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Health insurance policy with $100 bills.
This is mostly encouraging news: The big health insurer Blue Cross Blue Shield Association isn't supporting Republican efforts to find ways to try to delay the implementation of the Affordable Care Act. Mostly. There is this one teensy-weensy exception.
Although BCBSA isn't joining with the GOP to back a comprehensive delay, it does want the Obama administration to delay the full implementation of some parts of the Affordable Care Act — including new limits on how much insurers can vary their premiums based on age.

The healthcare law says insurers can only charge their older customers three times more than what they charge young people. Insurers wanted that ratio set at five-to-one, and have pushed the Health and Human Services Department to gradually phase in the 3:1 ratio as a way to avoid sticker shock for young consumers.

Wait a minute. That wasn't supposed to be how this worked. They weren't supposed to bring premium rates for younger people up to meet the level they've been using to gouge older people. They were supposed to bring rates for older people down, closer to what everyone else is being charged. Health insurers will be forced to justify dramatic increases in premiums under the law. But the federal government can't reject increases.

The good news is, 37 states have that power and 36 of them have exercised it. In 2010, regulators turned back over 900 rate increases. Looks like those regulators are really going to have their work cut out for them starting in 2014.

Originally posted to Joan McCarter on Fri Feb 08, 2013 at 11:32 AM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Man, what about the states that don't have the (7+ / 0-)

    power to reject increases?  Their rates will go through the roof.  

    "If the misery of the poor be caused not by the laws of nature, but by our institutions, great is our sin." Charles Darwin

    by Rockydog on Fri Feb 08, 2013 at 11:48:46 AM PST

    •  There is still the federal backstop (1+ / 0-)
      Recommended by:
      slothlax

      Insurers have to pay out 80% of what they collect in premiums for health care.

      The effect of increasing the cost for young people is an inevitable side effect of only allowing age to increase premiums 300%. Those last few years of life cost a lot more than 3 times the cost for all those young years where most people's only health care cost is an annual check-up.

      A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. Franklin D. Roosevelt

      by notrouble on Sat Feb 09, 2013 at 08:16:51 PM PST

      [ Parent ]

      •  of course (2+ / 0-)
        Recommended by:
        Sherri in TX, tb mare

        Those last few years of life people should be on Medicare so it is not as if young people will be charged 1/3 of the most unhealthiest years.

        •  That's true (2+ / 0-)
          Recommended by:
          nextstep, antirove

          But even a 55 year old is likely to have higher ongoing health care costs compared to a 25 year old. Heart problems, cancer treatments, diabetes, and a host of things are pretty uncommon in 25 year olds, but much more common in 55 year olds.

          The point of the 3x cost difference was to keep insurance affordable for those not quite old enough for Medicare. In other words, require insurance companies to shift costs to younger people.

          The 80% payout requirement still provides limits on total premiums collected.

          A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. Franklin D. Roosevelt

          by notrouble on Sat Feb 09, 2013 at 09:08:41 PM PST

          [ Parent ]

          •  The issue is getting young people to start paying (3+ / 0-)
            Recommended by:
            tb mare, notrouble, antirove

            The legitimate insurance co argument here is that if rates for young people are too high they will avoid purchasing recognizing that they are getting a bad deal for their premium dollar- paying lots but using little.

            Young people have very low medical utilization, and at 1 to 3 this demographic, still struggling to find work in a disastorous economy, is being asked to subsidize oldsters like me (age 53.)   Even at 1 to 5, they'd probably be getting a raw deal as their average medical costs are really, really low.  

            Personally I'd love to have my insurance premiums subsidized by unemployed 23 year olds... but I'd feel pretty guilty about it.   There is a "right" number and it can be discovered... but it's probably even lower than 1 to 5.

            How much the youth should be required to subsidize people in their 50s and early 60s is an interesting philosophical and actuaral question, and somewhere there are real numbers that would inform the debate.

            •  I wasn't suggesting it was right (4+ / 0-)
              Recommended by:
              antirove, Miles, jim bow, GayHillbilly

              only that a 3x age premium limit was inherently going to shift costs to the young. It was built in by congress when they established that limit.

              The flip side is how can people in their 50's afford to pay 5x the cost of 25 year olds? $1500 per month per person doesn't work either.

              A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. Franklin D. Roosevelt

              by notrouble on Sun Feb 10, 2013 at 08:54:42 AM PST

              [ Parent ]

              •  What kind of intergenerational compact? (1+ / 0-)
                Recommended by:
                notrouble

                Social security is built on the young paying for the old.  So is Medicare.

                Medicaid is built on a progressive taxation of income (to the extent that it is funded by the federal government), with the wealthier paying disproportionately for the poor.

                The ACA is a new "young pay for the old" plan, but it feels different from social security... the insurance you are buying is sold to you as YOURS, but in fact a young person is being asked to pay for older users.  (Of course current insurance has all sorts of cross subsidies too... for the uninsured for example)

                We accept that in insurance the HEALTHY pay for the SICK because we know that we are healthy today, but might be sick at any moment.    But when people realize that young is correlated with healthy, it quickly dawns on them that what they really are is YOUNG (and therefore HEALTHY), and it's going to be a long time before they are OLD (and SICK).   All of that is a long way of saying that the intergenerational subsidy isn't something that people tend to think about when they purchase insurance against medical costs, but the ACA is built around some level of intergenerational subsidy.

                If you think about WHY that was done politically, we might consider the higher voting rates of 50 to 65 year olds, or other explanations.

                SHOULD it be done?   Is it a good idea to pay for the health care costs of the old with the wages of the young?    That's an interesting policy and political question.   It probably comes down to voice - who will scream louder, youth or older middle aged folks?   The 1 to 3 ratio calculates that youth won't know what hit them.  The insurers may be saying, you know what, we can tap into that uninsured youth market with lower prices, while older folks who know the value of insurance will put up with rates that are closer to their real costs and utilization.    

                •  you missed the most important part (1+ / 0-)
                  Recommended by:
                  GayHillbilly

                  of why this is different than Social Security:

                  with Social Security, I am paying into the common good.  I'm paying to the government to have it redistributed.

                  With the ACA, I'm forced by law to pay for some health insurance company's CEO's fifth vacation mansion.

                  One is moral, one is not.

  •  We don't need the "intermediation" by insurers (9+ / 0-)

    Blue Cross or any greedy for profit insurers.

    Single Payer is the way to go and we will get there.

    This Monday I will be MCing this protest in front of Blue Cross HQ in Los Angeles.  We do what we can

    Lobby Day photo ScreenHunter_59Feb041858_zpsc08d9d00.jpg

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Fri Feb 08, 2013 at 11:49:16 AM PST

  •  The more I hear about insurance companies (10+ / 0-)

    trying to stop aspects of the ACA, the more I think we need a single payer system.  

    We'll cut our expenses in half and maybe we'll finally be in the top 10 or even top 20 in infant mortality.  

    "If the misery of the poor be caused not by the laws of nature, but by our institutions, great is our sin." Charles Darwin

    by Rockydog on Fri Feb 08, 2013 at 11:50:54 AM PST

    •  Are high infant mortality rates... (2+ / 0-)
      Recommended by:
      slothlax, nextstep

      ...mostly a function of health care availability or are they more a function of more females in America having babies at a very young age or using drugs/alcohol which result in higher risk of infant mortality?

      I don't know, but it seems likely simplistic to assume that lack of "free" (i.e., paid for by someone else) health care is the primary determinate of infant mortality.

      Also, one needs to be careful with inconsistent reporting of infant mortality across countries. The US is aggressive about reporting infant mortality (regardless of weight or term, if the baby is alive at birth and dies even ten minutes later, it's an 'infant death') while some countries don't report infant deaths if they are under some number of weeks of term, or survive less than 24 hours, or are under some birth weight weight. I think this is slowly being addressed, but it's an issue to keep in mind until all countries use the same standards.

      •  The reporting discrepancies (1+ / 0-)
        Recommended by:
        tb mare

        were ended in the early 90s when WHO pressured countries for uniform standards. That's an old excuse offered for sloppy care here.

        The problem of our high rates of teen births is real and does impact the stats somewhat but the key reason is our heavy medicalized care and our high rate of caesarians especially when done for convenience.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Sun Feb 10, 2013 at 03:29:44 AM PST

        [ Parent ]

    •  "that dog won't hunt"... (2+ / 0-)
      Recommended by:
      splashoil, antirove

      ...many posters here at Dkos were right here daily and in the streets on the frontlines all across America fighting like rabid dogs for single payer. But the battle was all in vain. The decision was all but decided from day one. There's enough blame to go around, though.  Big Insurance, Big Pharma, Wall Street, and many corporate-owned congress critters on both sides of the aisle dug in their heels and caved in to the special interests, including our current House Minority(then Majority) leader and beloved president. We were told time after time, that because many never even read the final bill that was drafted, crafted by the HC industry lawyers and who were scared to death of single payer, spent hundreds of millions to kill it in the crib.  Big Insurance crammed the final bill down our throats, and the only choice we had was tow the party line, that we had to pass the bill to see what was in the bill and that passing "half a loaf was better than no loaf". I read the PDF version of it then and let me tell you, if our Dems had bothered to read past the cover sheet, single payer would probably have stood a better chance, because a lot of its provisions, (not surprisingly to former full time Dem activists like me) have absolutely nothing to do with health care.

      "I wish to have no connection with any ship that does not sail fast, for I intend to go in harm's way." John Paul Jones

      by ImpeachKingBushII on Sat Feb 09, 2013 at 07:40:57 PM PST

      [ Parent ]

      •  IKBII: You are wrong. If any attempt (1+ / 0-)
        Recommended by:
        Sherri in TX

        was made for single payer you would have had an uprising to make the tea party look like a mole hill on a mountain.

        The majority of people have insurance through employers and would have been terrified of change particularly if they were in the midst of treatments for things like cancer. One key to getting reforms was to minimize disruption.

        Besides there is much more to the ACA than just the insurance regulation which was very much needed — or Medicare would have collapsed.

        Do you realize that 1 in 3 Medicare patients who are hospitalized incur a serious medical error? Do you realize that over 100,000 Americans die each year from preventible medical error? That is more than the number who die from lack of access to care.

        No the bill was not crafted by insurance industry; it was mainly crafted by Nancy de Parle who has admirable qualifications and nothing to do with insurance industry.

        I read the PDF version of it then and let me tell you, if our Dems had bothered to read past the cover sheet, single payer would probably have stood a better chance, because a lot of its provisions, (not surprisingly to former full time Dem activists like me) have absolutely nothing to do with health care.
        You may be a full time Dem activist but you don't know shit about the health care systems when you blow off the most important parts of the ACA to actually impacting the quality and cost of care.

        You are one of those people who  think that the insurance is health care. It is merely the vehicle for financing it.

        look:
        Medicare is a single payer system.
        Medicare has very serious cost and quality problems.
        Therefore: a single payer system does not preclude serious cost and quality problems.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Sun Feb 10, 2013 at 03:58:11 AM PST

        [ Parent ]

        •  sorry we have to agree to disagree... (1+ / 0-)
          Recommended by:
          antirove

          ...May I suggest that you may have forgotten some key facts. NYCEVE and SLINKERWINK (and many others here who were in the streets)are much more qualified than me to bring you up to speed, as I have been too occupied trying to survive a terminal liver disease and had to retire (against my will) from full-time activism. I do agree with you that Medicare is single payer. I wouldn't be alive today without it. My memory is failing me, however. I don't recall you being active in this fight. That is not to say you weren't, just  that I don't remember you.

          "I wish to have no connection with any ship that does not sail fast, for I intend to go in harm's way." John Paul Jones

          by ImpeachKingBushII on Sun Feb 10, 2013 at 08:17:32 AM PST

          [ Parent ]

    •  That will not cut expenses in half (1+ / 0-)
      Recommended by:
      antirove

      nor will it have a great effect on infant mortality.

      In the US we have a caesarian rate of about 35%. Ideal is below 15%. Countries with the lowest rate of infant and maternal mortality are well below that.

      Countries with better rates have much higher rates of midwife births.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sun Feb 10, 2013 at 03:22:26 AM PST

      [ Parent ]

    •  Print this for Reference (1+ / 0-)
      Recommended by:
      GayHillbilly

      Obamacare: A Deception

      The devil is in the details.  And what details await us!

      The author also points out that the cost of using the mandated policies will be prohibitive because of the large deductibles and co-pays. Many Americans will find themselves not only with a policy they can’t afford, but also with one they cannot afford to use. Those who cannot afford the insurance, even with a subsidy, will be faced with a costly penalty, and in many cases, this, too, will be difficult, if not impossible, to pay. As each year’s subsidy is based on last year’s income, there will be a substantial year-end tax liability for those who must repay the subsidy in whole or part because their income increased during the year. The stress alone from such a regressive scheme is, without a doubt, not conducive to good health and well-being.
      Hoocoodanode?
      •  Bronze, Silver & Gold (0+ / 0-)

        So much for the quaint concept of equal care for all.  Bronze plan recipients of Medicaid over 55 must plan on their estates reimbursing the States for the care received.  Gold plan Senators and Congressmen will have no such petty worries.  Their care is free...
        When the ACA stands naked for all to look at, we will be worse off than before it started.  If you don't get the gold plan.

  •  Of course insurers aren't impeding PPACA... (3+ / 0-)

    ...because they pretty much wrote the dang legislation, they had one of their own (Liz Fowler) in charge of implementing it, and--most importantly--they stand to benefit from virtually unlimited government subsidies to them from Americans' being forced to purchase their "products" without a dollar cap on costs from the insurers' side.

    Not to mention the new normals of extremely high deductibles and the elimination of so-called "Cadillac" plans; i.e., what we used to call comprehensive coverage. What's not to love about PPACA from an insurer's p.o.v.?

    Besides, they know they can throw their phat coin at Congress and eventually obtain even more concessions, such as the 5-1 ratio on us olds.

  •  Until the costs of actual care (4+ / 0-)

    you know, what is paid to doctors and hospitals and equipment makers and lab tests and   a whole lot of etceteras come down, then premium costs will be high.

    We could freeze premium costs if you would agree to limit medical care to what we do now unless it reduces costs. No new treatments. OK?

    My biggest question is why is everyone fighting to retain procedures/treatments that are proved to have no meaningful effect? Or those who harm more than help? Why are people so dead set against the IPAB? I know that some doctors hate it because some of their pet treatments do more for their wallets than for the patients.

    But why do so many have this "Whatever the doctor orders; no one dare question" attitude?

    I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

    by samddobermann on Sat Feb 09, 2013 at 01:33:58 AM PST

    •  But that's soshulized medasin doncha no? (1+ / 0-)
      Recommended by:
      samddobermann
      Why are people so dead set against the IPAB?
      ...a board of 15 unelected and unaccountable bureaucrats will determine benefits and cuts    link
      The March 2013 edition of Consumer Reports had an article, "Save your life," that listed 3 screening tests you should get and 8 tests to avoid. Too many people get tests they don't need. That drives up costs and can lead to unnecessary risks for patients.
      •  Right, but it is not just tests (1+ / 0-)
        Recommended by:
        cocinero

        It is treatments too. We need to educate ourselves and help disseminate information like the great stuff CR is putting out.

        Can you do diaries on their articles? I don't have a subscription.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Sat Feb 09, 2013 at 09:47:23 PM PST

        [ Parent ]

  •  I don't know what the cost of insuring... (2+ / 0-)
    Recommended by:
    slothlax, Sherri in TX

    ...a young person vs. an old person is. But, if it is 5x, why shouldn't that be allowed? Alternatively, why allow any age rating? Is the 3x arbitrary or based on actual medical costs of young vs. old people?

    If too much burden is pushed onto the young people, they will eschew insurance and simply pay the penalty because they don't expect to need the care. They also realize that if they do need care and can't pay for it, they probably have few savings and a long time to recover from bankruptcy, so will take that chance.

    •  or just get insurance when they get sick....no pre (0+ / 0-)

      existing conditions anymore....so why not?

    •  The real problem is the young prefer NO insurance (0+ / 0-)

      and do not want to participate in the the overall 'risk' pool with the rest of the workforce if these costs are felt to take away too much from their already small 'entry-level' pay.  When they get hit with high medical costs, due to unforeseen circumstances, due to trips to the ER or contracting unexpected illness, they are surprised at how expensive it is and get crushed financially to the point of ruin. If they can defer treatment, or get by with some minimal treatment, they'll struggle along until they do manage to get some insurance and then seek proper treatment, which is likely to cost more then than it would have at the time the health condition requiring care occured. Young workers saddled with such unanticipated debts will have a hard time recovering financially, especially to the point where they might again be able to afford to pay for health coverage.

      This skewing of participation leads to skewing of the premium models. By the younger workers' refusal to pay for the health insurance, to participate in our overall risk pool, when the rates are calculated for their risks, this shifts the costs for all of worker health care onto the rest of us.  Insurers recalculate rates, respreading the 'risks costs' for us all, based on younger worker rejection of insurance and deferring of health care. Part of making paying for coverage 'mandatory' is to eliminate this skewing factor in pricing premium rates. The other part is shifting more costs for health coverage back onto employers more able to pay than workers.

      I cannot see any way to defend a 1:5 spread in premium rates because worker pay difference by age is no longer even close to that difference. If employers made up for that skewing by funding more of the costs or keeping premiums assessed as employee costs more equal, perhaps that 1:5 spread might be possible to implement. Wages by ages is the other problem. Prior to the 2000's that sort of differece in pay (1:5) may have been more often true--but that was also when more people were protected by unions, or employers offered the types of full benefit coverages provided to unions in order to keep being non-union status attractive to its staff.

      If the average 21 year old made $20,000 and 50 year old made $100,000 perhaps we could give this proposed 1:5 differential in premium more serious consideration. But that requires employers to pay people based on experience and productivity instead of trying harder and harder to keep wages and benefits repressed. The hard economic fact is few 50 year olds are being paid more than $60,000 per year these days, so even that 1:3 spread in rates is hard to swallow and likely leads to older workers rejecting insurance coverage.  A typical 50 year old couple who has a 'middle class' income over $60,000 tends to be at the peak of having to pay out for college educations or weddings or helping with first mortgage or other large expenses for their young 'adult' children. Along with living in a home or condo or apartment whose value shriveled by tens of thousands, or more after 2007.

      Our current funding models for pricing healthcare costs and insurance premiums have inherent problems which lead to our struggles to set up conditions for good health care and universal coverage. By tying the participation and funding of health insurance to the individuals (whose circumstances and age vary widely) the pricing to individuals has to vary widely. So the rates will be experienced as 'unfair' to many groups of would-be participants.

      If we instead mandated that health 'insurance' be fully funded via taxation against corporate earnings, profits and capital gains, etc. rather than wage income, we could eliminate the many assoiated problems of health premium cost shift skewing and the disincentives to pay for decent coverage. We pay for other infrastructure benefiting all Americans via taxes, why not move the entire cost of health services and 'premium rates' to be funded via taxes? Especially since the gains and proficts of productivity workers earned on behalf of corporations have not been fairly shared with workers for the last few decades, but have gone into the pockets of CEO class and shareholders. Yes, perhaps having some 'skin in the game' is a needed incentive to help keep people from seeking unnecessary care. But requiring unreasonable amounts of skin keeps people from wanting into the game at all, pushing the costs of the game onto the skins of those still in.

      I'd rather see modest office visit costs (sliding scale of course) and low perscription costs be the costs passed on to individuals, with the full cost of worker health care costs paid out of the mighty engine of corporate profits and shareholder gains.  If that makes corporation management demand a single payer model as the most sensible way to fund the worker health costs, so be it.

      When life gives you wingnuts, make wingnut butter!

      by antirove on Sun Feb 10, 2013 at 10:20:49 AM PST

      [ Parent ]

    •  That ratio is actually more than 5:1. (0+ / 0-)

      It's like 6:1 or more.  But if you see what insurance premiums are for a 61-year-old in the individual insurance market, you'll see why there needs to be a lot of cross-subsidation from young to old.

      I knew the law would cause premiums to rise for young people like myself, and still supported and continue to support it.

  •  Isn't the medical loss ratio set at 85%? (2+ / 0-)
    Recommended by:
    slothlax, Sherri in TX

    in which case the total amount of premiums going to care vs. overhead/profit will be the same regardless of whether it is 3:1 or 5:1.

    Am not sure what the actual premiums amount to so it is hard to know what the true impact will be, but I can see some concern with younger people suddenly higher rates.

  •  I thought the idea was to expand the pool (1+ / 0-)
    Recommended by:
    mike101

    so that insurers are collecting a much greater amount of premiums from both those who will need services and this who won't thus making it cheaper for everybody.  Now the insurers are planning to soak the young who will need much less medical care to make up for not being able to continue soaking the old who, while sicker, already have the benefit of Medicare or, if they are still too young, in many cases SSI.  unbelievable.

    Get your facts first, and then you can distort them as much as you please -- Mark Twain

    by OnePingOnly on Sat Feb 09, 2013 at 07:31:58 PM PST

    •  Those who have the benefit of Medicare (1+ / 0-)
      Recommended by:
      slothlax

      don't need to buy private insurance. SSI has nothing to do with it...that's supplemental income, not medical insurance. The elderly who qualify for SSI have their Medicare premiums subsidized, but that's because anyone who gets SSI is very, very poor.

      The trouble is, private insurance is expensive, period, especially if the insurers can't cut expenses by limiting care or refusing to insure those with higher risk of illness.

      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

      by Alice in Florida on Sat Feb 09, 2013 at 08:19:22 PM PST

      [ Parent ]

    •  Honey, the expanded pool (0+ / 0-)

      includes the young people. Your "soak the young" means they will be paying in the pot of the "greater amount of premiums" for those who need services.

      This doesn't include those on Medicare. The older means from 50 or 55 to 65.

      SSI has nothing to do with health care or insurance. Perhaps you mean Medicaid.

      Read your own sig line.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sun Feb 10, 2013 at 04:06:34 AM PST

      [ Parent ]

  •  Uh, I hate to say it, (5+ / 0-)

    but this was utterly predictable.

    Please don't get me wrong; I think ACA was a step in the right direction. But one should never assume that any corporation is going to voluntarily give up a share of its profits. If there is a loophole, they will find it. And where there isn't a loophole, there is likely to be a negative consequence, or several. That's the nature of the beast, and so it will be until and unless we can ever get single payer.

    Let us all have the strength to see the humanity in our enemies, and the courage to let them see the humanity in ourselves.

    by Nowhere Man on Sat Feb 09, 2013 at 07:35:52 PM PST

    •  But, but...someone told us this would be (1+ / 0-)
      Recommended by:
      Nowhere Man

      interpreted in the good way. And now it's being interpreted in the bad way.
      Why, oh why would someone mislead us??

      -- We are just regular people informed on issues

      by mike101 on Sat Feb 09, 2013 at 07:46:48 PM PST

      [ Parent ]

    •  The loss ratio is set at 85%. So regardless (2+ / 0-)
      Recommended by:
      Sherri in TX, nextstep

      of the age ratio, 85% of all premiums will go to healthcare. So this issue really doesn't appear to be about profits (and some of these providers are non-profit, e.g., Blue Shield of CA)

      •  That doesn't mean that they'll limit their income. (3+ / 0-)
        Recommended by:
        jjohnjj, tb mare, jeopardydd

        In fact, what it means is that if they want to grow their profits, they have to grow their income -- limiting expenses no longer helps the bottom line all that much. It may seem like a good thing if it means that they spend more on healthcare, but there's no promise that they'll spend that additional money wisely (from the patient's point of view.)

        Again, I support the ACA; I do think the good outweighs the bad. But there are negative consequences here, and the ACA must be the start of health care reform, not its end point.

        (Oh, and large non-profits like Blue Cross are essentially just like for-profits that don't pay dividends to shareholders. They still have executive bonuses to pay for...)

        Let us all have the strength to see the humanity in our enemies, and the courage to let them see the humanity in ourselves.

        by Nowhere Man on Sat Feb 09, 2013 at 08:49:15 PM PST

        [ Parent ]

        •  Agree: ACA is the start of reform, not the end. (1+ / 0-)
          Recommended by:
          Nowhere Man

          I hope things will balance out... such as younger people having greater access to employer or exchange-based group rates.

          It seems that the ACA regulations, while deficient in the particulars, add up to a whole that will "fence in" the InsurCo's and force them to force cost controls on the medical providers, rather than just raising rates and passing costs on to the consumer (and Medicare).

          Have you noticed?
          Politicians who promise LESS government
          only deliver BAD government.

          by jjohnjj on Sat Feb 09, 2013 at 10:41:14 PM PST

          [ Parent ]

        •  They "spend" that money on (0+ / 0-)

          paying doctors and hospitals and all the little things that go along with care. It is up to you to see that it is spent wisely in part by not falling for everything a doctor tells you to do or that you "need."

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Sun Feb 10, 2013 at 04:10:35 AM PST

          [ Parent ]

  •  That's how its supposed to work (1+ / 0-)
    Recommended by:
    nextstep

    If the ratio can only be 3:1 and the only way to make that ratio and stay in business is to raise younger customer's rates, then that's just the way it has to be.  The whole idea behind a mandate was to force younger, healthier people subsidize older, sicker people.

    Now I don't have access to insurance companies balance sheets, so it might all be BS, but on the face of it this makes sense to me.

    There is truth on all sides. The question is how much.

    by slothlax on Sat Feb 09, 2013 at 07:40:09 PM PST

    •  I think that is valid. I focus more on the loss (2+ / 0-)
      Recommended by:
      slothlax, samddobermann

      ratio. It will be set at 85%. So regardless of the ratio between young and old, at least 85% of all premiums will go to healthcare.

      Given that we are now thinking more in terms of everyone paying into the system over their lifetime rather than in matching premiums to costs by age, it seems what is most important is to have an age ratio that makes it affordable for people in each age group. Am not sure what that is though.

  •  The more I learn, the less I like (2+ / 0-)
    Recommended by:
    jeopardydd, GayHillbilly

    I am now convinced that Obamacare is a  corporate giveaway and any positive elements of the legislation are nothing but crumbs thrown at us to prevent the outrage that is sure to come down the road when it all becomes clear to everyone.
    Making profits on the sick and infirm is immoral.  It may even be that certain Cancers in this country are preventable or curable but we will never see a solution because there is too much profit to be made in treating cancer patients.   We may achieve breakthroughs in medical care and treatment if the profit motive is removed.
    Single payer non profit health care is what civilized nations do.  It makes financial sense.  
    I am ashamed to be a USAmerican for many reasons, but this issue should be a no brainer for our lawmakers.

    •  then your problem is with the (1+ / 0-)
      Recommended by:
      nextstep

      doctors, hospitals, drug companies, etc, etc. They are the ones who decide on your care — to the extent you choose to let them.  

      They are the ones making the big profits.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sun Feb 10, 2013 at 04:14:30 AM PST

      [ Parent ]

      •  Bull shit, mostly. (1+ / 0-)
        Recommended by:
        jeopardydd

        Have you looked at insurance company profits?  They ARE big, even if they call themselves not-for-profit.  I have no idea how the IRS allows them to hold that category with the exorbitant profits they haul in.  So the insurance company CEO's -- who have nothing to do with the provision of your health care -- should be making millions of dollars each year?  Why should that money be siphoned out of the actual delivery of health care?  Just because the CEO manages a company that touches the dollars between patient and doctor or hospital, s/he deserves to take a substantial chunk of those dollars??  Ridiculous.

        •  Not quite (1+ / 0-)
          Recommended by:
          tb mare

          Health insurance company profit margins are 3.5 percent, far less than most industries.

          •  Thanks for the link. (1+ / 0-)
            Recommended by:
            jim bow

            You reversed the margin percentage with that of the hospital sector though. Ins. co. margin is actually 4.54% but your point is taken. I stand corrected. Still, not for profit ins. co. CEOs making multiple millions of dollars is obscene -- and immoral -- IMHO.

            The short article you link is worth a read, as is most of Ezra Klein's:

            The health-care sector is absurdly profitable. According to this data at Yahoo Finance, the sector-wide profit margin is 21.5 percent. But the insurance industry is one of its least-profitable parts: Its profit margin is at 4.54 percent. Hospitals are also a bit strapped, with an average margin of 3.5 percent.

            So where's the money going? Drugs and medical technology, mainly. The major drug manufacturers have a 23 percent profit margin. The medical device makers are pulling in 12.6 percent. And this is all happening despite the fact that researchers are having a very difficult time showing that there's much benefit -- either in longevity or quality of life -- to all these new, and incredibly expensive, treatments. I don't want to call this spending waste, exactly. Some of the treatments do improve health, and the money on the table is a good incentive to innovate. But just squeezing insurers and hospitals won't control costs unless the insurers and hospitals can figure out some credible way to either squeeze drug and device makers or somehow ration their products.

            What we're all hoping is that the apparently massive amount of health care that does no observable good means that better evidence will allow them to make those decisions in a way that doesn't harm health. We don't have very good answers for a world in which it doesn't work out that way.

  •  Wouldn't it be more fair to have one rate (0+ / 0-)

    for health care premiums based on national actuarial tables rather than a sliced and diced the population of competing age groups.   Most countries are fairer in this way.  While Germany, for one, also assesses premiums as a percentage of income rather than a set euro amount.   And it should be remembered that Germany has not only the oldest national health insurance plan but one that operates exclusively with private policies.  

  •  Whoa! (0+ / 0-)
    That wasn't supposed to be how this worked. They weren't supposed to bring premium rates for younger people up to meet the level they've been using to gouge older people. They were supposed to bring rates for older people down, closer to what everyone else is being charged.
    No, this is how the law is supposed to work.  Claim costs for 64-year-old males are six times that of a 24-year-old males; for females, this ratio is 3:1.  If you are going to limit an insurer's -- public or private -- ability to vary premiums by age, then in order to maintain plan solvency, rates for those with a lower predilection to the use of insurance have to increase in order to make premiums affordable for those with a greater predilection to the use of insurance.  Medicare certainly works this way (granted, there are taxpayer subsidies to lower the cost of insurance):  Medicare beneficiaries with a lower predilection to the use of insurance subsidize those beneficiaries with a high predilection to the use of insurance.

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