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Veteran Advisor

Re: Why the exemptions to those who supported the law?

I believe you will find that this is exactly what part of the bill is addressing.  "...insurance to be sold over state lines, insurance pools and groups to be formed."  On other fronts.   Don't expect these guys to offer any solution other than "get the govt out of my life!!!"  I really wish there was a way to do just that!!  I'm sick of hearing them bitch and moan about it day in and day out!!

Veteran Advisor

Re: Why the exemptions to those who supported the law?

You're not really advocating a system that leads to cheating on taxes, etc are you?

Senior Contributor

Re: Why the exemptions to those who supported the law?

Hey Husker,

 

I appreciate the thoughtful, non-critical reply. You are a thinking man rather than a knee-jerk reactionary. Opinions are fine with me!

 

That said, I am not sure if you or many people on this site (being primarily farmers) are part of any insurance group such as a typical Blue Cross/Blue Shield point of service (POS). These type of insurers typically work within "networks" of providers. Although I am not 100% sure, I believe the networks consist of health care providers and hospitals that are willing to work within the insurer's parameters for payment, services, etc. For instance, the insured will pay a $25 co-pay for a physician visit, a $35 co-pay for a specialist and a $100 co-pay for an emergency room visit for providers within the network. In turn, the providers in the network agree to accept the insurance companies pre-set payments for particular services, tests and office visits as well as certain procedures, etc. If the insured chooses to go outside the network for non-emergencies, they will pay more co-pay. The insurers probably determine this "network" based primarily on acceptance of the agreed payment although there may be other factors. It has been my experience that almost all providers will fall within the network with some exceptions, but I am not sure what those could be because I have never ran across any that are non-network.

 

All this is leading up to the fact that with such insurance collectives, the price is not a matter of concern. No matter what the provider in the network charges, they will only be paid so much by the insurance company, period. They either accept the terms, or they can not be in the network. Therefore, there is no need for shopping around since expenses are never out of pocket or cash unless you personally require something very different than standard medical care. Therefore there are no two standards...cash or insurance price.

 

That said, some thighs are not covered typically such as dental care or eye care. Some do, some don't, but if they don't insure these things, the shopping around would certainly make sense.

 

What conservatives have labeled "Obamacare" seeks to build networks that cross state lines and can build larger pools of insurer/insured matches in the way I have described above.

 

I would imagine that there could be for instance networks created for young, healthy people. This would probably be a high deductible, but low premium pool. Since these people rarely require medical care, they would likely save money by paying a low premium. If their deductions for care never rise above their premium expenses, they save money.

 

On the converse side, there is the lump all people together idea. If you lump the people who do not generally have claims with the people that are sure to have claims, the cost for all average out to be lower. This would not be for everyone, but it is one idea.

 

The bottom line is that many plans with many different levels of deductible, co-pay and premiums will be available if network services are allowed to happen. Insurers will be able to pick and choose their clients and the insured will be able to pick and choose providers according to their needs. The rub is that everyone will have to be insured under "Obamacare."

 

Like i said, I am not happy with what has been proposed and I feel that if all parties get together, something that benefits people, insurance companies and providers can happen.

Advisor

Re: Why the exemptions to those who supported the law?

"I would imagine that there could be for instance networks created for young, healthy people. This would probably be a high deductible, but low premium pool. Since these people rarely require medical care, they would likely save money by paying a low premium. If their deductions for care never rise above their premium expenses, they save money." Already completely possible, but it runs contrary to cutting the cost to high premium groups. As I've pointed out before unless you lump the low risk group in with the high risk you're not going to cut the cost of the high risk group. Here is another idea for your authoritarian plans, require plans have a sliding deductible as you progress into higher risk categories your deductible grows. This would reduce premium burdens on older people while still keeping more of the costs in that wealthier group.
Senior Contributor

Re: Why the exemptions to those who supported the law?

"Here is another idea for your authoritarian plans" - Not plans, just a mix of reality, legislation and ideas. It's called discussion. You sound a little "authoritian" yourself there when you keep ringing that bell, Sam.

 

This will be up to the insurance companies unless there is some provision that they will not be able to sell particular plans or that each plan must include all that want to be insured, young to old. Enlighten me on that if you will (that sounds pretty non-authoritian asking you for information BTW). Can the insurance companies make multiple plans for different groups? Can they deny certain groups? We know they will not be able to keep someone out for -re-existing conditions. Is there more? This will be the game of the insurance companies otherwise. Your sliding scale idea might just be what the insurance companies come up with, but don't forget the insured will be able to shop around.

Senior Advisor

Re: Why the exemptions to those who supported the law?


@KNAPPer wrote:

"Here is another idea for your authoritarian plans" - Not plans, just a mix of reality, legislation and ideas. It's called discussion. You sound a little "authoritian" yourself there when you keep ringing that bell, Sam.

 

This will be up to the insurance companies unless there is some provision that they will not be able to sell particular plans or that each plan must include all that want to be insured, young to old. Enlighten me on that if you will (that sounds pretty non-authoritian asking you for information BTW). Can the insurance companies make multiple plans for different groups? Can they deny certain groups? We know they will not be able to keep someone out for -re-existing conditions. Is there more? This will be the game of the insurance companies otherwise. Your sliding scale idea might just be what the insurance companies come up with, but don't forget the insured will be able to shop around.


This happens now, it is called smokers rates and non smoker rates. Should a non smoker be forced to pay for some one elses bad habit?

 

Senior Contributor

Re: Why the exemptions to those who supported the law?

No, 3020. Can you point to something in the legislation that says otherwise? If not and you are required to pay for smokers too, that would be called the free market and you can blame the capitalist insurance companies seeking to even their profits by mixing risk pools.

Senior Advisor

Re: Why the exemptions to those who supported the law?

Why do you think we have the exemptions? Some businesses and insurance companies do not have to provide the same coverage as others. Some insurance companies have to cover smokers while others do not, who do you think will charge the highest premiums and who do you think will be forced out of business? The marxist system at work.

Senior Advisor

Re: It could be as simple

As existing labor contracts that they do not wish to reopen for negotiations until the contracts expire.

Senior Contributor

Re: Why the exemptions to those who supported the law?

Though you did not answer my question 3020, I have found the answer - "Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don't meet those thresholds will be required to provide rebates to their policyholders."

 

So, if an insurance company wants to put together a group of non-smoking, non-drinking, young, healthy policy holders, they should be able to do that provided that 80% of premium dollars are spent on medical services. In this case, it means low premiums since there is little risk in the pool.

 

As far as the exemptions go. Can you tell me their premium to dollars spent on medical services ratio? Is it 85% or close to it?

 

I don't think smokers will be left out in the dark, they will just be lumped in with others with low risk to achieve the 85% model. Pre-existing conditions can no longer be a factor. If you are somehow mixing up life insurance and health insurance, those things are apples and oranges.

 

Here is an easy to read summary of the health care bill. http://www.whitehouse.gov/blog/2010/03/23/whats-health-care-bill

 

 

Good luck and have a blessed Memorial Day. Thanks for making me look into this deeper than I had before.