Health Insurance & why you need to take serious time to understand it

[TexasHusker]

For the marketplace to viable and competitive, the entire map should be dark green. Even though that map is a year old, it underscores the problem: Much of the U.S. has two or fewer insurers, many has just one. There is no good outcome in that scenario.

[disneysteve]

That map isn't too surprising. Areas that are yellow are largely areas that are very underserved medically overall, though I'm a bit surprised by that patch in central Florida.

[disneysteve]

What happens in the places with no carriers? How do people there get insurance?

[james.hendrickson]

For the marketplace to viable and competitive, the entire map should be dark green. Even though that map is a year old, it underscores the problem: Much of the U.S. has two or fewer insurers, many has just one. There is no good outcome in that scenario.

Texas - its entirely possible the consolidation of healthcare providers is due to capitalism, not necessarily statist policies. When we have policy discussions about this we should be careful not to reflexively blame all problems on socialism or capitalism. The truth may be somewhere in between.

[TexasHusker]

Texas - its entirely possible the consolidation of healthcare providers is due to capitalism, not necessarily statist policies. When we have policy discussions about this we should be careful not to reflexively blame all problems on socialism or capitalism. The truth may be somewhere in between.

Are you meaning consolidation of healthcare insurers? Yes, there has been some of that, but at least a dozen insurers scuttled their entire health insurance offerings when Obamacare went into law.

Imagine if the government suddenly passed "The Affordable Car Act": "Because we are sick and tired of folks having to pay $90K for a Range Rover that only gets 20 mpg and it's socially irresponsible to keep allowing that. By the year 2020, all cars must have four doors, a V6 engine, 10 speakers with a subwoofer, lane diversion sensory, 10 air bags, a sunroof, and it must deliver 35 miles per gallon in town."

"Furthermore, it is unlawful for a consumer to buy anything but the Affordable Car when his car goes kaput. We know what kind of car he needs, so we are going to mandate it."

How many car makers would hang in? How many makes and models would there be? What would happen to the prices when there were only 1, 2, or 3 carmakers left? What if I want a car that costs half as much, but only has 4 cylinders, no sunroof, and a cheap radio? "Sorry, that's against the law."

This is Obamacare. It has nothing to do with mergers and acquisitions, and everything to do with insurers exiting the market because the rules are untenable. Go back and look at the laundry list of insurers that were writing health policies 10 years ago. Most are gone.

[james.hendrickson]

Are you meaning consolidation of healthcare insurers? Yes, there has been some of that, but at least a dozen insurers scuttled their entire health insurance offerings when Obamacare went into law.

Imagine if the government suddenly passed "The Affordable Car Act": "Because we are sick and tired of folks having to pay $90K for a Range Rover that only gets 20 mpg and it's socially irresponsible to keep allowing that. By the year 2020, all cars must have four doors, a V6 engine, 10 speakers with a subwoofer, lane diversion sensory, 10 air bags, a sunroof, and it must deliver 35 miles per gallon in town."

"Furthermore, it is unlawful for a consumer to buy anything but the Affordable Car when his car goes kaput."

How many car makers would hang in? How many makes and models would there be? What would happen to the prices when there were only 1, 2, or 3 carmakers left?

This is Obamacare. It has nothing to do with mergers and acquisitions, and everything to do with insurers exiting the market because the rules are untenable.

Your analogy is basically correct TH, and healthcare industry consolidation was a challenge before Obamacare went into effect.

My major concern with these kinds of debates is usually there is a kneejerk default to a particular ideological perspective (e.g. capitalism is evil...socialism is slavery), when the truth is often more nuanced.

[disneysteve]

Imagine if the government suddenly passed "The Affordable Car Act": "Because we are sick and tired of folks having to pay $90K for a Range Rover that only gets 20 mpg and it's socially irresponsible to keep allowing that. By the year 2020, all cars must have four doors, a V6 engine, 10 speakers with a subwoofer, lane diversion sensory, 10 air bags, a sunroof, and it must deliver 35 miles per gallon in town."

"Furthermore, it is unlawful for a consumer to buy anything but the Affordable Car when his car goes kaput."

The government has already done a lot of that, though. A great many features of today's cars are mandated - seatbelts, airbags, inside trunk handle, tire pressure monitor, stability control, etc. You can not buy a car in this country without those features even if you don't personally care about them or want to pay for them.

[TexasHusker]

That map isn't too surprising. Areas that are yellow are largely areas that are very underserved medically overall, though I'm a bit surprised by that patch in central Florida.

Huh? You mean underserved areas like OKC, Tulsa, Omaha, Salt Lake, Denver, Memphis, Nashville, Lexington, Louisville, Raleigh Durham, Des Moines, Phoenix, and Tucson?

[TexasHusker]

Your analogy is basically correct TH, and healthcare industry consolidation was a challenge before Obamacare went into effect.

My major concern with these kinds of debates is usually there is a kneejerk default to a particular ideological perspective (e.g. capitalism is evil...socialism is slavery), when the truth is often more nuanced.

Obamacare wasn't crafted to address healthcare industry consolidation.

[disneysteve]

Huh? You mean underserved areas like OKC, Tulsa, Omaha, Salt Lake, Denver, Memphis, Nashville, Lexington, Louisville, Raleigh Durham, Des Moines, Phoenix, and Tucson?

I’m not exactly sure how many of those are underserved but I bet a lot are, or at least pockets of them. Bigger city does not mean it can’t also be underserved. There is probably also some correlation with income levels.

[disneysteve]

What happens in the places with no carriers? How do people there get insurance?

Can anyone answer this question? I'm really curious about that. Are these people unable to get medical insurance or is there some sort of high risk pool they are forced into through the state?

[disneysteve]

What happens in the places with no carriers? How do people there get insurance?

I looked this up.

This refers to the state health exchanges, not to insurance in general. The problem is the federal subsidies can only be used to purchase coverage from the exchanges. You can still go out and buy individual coverage the way my partner and I did at our office. The issue is that the zero carrier thing is mainly in rural poor communities so those people probably can't afford to buy their own coverage without the federal assistance. Some states are stepping up to help in various ways to keep affordable coverage available even if the exchange is no longer an option.

[jacklpalmer]

To add to the confusion...isn't the individual mandate no longer being enforced?

It's still enforced for 2018. The Executive Order that was signed by Donald Trump won't take effect until 2019 - assuming it takes effect at all. If you don't have have meet the requirements for coverage for 2018, you'll get penalized on your 2018 tax returns.

So which plan did you choose, Obummercare Bronze, Silver, or Gold?

I bet the good doctor went all out and took the GOLD!

I wouldn't be too sure. I have a few medical practices and doctors in my book of business - most of them opt for lower-cost health plans unless they have a medical concern that would warrant expensive medical costs. Doctors tend to be pretty smart, dude.

If you are an individual, you are breaking the law to buy anything except Obummercare. Obummercare makes it appear that there are multiple plans - HMO, PPO, etc., but they all fall into three categories, and whatever extra benefits you choose correlates directly with the premium quote. All insurers MUST offer the same benefit plan. So Blue Cross's gold plan is the same as Aetna's gold plan, because Obama said so. So the choices are in reality very, very few.

The only individual plans that are legal exceptions are religious-affiliated plans, such as Medi-share, which have become a cottage industry.

That's not entirely accurate. You can continue to have a grandfathered plan and still meet the requirements of the ACA. You just can't enroll into a new grandfathered plan, though. Most Health Care Sharing allow you to be exempt from the individual mandate through membership.

I looked this up.

This refers to the state health exchanges, not to insurance in general. The problem is the federal subsidies can only be used to purchase coverage from the exchanges. You can still go out and buy individual coverage the way my partner and I did at our office. The issue is that the zero carrier thing is mainly in rural poor communities so those people probably can't afford to buy their own coverage without the federal assistance. Some states are stepping up to help in various ways to keep affordable coverage available even if the exchange is no longer an option.

Yes - it's referring to the number of carriers participating in the exchange. For example, in California there's a number of carriers that sell on the individual market but refuse to participate in the state healthcare exchange ("Covered California.") Such as Sutter Health Plus as an example. It's not a lack of insurance carriers that is the problem, but carriers withdrawing from the exchange because of illedged losses.

[TexasHusker]

I wouldn't be too sure. I have a few medical practices and doctors in my book of business - most of them opt for lower-cost health plans unless they have a medical concern that would warrant expensive medical costs. Doctors tend to be pretty smart, dude.

I was being facetious.

[Smallsteps]

The cause really is much more likely that it was a training issue.

I was not going to post again on this thread and just agree to disagree , but something hilarious happened.
My daughter called me because her insurance ( is now managed by AETNA) denied her child's claim and during her call to them, the agent wanted to argue about who is PRIMARY insurance between two parents.
Not wanting to realize they are primary using the SAME insurance rule they had argued with me about when she was 12.
So this "Training ISSUE " has now spanned over a DECADE.

Jacklpalmer, Are you sure it is a training issue? Maybe the same hack is still training customer service agents or better yet they have not updated their Training manual.