Insurance companies trying to get even LOWER actuarial values for ACA exchanges approved

[eridani]

http://waysandmeans.house.gov/uploadedfiles/durham_testimony_final_hl912.pdf

Recognizing that these ACA provisions will have a major impact on the cost of coverage, we believe that the important goals of the EHB package can be met if HHS and the states place a high priority on offering affordable coverage options to consumers. In addition, consideration should be given to lowering the minimum actuarial value for coverage sold in the exchanges to ensure the availability of affordable coverage options and to allow smoother transitions to the new benefits packages.

Comment by Don McCanne of PNHP: As the Affordable Care Act was being drafted, many of us in the policy community were very disappointed with the decision to include in the state insurance exchanges low actuarial value plans, as low as 60 percent (the plan pays 60 percent of covered costs and the patient pays the other 40 percent plus 100 percent of all services and products not covered). Even with the subsidies, the financial barriers to care will be too great for many patients. Now AHIP - the all-powerful health insurance lobby organization - is asking Congress to lower even further the minimum required benefits and the actuarial values of the plans.

The reason is obvious. They explicitly state that "affordability should be the cornerstone of consideration," but they are not referring to affordability of health care, rather they are referring to the affordability of their own private health insurance plans. They want their premiums to be low enough for middle-income Americans to be able to purchase their plans. They remain silent on the fact that reducing minimum benefits and reducing actuarial values of the plans will shift large portions of the costs to those who need care. (Again, the cost sharing subsidies are not adequate for covered benefits, and the patient is responsible for 100 percent of the costs of excluded benefits which would increase with this proposal.)

The private insurance industry got virtually everything that they asked for when the bill was written. Now they are coming along with a pitch that appeals to members of both sides of the aisle - we should make insurance affordable by allowing individuals to "buy only the insurance you need." For people who are healthy on December 31, 2013, can they really feel secure with a low actuarial value, minimal benefit plan that begins on January 1, 2014, when they have absolutely no idea what health problems they may face throughout 2014 and into the future? Of course not, though the high premiums of plans with adequate coverage may serve as enough of a deterrent that they would want to or may even have to take the risk that they will remain healthy throughout the year - a safe bet for the insurers but a big gamble for the patient. With time, it becomes even more treacherous for individuals to bet that they will remain healthy forever.

It is particularly appalling when they say that the principle reason for the Affordable Care act was to enable people to purchase health insurance. Some of us thought that the principle reason should have been to remove financial barriers to essential health care for everyone.

Really, haven't we had enough of Congress and the Obama administration supporting the private insurance industry? How about demanding support for America's patients instead? Throw out the insurers and enact an improved Medicare for all. We just might have to throw out the politicians to get there.

My comment: And here I thought that 60% actuarial value was pretty shitty. No wonder medical bankruptcies in MA have not dropped very much. How in fucking hell is anyone supposed to know what "only the insurance you need" will be?

[Angry Dragon]

1. Universal health care

[Kolesar]

2. Does this refer to plans with high annual deductibles?

I cannot translate the industry jargon:

low actuarial value plans, as low as 60 percent (the plan pays 60 percent of covered costs and the patient pays the other 40 percent plus 100 percent of all services and products not covered).

[eridani]

5. High deductibles are a separate issue. Actuarial value comes into play--

--when the deductible is spent and coverage begins. Then you still have to pony up 40% of whatever amount that is.

[Kolesar]

6. Ok. I will have to watch out for this story

I try to keep up with the ACA stories, but coverage in the press is not very good. Even the AARP misses a lot.

[bornskeptic]

11. Deductibles are a major factor in figuring actuarial value of a plan.

Calculating actuarial value takes into account the size of seductibles, copayments, coinsurance, and any limit on out of pocket expenditures. There are many quite different ways a 50% actuarial value plan could be structured. It could have a low deductible with high coinsurance and copays, or it could have a high deductible with all expenses beyond the deductible covered. Even if plans with a lower actuarial value were allowed, though, the maximum out of pocket cost would still be set at the same level, which is about $6000 annually, except that that is reduced somewhat for people in lower income brackets. For young healthy piople with good incomes, a policy with a lower actuarial value may make economic sense. The advantage to insurance companies of having such policies included is not that they make more money on a low actuarial value plan, which they don't, but that it would lead to fwer people efusing to buy conforming insurance, and thus to more policies being sold.

[eridani]

12. Low actuarial value only makes sense if you know for sure that you will never

--get seriously sick. The whole concept is vile, because it is based on the premise that trying to get into a risk pool of healthier people and leave the actual care of the sick to the government is a good thing. Do you want to privatize your fire department because you are sure that your house will never catch fire--even though statistically that's the way to bet?

"Economic sense" in your terms implies that profiting making guesses about illness and health is a good thing.

[Recursion]

8. "Actuarial value" is what has to replace a lifetime cap now

So, they can't say "we'll only spend $X on you" anymore. Which means they have to do actuarial work and try to figure out "averaged out over the population, this is what we will spend if we cover treatments X, Y, and Z for everyone".

They are, of course, trying to make that value as low as possible, and between them and the states and the feds they'll come up with something. That's how the act works. It's ugly, but it seems to work for Switzerland.

[kenny blankenship]

10. In Switzerland insurance companies have to offer basic plans AT NO PROFIT

Whoever told you that Abominablecare was based on the Swiss system was LYING (yes, even if his name rhymes with Krugman).

[Recursion]

13. Not exactly, but I understand where you get that idea

Like ACA, Switzerland caps administrative costs for basic health care plans (and caps it somewhat lower than ACA; hopefully we'll move in that direction).

[B Calm]

3. Since they are not willing to play fair,

hopefully the newly elected democratic congress will pass medicare for all!

[JDPriestly]

4. We need single payer. If the insurance companies cannot provide good coverage

at affordable prices, then let the government try.

The insurance companies cannot argue that private companies can provide the best care if they then admit that, no, they can't provide decent care at the kinds of affordable prices for which Europeans on single payer systems get care.

The myth of the superiority of the private economy is swiftly crumbling when it comes to healthcare.

[area51]

7. Kick for this life or death matter.

We don't need the GingrichCare of mandated, unregulated, for-profit insurance that is still too expensive, only pays parts of medical bills, denies claims, bankrupts and kills people.

Mandated, loosely regulated, for-profit insurance is unconstitutional.

We need single payer health care, not a welfare bailout for the serial-killer insurance agencies.

"Employer-based health insurance has always been a bad idea. Your life should not depend on who you work for." -- T. McKeon

[font face="times"]"Any proposal that sticks with our current dependence on for-profit private insurers ... will not be sustainable. And the new law will not get us to universal coverage ...." -- T.R. Reid, The Healing of America[/font]

"Despite the present hyperbole by its supporters, this latest effort will end up as just another failed reform effort littering the landscape of the last century." --John Geyman, M.D., Hijacked! The Road to Single Payer in the Aftermath of Stolen Health Care Reform

[kenny blankenship]

9. Obamacare=SHIT Insurance that will double in premium costs every 7.3 yrs.

[Zalatix]

14. Remember, I warned ya, I told ya so. (And so did several others on here.)