Health Care Law Massacred in Supreme Court

[Dozyproductions]

I guess unions are good for something.

On the serious side. I have epilepsy that I was only diagnosed about 4 years ago. How do you guys suggest people with pre existing conditions to get coverage? I've asked around and it seems like I won't be able to afford living after paying for my healthcare with the rates that I'm getting. My serious go to right now is smoking marijuana in which studies show it lowers the chances of seizures.

[rwh11385]

And makes sense sleeve. I didn't know MN/WI were heavy rep'ed, although the rust belt certainly and even IA since ag equip.

A double-mandate tends to work this issue out. The small percentage of chronically ill patients are balanced with the large population of healthy ones.

But won't those chronically ill patients raise the cost of a healthy person's coverage? (You can't just look at one part of the equation) I've paid thousands of dollars for health insurance the last few years and have received non-vision or dental care ONCE, for a T-shot. If premiums go up because of those who cannot be charged more for a pre-existing condition, doesn't that mean my rates will skyrocket?

http://online.wsj.com/article/SB10001424052748703298004574455560453947646.html

[NY] The decline in the number of people enrolled in individual insurance plans, the authors say, is "attributable largely to a steep increase in premiums" because of the state's regulations.

In 1996, similar reforms in Washington state preceded massive premium spikes in the individual market. Some premiums increased as much as 78% in the first three years of the reforms—or 10 times medical inflation—according to a study presented at the annual meeting of the Association for Health Services Research in 1999. Other results included a 25% drop in enrollment in the individual market, and a reduction in services offered.

A 2008 analysis by Kaiser Permanente's Patricia Lynch published by Health Affairs noted that in addition to Washington and New York, the individual insurance markets in Kentucky, Maine, Massachusetts, New Hampshire, New Jersey and Vermont "deteriorated" after the enactment of guaranteed issue. Individual insurance became significantly more expensive and there was no significant decrease in the number of uninsured.

Supporters of federal health-care reform argue that the problems associated with these regulations can be addressed with the addition of an individual mandate, which is part of every ObamaCare bill in Congress. This would require every individual to purchase health insurance.

Guaranteed issue alone, the argument goes, results in slightly more expensive premiums, which drives healthier individuals out of the risk pool, which in turn further drives up premiums. The end result is that many healthy people opt out, leaving a small pool of sick individuals with very high premiums. An individual mandate, however, would spread those premium costs across a larger, healthier population, thus keeping premium costs down.

The experience of Massachusetts, which implemented an individual mandate in 2007, suggests otherwise. Health-insurance premiums in the Bay State have risen significantly faster than the national average, according to the Commonwealth Fund, a nonprofit health foundation. At an average of $13,788, the state's family plans are now the nation's most expensive. Meanwhile, insurance companies are planning additional double-digit hikes, "prompting many employers to reduce benefits and shift additional costs to workers

Meanwhile, survey data from the Massachusetts Medical Society indicate that the state's primary-care providers are being squeezed. Family doctors report taking fewer new patients and increases in wait time.

"Despite these state-level failures, President Barack Obama and congressional Democrats are pushing forward a slate of similar reforms. Unlike most high-school science fair participants, they seem unaware that the point of doing experiments is to identify what actually works. Instead, they've identified what doesn't—and decided to do it again"

[Vedubin01]

I guess unions are good for something.

On the serious side. I have epilepsy that I was only diagnosed about 4 years ago. How do you guys suggest people with pre existing conditions to get coverage? I've asked around and it seems like I won't be able to afford living after paying for my healthcare with the rates that I'm getting. My serious go to right now is smoking marijuana in which studies show it lowers the chances of seizures.

There is insurance though the state and private sector that will accept you with pre existing conditions. Or get on a group policy and they cant deny you.

[KenC]

But doesn't those chronically ill patients raise the cost of the healthy person's coverage? I've paid thousands of dollars for health insurance the last few years and have received non-vision or dental care ONCE, for a T-shot. If premiums go up because of those who cannot be charged more for a pre-existing condition, doesn't that mean my rates will skyrocket?

http://online.wsj.com/article/SB10001424052748703298004574455560453947646.html

And makes sense sleeve. I didn't know MN/WI were heavy rep'ed, although the rust belt certainly and even IA since ag equip.

When you have time, take a look at how Germany has their health care coverage system set up. Nationally, they have hundreds of competing insurance providers. They have a double-mandate that stipulates each citizen must purchase coverage, and similarly each provider must sell it to you. Nationally, there is a minimum coverage set that each carrier must provide.

Insurance is all about pooling risk. There's always going to be a mix of healthy and unhealthy people within each carrier.
Pre-existing conditions aren't what's driving insurance costs up. And the stipulation is just that you can't completely deny coverage, it doesn't mean that your premiums won't be higher than a young healthy individual, because they certainly will. Elderly pay more per month than I do. This is why it's important to have competing insurance providers that are forced to sell you insurance, and citizens that must purchase it. With so many choices and a double-mandate, it works itself out, and its a way to keep overall costs down because there aren't a boatload of unpaid ED bills that are paid for by higher premiums.
One could conceive of a health insurance provider that only covered healthy single males 18-34. Supposing that you could get a VERY large pool of individuals to subscribe, monthly premiums would probably be pretty low. Something like this does nothing to curtail the rising cost of care though. Many of them are bound to become ill or be seriously injured. Any unexpected major medical ailment will more than consume decades of premium payments by a single, healthy young male.

[KenC]

Or get on a group policy and they cant deny you.

That's what I was going to type next.

The VAST majority of the US receives their insurance via a group policy through their employer. The existing-condition coverage denial really only applies to a SMALL sliver of the populace.

[mrsleeve]

^

yes those that buy their insurance on the open market as an individual. We are dealing with this very thing with the little woman right now. Since she has a minor hormonal condition it makes it impossible for us to buy her coverage on the open market, so we have to go though the state "group" plan (even though its a private company BC/BS) its great coverage if you can afford it, lucky we can (even when I couldnt I still found a way to make sure she had something). Even though she has had coverage though Cobra for as long as we could buy it for her, its considered NON qualifying coverage for anything she has been treated for in the last decade. So there for the pre-existing condition exclusionary rules apply for the next year.


As to kids under 26 and not covered but are now still on their parents plan. FUCK them, you have to make choices in your life, and having decent H C I is one of those things you have to make choice with. I went out when I was 18 I was kicked off my parents plans. Not willing to live with out decent coverage, and the fact that living with out HCI was something that was not acceptable in my family. I went out and found a job that had good coverage and worked my ass off to keep it even though it didnt pay the greatest on actually bankable income. Its called personal responsibility and you are considered an adult at 18 and want to be treated like one, then go get your own health care dont make me and the rest of us that have been responsible and taken care of our selves pay for it with increases in our premiums

[KenC]

I guess unions are good for something.

On the serious side. I have epilepsy that I was only diagnosed about 4 years ago. How do you guys suggest people with pre existing conditions to get coverage? I've asked around and it seems like I won't be able to afford living after paying for my healthcare with the rates that I'm getting. My serious go to right now is smoking marijuana in which studies show it lowers the chances of seizures.

Are you not on a group plan through your employer?

I think people are confusing two separate issues as they pertain to individuals with pre-existing conditions. The Affordable Care Act stipulates that coverage cannot be denied based upon pre-existing conditions, not that premium payments should be equal to those of healthy individuals.
Premium payments for ill or high-risk patients always will be, and have to be, higher than those of young healthy individuals.
Requiring the aforementioned healthy, young individuals to purchase coverage is one way to decrease the cost of insurance overall.



PS marijuana is a terrible medicine

[rwh11385]

When you have time, take a look at how Germany has their health care coverage system set up. Nationally, they have hundreds of competing insurance providers. They have a double-mandate that stipulates each citizen must purchase coverage, and similarly each provider must sell it to you. Nationally, there is a minimum coverage set that each carrier must provide.

Insurance is all about pooling risk. There's always going to be a mix of healthy and unhealthy people within each carrier.
Pre-existing conditions aren't what's driving insurance costs up. And the stipulation is just that you can't completely deny coverage, it doesn't mean that your premiums won't be higher than a young healthy individual, because they certainly will. Elderly pay more per month than I do. This is why it's important to have competing insurance providers that are forced to sell you insurance, and citizens that must purchase it. With so many choices and a double-mandate, it works itself out, and its a way to keep overall costs down because there aren't a boatload of unpaid ED bills that are paid for by higher premiums.
One could conceive of a health insurance provider that only covered healthy single males 18-34. Supposing that you could get a VERY large pool of individuals to subscribe, monthly premiums would probably be pretty low. Something like this does nothing to curtail the rising cost of care though. Many of them are bound to become ill or be seriously injured. Any unexpected major medical ailment will more than consume decades of premium payments by a single, healthy young male.

Wouldn't a provider removing healthy single males 18-34 from the larger pool increase costs to those not healthy?

How are obese people who have diabetes and eat at McDonalds going to afford their coverage? Especially if their costs aren't on the backs of others? And if they are uninsured now, how is a "penalty" going to motivate them to pay more to get insured if they are not being treated now?

In Germany's case, sounds like competition is key... which liberals seem to equalize to profit-hungry companies who only see dollar signs...

In any case, regardless if everyone is insured in many different groups, or one big group, if we don't have costs savings, innovation, of efficiency improvements... it's not going to make care fundamentally cheaper. (That's the real problem)

If I am in this super cheap young male health care and they can't drop me, then what encourages me to not do death-defying hobbies, or eat healthy, or whatever? The pool's and provider's monetary funding is not my individual concern, unless they can bump my premiums because of my expenses. (sure, co-pays and limits) but how can you incentive people to make better health choices? (Private companies can for their employees, but not the government... you can't mandate good decisions, because people have the liberty to be stupid)

[KenC]

I'm on my phone, so I'll just reply in caps individually. I'm not E-Yelling lol.

Wouldn't a provider removing healthy single males 18-34 from the larger pool increase costs to those not healthy?
I DON'T SEE HOW IT WOULD'T. WHY WOULD A PROVIDER WANT TO REMOVE THEM THOUGH?

How are obese people who have diabetes and eat at McDonalds going to afford their coverage? Especially if their costs aren't on the backs of others?

MOST PEOPLE RECEIVE COVERAGE THROUGH THEIR EMPLOYER, SO PREMIUMS DON'T REALLY VARY THAT MUCH. I DON'T EVEN HAVE A MONTHLY CONTRIBUTION FOR MY INSURANCE.

And if they are uninsured now, how is a "penalty" going to motivate them to pay more to get insured if they are not being treated now?

I'M NOT SURE HOW EFFECTIVE THE PENALTY WILL BE DUE TO THE LOW AMOUNT. IT SHOULD BE CLOSER TO THE COST OF COVERAGE IF MOTIVATING THEM TO BE COVERED IS THE ULTIMATE GOAL. A LARGE PORTION OF THE UNINSURED ARE HEALTHY YOUTH WHO ARE TOO STUPID TO REALIZE THAT ONE MAJOR INJURY WILL PUT THEM IN DEBT FOR LIFE.

In Germany's case, sounds like competition is key... which liberals seem to equalize to profit-hungry companies who only see dollar signs...
IT REALLY IS THE KEY THERE (ALONG WITH THE DOUBLE-MANDATE). I DON'T THINK MANY PEOPLE REALIZE HOW LOW THE "PROFIT" MARGIN IS FOR INSURANCE COMPANIES. FOR EXAMPLE, WE'RE OPERATING ON <1% RIGHT NOW. MOST INSURANCE PROVIDERS AREN'T PUBLICLY TRADED ANYHOW.
ON AN OPINIONATED SIDE-NOTE, A FOR-PROFIT PUBLICLY TRADED HEALTH INSURANCE COMPANY IS A MORAL ABOMINATION. INVESTING HEALTH INSURANCE PREMIUMS TO PROVIDE RETURNS TO SHARE HOLDERS IS DISGUSTING. THOSE DOLLARS SHOULD BE RETURNED TO THE PATIENTS BY MEANS OF LOWER PREMIUMS OR BETTER COVERAGE.

In any case, regardless if everyone is insured in many different groups, or one big group, if we don't have costs savings, innovation, of efficiency improvements... it's not going to make care fundamentally cheaper. (That's the real problem)

HALLE-FUCKING-LLUYAH!
INSURING EVERYBODY ISN'T SOME MAGICAL PANACEA THAT WILL DRIVE COSTS TO A REASONABLE LEVEL. THERE NEEDS TO BE IMPROVEMENTS IN CARE DELIVERY AND CARE COORDINATION.

If I am in this super cheap young male health care and they can't drop me, then what encourages me to not do death-defying hobbies, or eat healthy, or whatever?

BECAUSE YOU DON'T WANT TO GET FAT AND DIE WITH TWO STUMPS FOR LEGS. I'M SURE YOU HAVE NON-MONETARY MOTIVATORS.


The pool's and provider's monetary funding is not my individual concern, unless they can bump my premiums because of my expenses. (sure, co-pays and limits) but how can you incentive people to make better health choices? (Private companies can for their employees, but not the government... you can't mandate good decisions, because people have the liberty to be stupid)

PREMIUMS ARE HIGHER FOR HIGHER-RISK PATIENTS, GENERALLY. SO THERE'S AT LEAST SOME AMOUNT OF MONETARY INCENTIVE.

YOUR PREMIUMS WILL INCREASE AS YOU AGE. THOUGH YOU MAY NEVER REALLY SEE IT IF YOU'RE ON A EMPLOYER GROUP PLAN.

YOU CAN'T REALLY FORCE PEOPLE TO BEHAVE APPROPRIATELY OR HAVE A HEALTHY LIFESTYLE. INCENTIVIZING CERTAIN PATIENTS (*ahem* non-compliant diabetics) TO MAKE HEALTHY LIFE CHOICES IS A REAL CHALLENGE.

[rwh11385]

I'm still unclear about: How can you make insurance affordable for the most costly without bumping the costs for those who are healthy?

And if groups can cater to healthy pools alone, won't that create very expensive pools for the others? [a provider for healthy youth would remove them from other pools, not the pools kicking them out] If most of uninsured are cheap dumb kids and they all go into a less dumb provider for kids, how's that gonna make the rest more affordable?

Are all unhealthy people on employer plans and only healthy young uninsured? Forcing everyone to get coverage could make the only avenue for people without work employer coverage be expensive. Either pay this or pay that.

And isn't the American diet and other factors (our workweek, lack of rest or vacation) going to have an impact on our costs compared to Germany who don't eat much red meat, or other nations that have better health lifestyles?

Obviously I have incentives not to die but if costs don't jump if I take fun risks, then what discourages me financially from doing extreme sports and then just getting fixed up. (My Canadian friend competitively boxes and doesn't wear protection much on a bike or otherwise because single payer has him used to not being accountable for his decisions)

Likewise, if we can treat health issues with surgery and drugs, then what's to encouages people not to chow down on triple cheeseburgers? There is a lever balance with affordable care for people who need it and then keeping it affordable for those after they use it. If individual insurance costs jump dramatically with problems it's value is reduced while not jumping would not putting costs on those who live unhealthy would subsidize poor lifestyles by those who are healthy, reducing their benefit from insurance.

[mrsleeve]

so now 40 hours a week 50 weeks a year is considered excessive amount of time to be at work?????

[kronus]

so now 40 hours a week 50 weeks a year is considered excessive amount of time to be at work?????

compared to the rest of the civilized world, yes, and it has been for some time.

[naplesE30]

Health insurance is insanely cheap for most young adults. I bought my own plan when I grad college through bcbs for like $100 a month with no physical etc. So most can afford it. To bad for those 26 yr olds that would be dropped. They should be considered lucky they got a break that hundreds of millions before them didn't get.

[KenC]

so now 40 hours a week 50 weeks a year is considered excessive amount of time to be at work?????

Not at all... that's more than reasonable. But a decrease in stress via relaxation is very healthy, both physically and mentally.

[KenC]

compared to the rest of the civilized world, yes, and it has been for some time.

That's all supplemented through taxation though.