Republicans invented these healthcare exchanges because the free market will create competition and keep prices down. Do you not trust the GOP and the free market? Are you some kind of godless Communist?!

10/6/2013 10:16:41 AM

I was asking what I thought to be a straightforward question, not expecting any of your sarcasm. Are there any mechanisms in the bill, that anybody knows of, that prevents insurance companies from setting whatever rates they like, other than being "the free market."

10/6/2013 10:26:06 AM

Well the theory would be by reducing barriers to entry into the market if a company was over charging a new company would come in at a lower cost.

10/6/2013 11:08:58 AM

Quote :

" Are there any mechanisms in the bill, that anybody knows of, that prevents insurance companies from setting whatever rates they like, other than being "the free market.""

What are you, a Democrat?

10/6/2013 11:41:54 AM

http://reason.com/archives/2013/10/04/obamacare-chad-henderson-father

Nice.

10/6/2013 12:18:14 PM

There are caps on much premiums can increase annually.

10/6/2013 1:53:38 PM

o wait I thought nobody wanted obamacare: http://thinkprogress.org/health/2013/10/04/2732141/uninsured-nevadans-obamacare/

10/6/2013 3:55:25 PM

I'm pretty sure everyone wanted something better than what we had. Regretfully, what we're getting isn't better, just different.

10/6/2013 4:23:11 PM

^^Harry Reid's state, if anyone is wondering why his balls suddenly grew three sizes during this shutdown fiasco. His constituency has his back.

10/6/2013 6:07:09 PM

^^^^ are you ok with making the majority of those that already had insurance pay 100-200% more than they were previously paying because this bill forces insurance companies to offer coverage to everyone? That includes those that they will lose a significant amount of money on due to pre-existing conditions that are extremely expensive to take care of. That is the reality of what ACA does.

10/6/2013 7:00:33 PM

Quote :

" the majority of those that already had insurance pay 100-200% more than they were previously paying"

do you have any evidence or proof of this claim?

because i suspect it's bullshit.

10/6/2013 7:12:33 PM

Would it be better if I changed it to "many?"

Anecdotal from everything I have seen, but the majority of people I have talked to so far that already had insurance in NC, are experiencing significant premium increases with increased deductible requirements.

Is there any part of ACA that leads you to believe people with insurance already would see comparable rates to what they had prior to ACA enactment?

10/6/2013 7:18:55 PM

Quote :

" Anecdotal"

lol, k.

10/6/2013 7:26:58 PM

^^ its probably true when your sample is all of your 20- and 30-something healthy friends

10/6/2013 7:30:53 PM

^^ So what d you expect to ACA to do to insurance premiums for the majority of people that already had insurance?

10/6/2013 7:46:48 PM

^ It's irrelevant what I "expect" if I don't have any actual facts or proofs or studies to back it up.

It doesn't make sense to spread FUD based on anecdotes, or without any context.

There's been several articles posted in this very thread of peoples' premiums going down, but premiums aren't the only important factor.

10/6/2013 8:29:45 PM

^^ the prediction was that insured healthy people in their 20's and 30's would see their premiums increase, more so for men than women

10/7/2013 7:22:33 AM

If you're buying insurance through the NC exchange, do you have any other options besides BCBS?

10/7/2013 11:00:17 AM