ACA is in trouble and could be on course for a death spiral

[hill2016]

Don't need the Republicans in the House to shut it down, this could sink all on its own weight.

http://www.wsj.com/articles/rising-rates-pose-challenge-to-health-law-1447894371
Rising Rates Pose Challenge to Health Law
Higher-cost premiums for 2016 threaten the appeal of the program for the healthy customers it needs

http://www.wsj.com/articles/health-laws-strains-show-1446423498
Health Insurers Struggle to Profit From ACA Plans
As third enrollment season kicks off, insurers move to curb costs, boost premiums

http://www.wsj.com/articles/unitedhealth-cuts-guidance-evaluating-its-insurance-exchange-segment-1447933310
UnitedHealth Raises Doubts About Its Participation in Affordable Care Act
Insurer cuts earnings outlook, citing losses from health-exchange products

http://www.wsj.com/articles/more-health-co-ops-face-collapse-1445034912
More Health Co-ops Face Collapse
Colorado’s co-op and one in Oregon are folding, joining six others; coalition considers legal action





If you recall, ACA forces the mainly young/healthy/male to subsidize the old/sick/female by banning insurance companies from charging different prices based on gender or pre-existing conditions. There's a limit to how much they can charge based on age. There are also 10 essential benefits which are expensive to cover and not everyone needs.

So given the dynamics of higher premiums, it's logical for the young/healthy/male to start thinking whether they really need to be covered and should just drop out.

Which raises the premiums for everyone else in the pool since they are by definition sicker. Kind of an adverse self selection going on.

And despite what you may think of greedy insurance companies, they haven't been profitable either due to higher than expected costs. And if the health insurance companies can't be profitable, they are going to drop out.

So on the one hand you have the healthy people dropping out and on the other hand more and more insurance companies are going to drop out. That's by definition a death spiral.



Note: I haven't taken any position on ACA vs single payer in this OP. I'm just laying out facts and an analysis. So let's stick to facts and avoid name-calling, if that's possible.

[FSogol]

1. Actually, you just repeated a bunch of pro-insurance company RW memes about the ACA like

There are also 10 essential benefits which are expensive to cover and not everyone needs.

and

And despite what you may think of greedy insurance companies, they haven't been profitable either due to higher than expected costs. And if the health insurance companies can't be profitable, they are going to drop out.

You also fail to understand how insurance works which you demonstrate with:

So on the one hand you have the healthy people dropping out and on the other hand more and more insurance companies are going to drop out. That's by definition a death spiral.

Unrec.

[hill2016]

3. did

you actually have any substantive points to contribute?

[FSogol]

5. Besides the Wall St Journal article you posted being nothing but bullshit?

No, I guess not. Thanks for asking.

[hill2016]

6. the thing about facts is

they don't matter what you think of them. Eventually they will show themselves.

Here are similar articles from the New York Times

http://www.nytimes.com/2015/10/12/us/insurance-dropouts-present-a-challenge-for-health-law.html?_r=0
Insurance Dropouts Present a Challenge for Health Law

http://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html
Many Say High Deductibles Make Their Health Law Insurance All but Useless

http://www.nytimes.com/2015/10/29/upshot/if-they-want-deals-obamacare-customers-will-need-to-switch-plans-again.html
Obamacare Shopping Is More Important Than Ever

http://www.nytimes.com/2015/08/15/us/most-health-insurance-co-ops-are-losing-money-federal-audit-finds.html
Most Health Insurance Co-ops Are Losing Money, Federal Audit Finds

http://www.nytimes.com/2015/10/26/business/health-care-co-op-closings-narrow-consumers-choices.html
Health Care Co-op Closings Narrow Consumers’ Choices

On UnitedHealth
http://www.reuters.com/article/2015/11/19/us-unitedhealth-grp-outlook-idUSKCN0T81E020151119
http://www.usnews.com/news/business/articles/2015/11/19/insurer-unitedhealth-cuts-forecast-due-to-overhaul-business

[FSogol]

11. Yes to some, 23 million more insured people is the worst thing in the world.

Those poor insurance companies. How will they survive?

[hill2016]

22. like I said

I'm not taking a position on the merits of ACA as public policy.

BTW, the poor insurance companies will exit the ACA market if they can't turn a profit. Which is what I referred to in my OP as part of the death spiral.

[jberryhill]

26. The required benefits are the same whether offered on the exchange or not

[hill2016]

32. not

for group plans.

[jberryhill]

33. Hobby Lobby begs to differ with you

[hill2016]

43. it's a different part of the law

http://obamacarefacts.com/obamacare-birth-control/
http://obamacarefacts.com/essential-health-benefits/


It's not under the 10 essential benefits.

[jberryhill]

47. If you are going to sell something and call it "health insurance"

Then it has to meet the required coverages.

[hill2016]

49. well

https://www.cms.gov/cciio/resources/files/downloads/ehb-faq-508.pdf

How would the intended EHB policy affect self-insured group health plans,
grandfathered group health plans, and the large group market health plans? How would
employers sponsoring such plans determine which benefits are EHB when they offer
coverage to employees residing in more than one State?

A: Under the Affordable Care Act, self-insured group health plans, large group
market health plans, and grandfathered health plans are not required to offer EHB.
However, the prohibition in PHS Act section 2711 on imposing annual and lifetime
dollar limits on EHB does apply to self-insured group health plans, large group
market health plans, and grandfathered group market health plans. These plans
are permitted to impose non-dollar limits, consistent with other guidance, on EHB
as long as they comply with other applicable statutory provisions. In addition, these
plans can continue to impose annual and lifetime dollar limits on benefits that do
not fall within the definition of EHB.

[zipplewrath]

40. Careful

You're conflating a lot of things all at once here.

1) Yes, SOME insurance companies were overly aggressive in their initial pricing in order to build market share. They are now seeing participation and reconsidering whether they want to continue to participate at all. It is very possible that this is just some normal "shake out" of a market. It's also possible it's just some posturing on their part to keep the government from resisting their premium increases.

2) Nonprofit co-ops, are having some troubles, mostly because they need up front funding to operate and they have a hard time getting that funding. The feds provided some funding early on but that is ending. (It's a cash flow thing). For profits, especially existing commercial entities, don't have this same fiscal problem. (they have plenty of cash on hand and access to credit markets).

3) They aren't getting the "not sick but buying insurance anyway" crowd they need. That was always going to be a problem and it was the weak spot in the ACA. It was also why the public option was so important despite what Obama was selling.

4) One of the biggest problems is that health CARE is way too expensive and that really hasn't changed significantly to change the basic problem. Health care is expensive and still grows at rates well in excess of inflation, not to mention in terms of real salary growth of the typical American worker.

[hill2016]

45. well

(1) According to the McKinsey study

http://healthcare.mckinsey.com/health-insurance-enrollment-and-revenue-shifts-2013-2014-emerging-story

2/3 of them lost money. Aggregate loss of -$2.5b. This is not sustainable.

(2) They were also underpricing their products as you mentioned in #1. Perhaps the death of the nonprofit co-opts shows that the big insurance companies are not making huge profits that new players could try to undercut?

(3) Yup and that's the death spiral which I referred to in the OP

(4) Agree completely.

[zipplewrath]

50. The co-op thing is about cash flow

The co-op thing is entirely about cash flow. Most of them didn't exist before this started. They had no money in the bank. They'd be making payments to the health care industry before they had collected more than a couple of months of premiums. They needed cash up front. Until they could build up some capital to absorb fluctuations in their costs, they were going to need help in the form of credit/loans. Nonprofit co-ops have trouble getting that kind of credit. The government helped them out the first couple of years, but that is ending and the GOP has no interest in continuing/renewing that.

And yes, 2/3 or so are "losing" money, but that is not unusual in new markets. Most of them charged premiums they knew they couldn't sustain. They just wanted to get their market share first. The real problem now is determining in the long term what they need to charge to cover their costs, including profit. No one knew for sure, and there was hope they'd do somewhat better on the "young and health" crowd. Maybe if we had a better employment picture, that would have happened. But we have a terrible employment problem with the "young and health" crowd, and they are overloaded with education debt. Of course this could have been moderated somewhat with a public option, but that wasn't important enough.

[hill2016]

55. so

(1) if the premiums charged are not sustainable
(2) at these premium levels the "young and health" crowd isn't participating,

how would the situation improve if the premiums increase?

[zipplewrath]

63. Depends upon how you define "improve"

The heightened premiums won't necessarily cause the system to collapse. The problem is whether or not those premiums will be "sustainable". The current values weren't some "upper limit". Almost the opposite, we knew going in they were artificially low.

That said I always asserted that one way or another that soon premiums would grow too high for even the middle/upper middle class and then the crisis would be on us. Until they get control of health CARE costs the system is ultimately unsustainable. We're probably still about 8 - 10 years away.

[Recursion]

86. But we can't even get Congress to get rid of the 20% doctor markup

For two decades now. I'm not convinced we'll ever do anything about provider proces.

[marmar]

16. Perhaps, but the ACA is pretty pro-insurance company on its own.

[FSogol]

17. Yes, it is terrible when the uninsured get insurance, or when kids can stay on their

parents insurance until they are 26, or that you can't be denied coverage because of pre-existing conditions.

[marmar]

18. And who said it was terrible?

[2naSalit]

79. I don't qualify for either

the subsidies or the actual plans because I either made too much this year or I can't afford ins. that costs 20% more/month than my other living expenses combined. And I got some pile of stuff in the mail telling me that because I won't agree to let the "system" approach my 88 yo mother for my premiums should I not be able to pay them or some shit. I don't see why they need to monitor all my personal bank accts and personal expenses and then have my permission to harass my mother if something doesn't match up. Sounds like a new way to extort money from the poor. And because I can't get any affordable care, there will be some exorbitant amount of my income tax refund taken away so I can be even more destitute this coming spring/summer. Just lovin' it y'all. From where I sit, the ACA looks like another giveaway to the medical industrial complex, always has. Until it's single payer, I can't afford to participate.

[ScreamingMeemie]

2. My premium is $50 cheaper a month this year.

It went up $100 last year. For this, anecdotal evidence is all I need.

[bigwillq]

7. Good for you.

I'm glad it helps people that need the help. Still don't love the ACA, but if it helps one person, then fine by me.
Mine went up again, but that was not entirely unexpected.

[ScreamingMeemie]

10. I don't love it either, but it is what we have. It's better than the $1400/month

high risk I was quoted before ACA.

[Maeve]

12. Mine will be cheaper next year than this

And I've seen a doctor for the first time in five years...both my husband and I now have our blood pressure under control....
Before, I couldn't afford the blood work needed for monitoring of a hormonal issue. But just because I have insurance, the cost is @$65 instead of @$680 (negotiated fees, not insurance payments, make the difference)

[City Lights]

19. Ours is going up $450/month.

The policy we had for the last 18 months is being cancelled 12/31 by BCBS. The replacement plan is not as good (but close as we can get) to the one they cancelled. We are looking into plans offered from other companies, and what we've found so far is that those that offer similar coverage are about the same price.

[JoePhilly]

4. My insurance went up $6 a month.

I'm doomed.

[meaculpa2011]

8. Mine went from $1,200 per month to...

$2,300 per month with higher co-pays and deductibles.

Family of four. All relatively healthy.

Thankfully, we can still afford coverage, but many fall into the category where they can't afford the premium and have incomes too high for any meaningful subsidy.

[SammyWinstonJack]

9. ...

[Recursion]

65. How are you being asked to pay more than 9.5% of your income? (nt)

[meaculpa2011]

83. The 9.56% rule is for employer...

sponsored plans, not the individual market.

As I said, our income makes us ineligible for a subsidy. We're lucky.

The threshold is so high that for many who are barely over the income limit it's a burden. Also, my increase came in three or four stages. In previous years it crept up gradually, but these last few years have been dramatic. I'll be eligible for Medicare soon, so that will be a relief.

[Recursion]

84. You're above 400% of the FPL?

Then, yeah, this is that wealth-sharing DU is so enthusiastic about.

[meaculpa2011]

85. Yeah. I think the number in New York...

is about $95,000 per year for a family of four.

With the cost of living here, $95,000 doesn't go as far as some may think. Our property taxes just went to $15,000 in a very nice, but very modest home in a working/middle class community. I make a good living, but I'd much rather put it away for my kids than give it to an insurance company.

At some point it just makes sense to pack up and move. I'm a freelancer so I can live anywhere with high-speed internet.

The kids can make new friends.

[Recursion]

87. The median household income in NYC is about $51K

Nobody has ever thought himself to be rich or asleep.

[meaculpa2011]

89. Believe me, I'm not crying...

We've done very well here. My income fluctuates wildly and in some years, post 911 and post crash, it has evaporated completely.

Thankfully, my wife manages our family finances and learned early on (I've been a freelancer since 1981) how to smooth out the peaks and valleys.

BTW: I just looked it up. Median household income in NYS is $57,000 statewide and $95,000 in Nassau County. So half of all Nassau residents are not eligible for ACA subsidies on individual plans. If you're at that median number, it's a burden.

[edhopper]

13. Murdock says what?

[Rex]

14. Congress could not kill it even after 50 tries! The $COTUS had to leave it be.

I don't think it is going anywhere anytime soon.

[Festivito]

15. 1. Rising rates, but, no mention of rebates. 2. Profits down, but, down to what? 3. ...

Co-op collapse, but, no mention of a less than 20% profit margin cushion, trying to price too low up front rather than returning the unused portion after the year is up -- aside from being able to return more than a 20% profit based corporation, a corporation that keeps the entire 20% all to itself.

It's all pay per view WSJ -- who has its RW audience to itself.

I see the disclaimer, but it reads like a RW hit piece.

[magical thyme]

20. Some facts & analysis from NBER & HHS, via Naked Capitalism

I've been one of the "above poverty" level who didn't or barely qualified for some subsidy, but could do the math and knew I'd end up in the red and would have nothing set aside for actual health care. So my plan has been, and remains, pay the penalty until it's the same or more than forced insurance. I also was burned big-time by a top health insurer, so trust them about far as I can spit. I also, as a health care worker, understand the difference between a health care insurer and a health care provider. And I know which one is synonymous with parasite.

http://www.nakedcapitalism.com/2015/10/obamacares-open-enrollment-period-to-begin-faces-challenge-of-selling-to-those-whove-done-the-math.html

Officials are eyeing about 10.5 million people who could buy coverage through HealthCare.gov or state sites, often with federal subsidies to offset premiums, but who have resisted signing up as the law rolled out.

From a June 2015 study outsourced to the Robert Wood Johnson Foundation:

Cost remains the main barrier to insurance. Those who have looked made a calculated decision based on more than just the premium. They also consider out-of-pocket expenses, deductibles, co-pays and other factors in their decision.


From NBER working paper number 21565,
[E]ven 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

“Most uninsured will lose and, according to our estimates, will prefer to remain uninsured at the current penalty levels for violating the individual mandate,” the report continues.

[pnwmom]

21. So why do you think young people would be willing to pay more in taxes

to support a single payer system that would be utilized more heavily by older people?

[hill2016]

24. I really think

this is a question to be posed to the young millennials who support Sanders' vision of single payer system.

[pnwmom]

25. I think most of them are assuming it wouldn't cost them much.

But it would cost them just as much, based on income, as it would for older people at the same income. Though they would be getting far less in financial payouts.

And unfortunately, there are as many young people supporting Rethugs as there are young people supporting Sanders.

[treestar]

56. This ^^^^^^^

Plus when they get older they would be glad to have paid into it earlier.

[Xithras]

61. Because a tax based system spreads the costs more widely.

Not only does it catch people like me who don't currently pay anything into the system (I have a 100% employer funded plan that costs me $0 per month), but it allows the government to apply other sources of tax revenue to the programs cost in order to bring down the cost carried by individual taxpayers. The current scheme makes insurance buyers carry the full cost of the system.

[Recursion]

66. Does it? Mitt Romney and Warren Buffet pay a lower tax rate than I do

And the places in the world with working universal health care systems finance them through tax systems much more regressive than ours, generally based on a VAT.

[davidpdx]

80. Yes, I think they would

I am not exactly young (44) nor a Millennial, but I pay for health insurance that subsidizes the elderly here in Korea. The rate is something like 6.07% and is paid 50/50 by the employer. For my wife and I, it costs about $200.

For that I can go into any clinic or hospital any time. My copays are very low on most things. The catch is it does not cover much as far as major medical tests (MRIs or CTs) and has minimal dental coverage (dental work is so much cheaper here anyway). Every other year you get a full free health examination. Is it perfect? No. It is a hell of a lot better than what the US has. That is why I hope the tide will turn enough that you guys (Americans) will have better coverage.

[pnwmom]

82. My son has an ACA plan and he's been very happy with it.

Even though he's young and therefore subsidizing older people. (He doesn't get a subsidy himself, either.)

But what I don't understand, if many young people are objecting to subsidizing older people through the ACA, why won't they also object to subsidizing older people on single-payer?

[davidpdx]

93. Honestly I can't answer that one

I believe many would say it is the right thing to do morally. The Republicans would say "die faster."

[pnwmom]

94. It IS the right thing to do.

But I think the same people who object to doing it under the ACA wouldn't be happy paying higher taxes to help support medical costs of older people.

[davidpdx]

95. One way to frame it for them is to ask them how they feel knowing they won't have

adequate healthcare when they are old. How about their parents? Certainly taxes are an issue, but it shouldn't be one that dooms having healthcare for all. Certainly other countries have pulled it off without massive tax increases as I've pointed out.

I will tell you that taxes are spread around, that not ALL of it is directly for health insurance. The individual rate I quoted before is what is paid monthly, but there are other taxes. When you buy a car or a house there is an acquisition tax, there is a yearly car tax (mine is about $350), and a flat VAT of 10%. I'm not saying I agree with all of those (I pay them as a foreigner whether I like it or not). The VAT is integrated (unlike in California and Washington where I have paid a sales tax when I visit) so you see the tax separate on the receipt, but the price of an item includes the tax. These taxes don't all go to pay for health insurance, but schools and other stuff as well.

[TampaAnimusVortex]

23. UnitedHealth warns it may exit Obamacare plans

http://www.usatoday.com/story/money/2015/11/19/unitedhealth-group-earnings-downgrade-obamacare-affordable-care-act/76040322/


Insurance giant UnitedHealth Group dealt a blow to the Affordable Care Act on Thursday when it warned that it may stop offering insurance plans to individuals through public exchanges established by the reform law.

In a surprise, UnitedHealth (UNH) downgraded its earnings forecast in a sign that ACA, commonly referred to as Obamacare, is taking a toll on the company’s bottom line.

People who purchase insurance through the public exchanges are typically heavy users of their plans, draining insurers' profits.

“The company is evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017,” UnitedHealth said in a statement.

The move comes amid indications that insurers are absorbing steeper costs than they expected from plans offered to individuals through the public exchanges, which are purchased online.

The average premium increase for medium-benefit plans offered to 40-year-old non-smokers is set to rise 10.1% in 2016, according to the Kaiser Family Foundation.

UnitedHealth warned investors that it would reap $425 million less in revenue during the fourth quarter than it had previously expected, translating into 26 cents in earnings per share, in losses attributed to a worse outlook for the quarter and all of 2016.

The company lowered its full-year 2015 earnings-per-share forecast to $6, and shares of UnitedHealth stock fell 4% to $112.65 in early trading.

S&P Capital IQ analyst Jeffrey Loo said in a research note that he was "a bit surprised" by the revelation because UnitedHealth had previously "indicated optimism" about the exchanges.

But UnitedHealth blamed “a continuing deterioration” in the financial prospects of health care plans provided to individuals who purchase insurance through exchanges established by Obamacare.

“In recent weeks, growth expectations for individual exchange participation have tempered industrywide, co-operatives have failed, and market data has signaled higher risks and more difficulties while our own claims experience has deteriorated, so we are taking this proactive step,” UnitedHealth CEO Stephen J. Hemsley said in a statement.

The Obama administration argued that the health care marketplace would stabilize after a period of changes in the early years following the law's implementation. An average of 10 insurers per state are offering plans for 2016, up from nine in 2015 and eight in 2014.

In its third year, the number of plans offered through the exchanges "continues to grow, giving millions of Americans access to quality affordable insurance," Ben Wakana, a spokesman for the U.S. Department of Health and Human Services, said in an emailed statement.

Even though UnitedHealth wasn’t a major player yet on the ACA exchanges, the fact it priced plans conservatively and entered cautiously made its statements more significant, said Katherine Hempstead, who heads the insurance coverage team at the Robert Wood Johnson Foundation.

“If they can’t make money on the exchanges, it seems it would be hard for anyone,” Hempstead said.

More than half of the 23 non-profit insurance co-ops established under the ACA are shuttering by the end of this year, but UnitedHealth is the largest single insurance carrier in the U.S. United’s comments about the health of exchange-plan holders also runs counter to what was expected. Experts including Hempstead assumed the sickest people would get insurance first and then the “risk pool” would improve as more healthy people bought plans.

While UnitedHealth’s statement is significant, Kaiser Family Foundation senior vice president Larry Levitt said it "matters more for what it says about what industry as a whole thinks about Obamacare."

"If they exited (the exchanges), it wouldn’t matter that much to the functioning of the ACA, but it would show why increasing enrollment is so important," Levitt said. "This market is not yet profitable for insurers but it could become profitable if enrollment grows."

The Obama Administration’s low predictions for 2016 enrollment may also have "spooked the insurance industry a bit," Levitt says. "More enrollees (means) more business for insurers and that more healthy people are coming into the market."

UnitedHealth executives told investors in a conference call that insurance holders who sign up after the open enrollment period are particularly expensive. Those patients, who are able to obtain coverage after a life event such as losing a job or having a child, have been among the most active users of the insurance plans.

Obamacare established a network of federal and state exchanges through which individuals who do not have insurance through their employer can obtain coverage — often with federal tax credits and subsidies.

[still_one]

30. Maybe if the CEO didn't take a 102 million dollar payout in 2010, they wouldn't have an issue

http://ctwatchdog.com/health/102-million-payout-to-united-healthcare-ceo-draws-outrage

I am sorry, but these folks are greedy pigs

[hill2016]

34. both statements can be true

the CEO is a greedy pig and they are not making money on ACA plans.

[still_one]

35. No, they have been badly managed even before the ACA. Wise and other rating agencies have rated

them at a C for a long time.

even with these "lower than forecast" earnings, they will still make 50 BILLIION dollars over the next 5 years

[hill2016]

37. so if they are badly managed before ACA

and they can't turn a profit on ACA that means they'll probably exit ACA?

[still_one]

38. they are turning a profit, it just isn't a large as was estimated, but it is still huge. Even if

exit, other providers will jump right in

[jberryhill]

48. They still need offsetting losses from other plans

They have to satisfy the medical loss ratio, which is why I got a pretty decent rebate check from my non-exchange plan.

[Recursion]

67. That's absurd; a bonus of 0.1% of market cap is not what causes their financial problems

It's fine to hate large bonuses for moral reasons, but they absolutely are just rounding errors in these companies' numbers.

[X_Digger]

75. Fuck UHC. They wait until the 89th day to pay things that are due on day 90.

When I had them, I had collection agencies calling because of medical debt that UHC was obligated to pay, but waited until the absolute last goddamned minute, so they could keep that $500 they owed gathering interest for as long as possible.

[still_one]

27. I am not sure if this is the way for the insurance companies to bargin or not, but I would pretty

much bet if anyone thinks we have a chance for Single Payer if the ACA goes down in flames, there is no way that could happen with the house republicans in control, and even if we take back the Senate in 2016 it won't be enough to get single payer. Maybe in 5 to 10 years, but even then it is doubtful.

If the ACA fails, we would either revert back to what was before, (nothing), or have something far worse. The problem is that as long as the model is based on profits someone will get burned.

[Agnosticsherbet]

28. At this point, what we need is a Congress that will act to fix problems in the ACA...

Which is what we have done in the past within our system.

No such Congress exists now, and will not exist for at least until 2018, and probably not until 2020 when we have a chance fix the problems caused when Democrats refused to vote in 2010 and gave Republicans the power in most states to redraw congressional districts. 2020. being a Presidential election, is friendlier ground for a party that does not like to show at the polls in when no President is on the ballot.

This is the same reason why Single Payer will not be enacted. It will be very difficult to do, and the one state that tried abandoned it before it could be instituted because a raise in taxes of 10% or more proved to be a third rail even Vermonters were not willing to touch.

[Todays_Illusion]

29. I don't think Rupert Murdoch's WSJ is a good source for the status of the ACA.

[taught_me_patience]

31. As the penalties ratchet up, more healthy people will join

Because taxes are done annually and they've been slow to ratchet up the penalties, it's taking longer for younger, healthier people to sign up. In the next couple of years, expect a lot more people to sign up as the penalties start being felt.

[hill2016]

36. penalties can be avoided easily

http://www.forbes.com/sites/mikepatton/2015/03/25/obamacare-exemptions-how-to-avoid-a-penalty/

[virginia mountainman]

76. Not really..

My family falls in the "makes too much" for any significant help, but the prices, and deductibles are in orbit, and are out of line.. Cant afford to pay for it, AND the deductible so screw it..

So my wife and I, went for over a year without insurance, and we adjusted our tax withholding, so that when tax day rolls around, we will owe a small amount...

If you don't have a refund to take, they get no penalty...

It's as if we are being punished for being middle class..

https://www.healthcare.gov/fees/fee-for-not-being-covered/

[Doctor_J]

39. the insurance & drug lobbies are NOT going to let ACA die

they hit the motherlode when it passed - guaranteed payments from every single american, forever. Need to keep it real, folks

Here are some headlines from a google search

United Health's Profits Better Than Expected

Health insurers watch profits soar as they dump small business customers (this was me - the deductibles, coinsurance, and copays went from $500/year to $8300/year for all of us)

Thanks, Obamacare! Health insurer stocks soar

Hospital Profits Soar As Obamacare Prescribes More Paying Patients

CVS Reaps Robust Profits In Health Care Upheaval

[magical thyme]

54. don't know what you googled, or when, but this is what simple "aca" yielded for news just now:

UnitedHealth considers ditching ACA's exchanges due to giant losses
ModernHealthcare.com-7 hours ago

UnitedHealth Group has lost $425 million from health plans sold on the Affordable Care Act's marketplaces, which forced the company to lower ...

Cramer: UnitedHealth news 'very damning' for ACA
CNBC-7 hours ago


UnitedHealth Raises Doubts About Its Participation in Affordable ...
Highly Cited-Wall Street Journal-9 hours ago


UnitedHealth Group says it is scaling back efforts in ACA exchanges
In-Depth-Washington Post-2 hours ago


UnitedHealth Cuts Guidance, Citing Affordable Care Act
Highly Cited-Morningstar.com-10 hours ago


UnitedHealth warns it may exit Obamacare plans
In-Depth-USA TODAY-8 hours ago

Note that the United Health CEO had expected good news a month or so ago when he said UH would expand. Now that the numbers are actually in, they're considering dropping out of the exchanges in 2017.

[Laura PourMeADrink]

41. We were told our non-ACA HMO premiums are rising 40% next year nt

[tabasco]

42. Thanks for your concern and

enjoy your stay.

[restorefreedom]

44. i know you didn't take a position on aca vs sp,

but i will. i think this situation is going to get worse, and shows that the only way forward is dumping the insurance companies altogether and doing medicare for all.

and yes, before anyone asks, i would be ok with a tiny tax increase to make that happen.

[ileus]

46. My DW attended a conference last month of Virginia FQHCs

and evidently the only thing of interest was the ACA and how it just wasn't working for most established patients.



By the time they find a plan that's affordable it's useless, then the meds they used to get for free half aren't covered, and the other half the co pays aren't affordable. She calls it good insurance if a building falls on you....LOL

I know from previous conversations we've had that she's personally called sales reps and asked to more free samples to give their patients that can't afford to pay.

[Purveyor]

51. Michigan has a decent expanded medicaid program that is

helping out a lot of people.

I'm strongly advising them to get everything 'fixed' that can be fixed before 2017 as it will most likely be scuttled shortly after the next government is seated.

[onenote]

52. I hear this all the time from ACA opponents, and it makes me wonder

if they're so certain that the inevitable collapse of the ACA is imminent, why do those same folks support the repeated, and doomed to failure, efforts to repeal the law. And even more to the point, why was there such gnashing of teeth amongst the ACA's opponents just last year when the ACA survived a Supreme Court challenge?

[madinmaryland]

53. The Wall Street Urinal is a Murdoch rag. They hate the ACA and slant their coverage of anything

Liberal.

[hill2016]

74. facts are facts

there are no liberal facts or conservative facts.

The answer to the question "what should we do?" though is liberal/conservative.

[treestar]

57. Mine went up 23%

for 2016, but the deductible is $200 and the co pays were cut in half (they had doubled before, back to what they were, only $5/$10

[magical thyme]

58. more facts: CMS determined to make full ACA fallback payments

The CMS released a memo (PDF) late Thursday that reiterated the federal agency's desire to pay out risk-corridor payments, even if there's a massive shortfall.

The notices came the same day that UnitedHealth Group, the nation's largest health insurer, said it was seriously considering pulling out of the Affordable Care Act's marketplaces. UnitedHealth's announcement shocked the healthcare industry and raised questions about the stability of the exchanges.

The memo states that if health insurers are still owed money under the risk corridors program for 2016, HHS “will explore other sources of funding for risk corridors payments, subject to the availability of appropriations. This includes working with Congress on the necessary funding for outstanding risk corridors payments.”

It's a similar message from October, when the CMS first announced it would only be paying out 12.6% of risk corridors requests for 2014 claims. The risk corridors program, one of the three health insurance risk program established by the ACA, essentially helps mitigate insurers' losses in the early years of the new insurance marketplaces.
http://www.modernhealthcare.com/article/20151119/NEWS/151119846/cms-determined-to-make-full-aca-fallback-payments

So is this a checks and balances battle? That is, the risk programs pay out as little as they could get away with, so insurance companies threaten to leave the exchanges to pressure the risk programs to find some $$ anyway/where they can to payout more? Capitalism at its best!

[hill2016]

59. it means

that if the insurance companies can't survive without these risk corridors, either (1) premiums go up or (2) they pull out.

[BootinUp]

60. I don't trust the Wall Street Journal on Politics nt

[hill2016]

68. this isn't politics

this is financial analysis, right up their alley.

[Warren DeMontague]

73. Financial analysis with a pretty clear set of political implications.

so again, they may have an agenda.

Got any other sources besides the Wall St. Journal, perchance?

[SoCalDem]

62. "...forces the mainly young/healthy/male to subsidize ..."..hahahahahaha

The first thing you wrote "took sides"..

it's I N S U R A N C E ..

That's the MAIN focus of insurance..

get LOTS of people who will NEVER have an accident to "prepay" any costs to the insurer when others DO have accidents..

get LOTS of younger folks to buy life insurance ("as an investment"..wink wink) so insurers have the cash on hand to pay out death benefits to older folks who somehow managed to keep up with the premiums all those years..

get LOTS of (as in everyone with a mortgage) to pay homeowners insurance even though MOST will NEVER make a claim. (or if they do, they will likely be denied) so that when SOMEONE'S house burns down, blows away, etc. there is money to pay the claim.

Insurance is just that simple.

[hill2016]

69. ok

so why have the personal mandate AKA tax penalty at all if you're not forcing people to buy in?

Why not let insurance companies run separate risk pools for "young healthy males"? The young healthy males would be perfectly happy to have such an option and so would the insurance companies.

[hill2016]

71. here's an article you might be interested in

http://www.forbes.com/sites/scottgottlieb/2014/03/28/how-much-does-obamacare-rip-off-generation-x-we-ran-the-numbers-here-are-the-results/

Obamacare is asking young adults to effectively subsidize the healthcare costs of older Americans. So far, Millennials are resisting this age-based transfer of wealth.

more articles
https://www.washingtonpost.com/news/wonk/wp/2014/01/13/one-in-four-obamacare-enrollees-are-young-adults-thats-below-the-target/

That's an important target to hit because more young adults in the exchanges would mean a more healthy population, whose premiums could help subsidize the health care of older and sicker enrollees.

http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/

For this system to work, young people need to enroll in sufficient numbers to produce a surplus in premium revenues that can be used to cross-subsidize the deficit created by the enrollment of older people

[WinkyDink]

64. "young/healthy/male to subsidize the old/sick/female". ARE THERE NO OLD/SICK/MEN????????????????????

What a load of bull.

[hill2016]

70. insurance

is a statistical game.

Overall young/healthy/male use much less medical care than old/sick/female.

[Warren DeMontague]

72. The WSJ was also the source of that absurd assertion that "Sanders' Plan will cost 17 Trillion"

Dare I suggest that they may not be a totally unbiased source.

[yourout]

77. If it dies it will be directly the result of not having a public option.

[cheapdate]

78. My premiums rose on average 7-1/2% per year, every year

for 15 consecutive years prior to the ACA. Meanwhile, coverage and deductibles got steadily worse. My rate increases have slowed noticeably over the past 3 years.

My premium today for a full family PPO plan is around $1,100 per month -- which is a very big hit for our household.

Health insurance sucks. I expect many people will forget that it has always sucked and imagine it sucks worse now. It generally doesn't.

[Contrary1]

81. This "old/sick/female" on social security is paying almost $900 a month

Bullshit.

[6000eliot]

88. Horseshit.

Pure, unadulterated horseshit.

[ecstatic]

90. "UnitedHealth's Warning Shows How Medicaid Is Taking Over Obamacare"

it’s the Medicaid managed care companies that are growing the number of plans they market on the exchanges. They are also offering the best prices. The cheap health plans that they end up selling on the exchanges mirror what they offer in Medicaid – in terms of the skinny doctor networks, the closed drug formularies, as well as the basic design of the austere health coverage.

In short order, Obamacare is evolving into a Medicaid marketplace. Not only in terms of the design and quality of the narrow-network plans that are being offered, but in the actual carriers that sell those policies.

http://www.forbes.com/sites/scottgottlieb/2015/11/19/uniteds-warning-shows-how-medicaid-is-taking-over-obamacare/

Isn't that moving things closer to single payer, and isn't that exactly what many people (at least on DU) wanted?

[GusBob]

92. Some of the Medicaid HMO's are horrible

In fact most. They are OK for "routine" things (is there such a thing in your health?)

But man, if you need a specialist, good frisking luck

[Omaha Steve]

91. Kick

Just found this and have to read more.

OS

[lindysalsagal]

96. "Health Insurers Struggle to Profit From ACA Plans" oh, boo hoo.

Which is why all civilized countries have made sickness and age a non-profit industry:

Let's stop trying to make money off of old and sick people!!!!!!


Can I hear a "DUH!!???"