I’m starting to think she is proposing that we allow ACA coverage to be fully underwritten. And then, secondary to that, create transfer payments from group plans to individual plans, to offset ACA premiums being higher.
Maybe I’m still not getting it.
I’m willing to spread them across, I don’t know, 350 million people.
Do we need an ACA thread set up too? Aren’t there already a couple to choose from?
I’m referring to the fact that people in the individual market are sicker than those in the group market and insurers are not permitted to use premiums from the group market to subsidize* the premiums for those in the individual market. Only people in the individual market can do that. It got so bad in Iowa that every single insurer pulled out of the individual market because they couldn’t charge a high enough premium to cover the risk. You & I weren’t paying higher group rates to cover Member X in Iowa, only Iowans in the individual market were.
*Now the word subsidy is confusing here because it means different things in different contexts.
Let’s assume that group has claim costs of X per member, underwritten individuals have claims costs of 0.5X and individuals where underwriting is forbidden have claims costs of 1.5X. The insurer needs 20% to cover their expenses and turn a profit. Obviously this is hugely simplistic. Let’s also ignore inflation.
The premium for folks with group coverage will be 1.2X, pre-Obamacare the individual insurance would have been 0.6X, and post-Obamacare it’s 1.8X. And maybe on average an employer covers 75% of the premium meaning people in the group market are only seeing 0.3X coming out of their paychecks.
Now poor people in the individual market might get premium subsidies that reduce the amount that they pay. The insurer is both charging and getting 1.8X for each covered individual even though some individuals might be paying 1.2X or 0.6X or even $0. You and I are paying for that through our federal tax dollars, sure. So are people making actuary-level money who are in the individual market. That’s not what I’m talking about. Whether we’re in the individual or group market has no impact on that whatsoever.
What I’m talking about is that individuals making too much to qualify for a premium subsidy are paying 1.8X for insurance whereas you and I are only paying 1.2X. And those people are really feeling the pinch because they’re accustomed to paying 0.6X. And even the 0.6X felt like a lot to them because they see you & I “paying” 0.3X. Even if you account for the piece our employers cover though, our insurance is still a lot cheaper because the insurance company isn’t charging us in the group space for the extra sickness.
The federal government is charging all of us for the subsidies that go to the poor. Yes. Individuals are paying that too. But they expressly forbid the insurer from charging 1.5X to everyone. (Or since there’s more of us in the group market than the individual market they could probably get away with charging everyone 1.3X.) The insurer must charge you & me (plus our employers) 1.2X and they must charge the individual folks 1.8X.
It’s the 1.2X vs 1.8X that is unfair.
I personally believe this means that we should take what we get from the government. Certainly doesn’t mean we can’t vote to change the way the government works. Christians should certainly appreciate the government and the folks who aren’t on their side much more than many do though. I also think the patriotism exhibited by some is idol worship. The love of Trump is certainly idol worship by some.
It’s so-so for most insurance products, and horrendously bad for health insurance. Because there exist people like “person x”. So underwriting health insurance basically means no one can be meaningfully insured against the risk of developing an expensive condition.
This is why we should have universal health insurance. Like every other country that can afford it, and several that can’t.
Had to google “person X”. It’s a 17 year old with hemophilia that somehow costs a $million / month. Which is a lot, even for a hemophiliac.
If you want to complain a solution not able to handle that boy, try to ask yourself if what alternative is actually better, and whether that alternative is politically feasible.
I barely worked in health, really only in stop loss, but hemophilia was one of those conditioned that was just insanely expensive, always lasered (which for those who aren’t familiar, a laser puts a higher spec deductible on that person because their claims are known to be high. This sounds cruel, but has no impact on the participant, only their employer - although I’ve often wondered if this has resulted in any employees being fired for the cost).
Universal healthcare isn’t perfect but the current situation is an unsustainable mess. Unlike other types of insurance, everyone utilizes healthcare and society isn’t willing to completely turn their back on those who can’t afford medical care, including those who choose not to insure themselves even if they can afford it. We’re collectively on the hook anyway. Universal healthcare is a way to streamline that.
I have a PPO and still ended up with a $3k bill after insurance for an ER visit this summer. I could afford it but there’s a significant amount of our country’s population that couldn’t, so they go into debt, declare bankruptcy, or the hospital writes off charity care. There are insured people who don’t seek or proceed with recommended treatment because there’s still a huge price tag. I even paused seeking treatment but decided avoiding the small but real risk of death was worth it.
Catastrophic reinsurance that is spread beyond just the members of the particular state and group/individual market.
Obviously that wouldn’t be legal but the employer would have a motivation to seek out a legal reason.
This is the first I’ve heard the term “lasered”. Does the employer know which employee is lasered? Can you explain more about how that process works?
I’ve only worked on it from a reserving standpoint, not a pricing or MGU standpoint, so I really don’t know how much the employer knows.
A laser can be applied to covered lives with very high costs - cancer treatments, chronic conditions, etc. I believe the stop loss provider has a limited number of lasers they can apply, and my understanding is that the aggregate deductible does not get increased by the amounts of the lasers (but hitting the agg deductible is not as common as hitting the spec deductibles).
And some contracts can be negotiated with no lasers - but those will incur higher premiums, naturally.
I mean, given HIPAA, I can assume the employers cannot be told who has high costs, but I don’t know if they get told “a covered life has had a laser applied” or not. Many of these employers are large enough to self-insure but not large enough to absorb the entire risk, so if they know they have a covered life with a laser, I don’t know how difficult it would be to piece it together, especially if that person was taking medical leave or something. I know I share some health info with my employer, voluntarily. I probably shouldn’t.
when a member of a plan is lasered, the buyer (the HR team, possibly the risk management/treasury/finance team) is told there is a laser and may get the name of the member. someone at the company 100% knows “joe smith” is lasered and to what amount.
Another day another Trump Karen being ridiculously uncivil. Watch the video, it shows what we’re up against.
Whoa, whoe waoah, guys, You’re looking for the “Republicans say the darndest things!” thread.
It’s been 500 posts since this was that.