Obamacare failing?

[LivingAlmostLarge]

The dr office says it depends on the insurance and who reviews it. They can't even tell you how insurance works they have no idea themselves. How crazy is that? That people who work on it every day have no idea sometimes until they submit?

[Propheit]

obamacare holds the "low income housing" concept...Which is a notions adopted from states that provide life necessities at 0 cents on the dollar....but in return will incessantly subtract any capital gained that could possible better a persons quality of life...in other words...The more money you make annually, the more your obamacare health insurance take from you annually....

[bigdaddybus]

http://reason.com/blog/2017/02/14/irs-blow-to-obamacare-individual-mandate

Major Blow to Obamacare Mandate: IRS Won't Reject Tax Returns That Don't Answer Health Insurance Question

The tax agency has stopped requiring individual filers to indicate whether they maintained health coverage or paid the mandate penalty as required under the law
Peter Suderman|Feb. 14, 2017 9:44 pm


if this is true, the ACA is in big, big trouble

[bjl584]

I heard some commentary recently on the problems with the ACA.

One of the main aspects that is hugely popular is the pre existing conditions mandate. An insurer can't deny someone insurance based on pre existing medical conditions. While popular, the main problem is that lawmakers never considered how the Insurance companies were going to absorb the cost of this mandate.

[disneysteve]

One of the main aspects that is hugely popular is the pre existing conditions mandate. An insurer can't deny someone insurance based on pre existing medical conditions. While popular, the main problem is that lawmakers never considered how the Insurance companies were going to absorb the cost of this mandate.

This is one of the most critically important parts of the plan, though. If they reverse that, it will be devastating. I know many, many people who are terrified that they will become uninsurable if the pre-existing clause gets reinstated. Cancer survivors, cardiac patients, diabetics, etc., could all find themselves uninsurable if the companies are allowed to start denying coverage to people with pre-existing conditions.

[StormRichards]

I had a reply for this thread but it vanished when the site started having server errors.

[bjl584]

This is one of the most critically important parts of the plan, though. If they reverse that, it will be devastating. I know many, many people who are terrified that they will become uninsurable if the pre-existing clause gets reinstated. Cancer survivors, cardiac patients, diabetics, etc., could all find themselves uninsurable if the companies are allowed to start denying coverage to people with pre-existing conditions.

The trick is to keep the policy but find a way to pay for it. It was never considered when the law was crafted.

[cornfieldj]

Only screening tests, not done for any reason other than pure screening, count as preventative. So if you had a polyp before and they're doing a repeat test, that would be diagnostic. The same would be true for a woman who had a previous abnormal mammogram. The initial one would be a screening. The subsequent ones would be diagnostic.

The real problem is the issue of something starting out as screening and getting changed to diagnostic because something turned up. That shouldn't happen.

Yeah, it's like a sort of back-door pre-existing condition.

[disneysteve]

The trick is to keep the policy but find a way to pay for it. It was never considered when the law was crafted.

One way to pay for it is by charging people a higher premium based on their condition the same way life insurance policies do.

The hope with the ACA was that getting more people into the pool would help fund care for the sicker patients, which is typically how insurance works. The problem is so many people chose to opt out so they didn't have the premium dollars from the healthy low utilizers to help subsidize the care of the sicker high utilizers.

[bjl584]

One way to pay for it is by charging people a higher premium based on their condition the same way life insurance policies do.

The hope with the ACA was that getting more people into the pool would help fund care for the sicker patients, which is typically how insurance works. The problem is so many people chose to opt out so they didn't have the premium dollars from the healthy low utilizers to help subsidize the care of the sicker high utilizers.

The idea of opening up enrollment across state lines, and tearing down some of the regulations so networks can be built should be explored to see if it's a viable solution.

[disneysteve]

The idea of opening up enrollment across state lines, and tearing down some of the regulations so networks can be built should be explored to see if it's a viable solution.

I agree. The problem is the whole federal vs. state conflict. Insurance has always been a state issue. They would need to change that and make it a national thing, which it should be. I have many patients who struggle to get the best care in a convenient location because we are located about a mile from Philadelphia but my patients can't go there because their insurance doesn't cover them if they leave the state. Instead, they're stuck going somewhere 10 or 20 miles away because they have to stay in-state. It's a big barrier to care as many of them have transportation issues.

[TexasHusker]

One way to pay for it is by charging people a higher premium based on their condition the same way life insurance policies do.

That's called "medical underwriting". Underwriting (that is, the actuarial analysis and appropriate assignment of premium for the risk) is a key part of insurance.

Except Obamacare. Medical underwriting became illegal under ACA, which spelled doom for the whole thing.

Insurers are not interested in taking on risks that they cannot reasonably cover with premiums. Greedy bastards!

Somehow the most elementary of concepts often escapes the comprehension of elitist liberals.

Surprise, surprise.

[txex86]

Having young people purchase medical insurance would help lower the cost. The ACA shot themselves in the foot by allowing young adults to stay on their parent's policies until age 26. Before the ACA, you could keep your child(ren) on your medical insurance if they were in school. That made more sense and should be considered again when the ACA is repealed and replaced.

[disneysteve]

Having young people purchase medical insurance would help lower the cost.

True. The problem is that young healthy people are the ones most likely to forgo coverage. A 30-year-old who goes to the doctor once every couple of years maybe often sees no reason to spend all the money every month for insurance. It's cheaper to just take his chances and pay out of pocket if something happens.

That's part of why things aren't working. You need EVERYONE in the insurance pool for the shared risk model to work.

[txex86]

That's part of why things aren't working. You need EVERYONE in the insurance pool for the shared risk model to work.

Hence my comment that those young adults not in school should be on their own health plan, mandated by law for them to carry.