Health care and entitlement
Hi Wilderness. I hope I can interupt a bit at this point just to insert an element of truth.
The often repeated claim that insurance companies are issuing policies that cannot be used by those who own them is utter nonsense. This statement is untrue. It is not even remotely close to being true. It is an imaginary fantasy having no basis in reality.
Not everyone is unhappy with the ACA or with the policies they purchased on exchanges. It is the nature of insurance that some fare better than others.
According to Scott Harrington, a professor of health care management at the University of Pennsylvania’s Wharton School, at least 80 percent of all premium dollars, maybe more, he says, go directly towards paying medical claims of enrollees {1}
Close to 182 million people are covered under group and individual healthcare policies in the US. Of the 182 million now insured, an estimated 169 million have had healthcare policies before the ACA took effect and another 13 million have enrolled in healthcare policies since. A very large segment of them have or will have an occasion to use their policies on an ongoing basis. Most of them recognize that their policies will limit their financial risks from costly illnesses. Contrary to the claims quoted above, many probably wish that they did not have to use their policies too often but are still grateful to have the benefits when they are needed.
Wilderness wrote:
“Obamacare is …mostly a way to funnel huge amounts (trillions) into insurance companies,”
Really? Those dollars will cover the cost of premiums for millions of citizens who need the help. More than 80%, as noted above, will be paid out for medical costs. The ACA is expected to provide $43B this years and perhaps $90B next year for subsidies. Last year, before the ACA startup, the eleven companies on the Fortune 500 list in the Healthcare Insurance and Managed Care industry had combined revenues of $319B. Government subsidies are not likely to even make it down to the bottom lines of these insurers. Of the eleven, only two saw profits exceeding 4.9 % of revenues.{2}
Under the ACA, by the way, the insurance industry must absorb nearly $11.4B in additional taxes that flows back to the government.
Those who claim the ACA is a boondoggle know little or nothing about the impact of the bill on those already insured. Most of the criticism comes with anecdotes but rarely with nationwide data.
{1} http://www.politifact.com/punditfact/st … llion-ins/
{2} http://money.cnn.com/magazines/fortune/ … full_list/Hi Wilderness. I hope you are well.
I actually think that I understand your situation a little better than I did before. Never the less, my comments are not intended to change your mind about the ACA only to correct false and misleading statements.
Each of us is responsible for our own medical bills. However, not everyone is aware that the objective of healthcare insurance is to allow some of us to spread the risks of extraordinary medical expenses among a large pool of insured. Our individual policies are intended to share above average bills but some of us are complaining because they do not pay ALL of our medical expenses. The real problem here is not actually caused by the Affordable Care Act (ACA) at all. The real problem is that some of us are unable to pay for our own typical medical bills. We should not blame the ACA for our situation nor should we falsely proclaim that the insurance policies we chose are worthless or worse, that millions of insured citizens will never use their policies. Most of us recognize the that the most important benefit of healthcare insurance comes from having it and not from using it.
Wilderness wrote:
“Bronze packages are intended for poor people that can't afford any better, that's who buys them, and the deductible is far beyond what most of those people can ever pay. My own deductible is over $12,000 - at least quadruple what I can afford to put into health care.
Income level does not matter. Bronze plans are designed so enrollees will be responsible for 40% of their own projected healthcare services. These plans tend to have the lowest premiums of the four metallic categories of plans but they also have the highest out-of-pocket costs for healthcare services. {1}
Those who find they can not afford to pay 40% their own anticipated medical bills should not be blaming the ACA or the insurance companies for their dilemma. Those with inadequate income should explore the other alternatives included in the ACA such as opting to pay an annual penalty which is a fraction of the typical insurance premiums or applying for extended Medicaid.
For guidance with the tax penalty see “Should I Pay the 'Obamacare' Tax Penalty?” {2}
In states that have not expanded their Medicaid program under the ACA, citizens in need should be asking their governors why those in need are NOT receiving the expanded Medicaid benefits that are going to more than half of the country. {3}
An important thing to remember is that the insurance coverage provision of the ACA is not intended to eliminate poverty. Rather, it attempts to ease the cost of premiums and to provide access to healthcare insurance for millions who had been denied insurance before the bill was enacted.
{1} http://www.healthpocket.com/individual- … 0wtsVVdVA2
{2} http://health.usnews.com/health-news/he … int=2d2e1b
{3} http://kff.org/health-reform/issue-brie … -medicaid/Hi Wilderness.
The statement “that leaves that $9,000 per year as pure profit.” appears to reveal a disconnect from the real world.
Nearly 80%, some times more, of ALL premiums, that is ALL premiums, pass through the insurance companies to pay for healthcare services. It does not matter if the money pays for one family’s treatment or for another’s. The mindset that some premiums are “pure profit” is actually pure fiction! This false statement then leads to another:
“Or do you mean to insinuate that that money will be used to subsidize the gold/platinum plans? I don't think so - every plan is to stand on it's own, without being subsidized by another set of plans.”
I am afraid that this statement is also untrue! Risk pools under the ACA are defined as ALL the insurance company’s policy holders in a state and NOT as the different type of plans they have. Bronze, silver, gold and platinum plans represent different premium vs. out-of-pocket structures but not different risk pools.
“The adjusted community rating rule in the ACA requires that issuers must consider all members of their small group and individual plans part of a single risk pool, including members in small group and individuals plans both inside and outside the exchange. The premiums for each group in the insurer’s pool will be based on the average experience of that insurer’s entire pool, adjusted for the rating variation factors that the ACA permits” {1} [underscores added for emphasis.]
As a result, ALL premiums are applied to reimburse ALL valid claims received from ALL policy holders in ALL metallic groups in the company’s state wide risk pool.
{1} http://pioneerinstitute.org/wp-content/ … -Final.pdf Sec.4.4
Hi again, Wilderness.
Yes, I do understand what you are saying. Again, I really have no interest in what you believe about the ACA. I only post facts whenever I come across false claims and statements that distort the truth.
Yes, a bronze "plan is just an insurance policy" but it is far from being worthless and such hyperbole is untrue in a practical and legal sense. Figuratively speaking, they may appear worthless in the minds of some but they have real value in the real world. The inability to pay the full deductible amounts DOES NOT render the policies worthless. They are legally binding contracts as long as the premiums have been paid without regard to the solvency of the policyholders. The insurance companies must and will pay major claims minus the remaining deductibles and they do not care if the policyholders can satisfy their out-of-pocket responsibilities. The deductible amounts are responsibilities that exist between the insured and the providers. Therefore, the insurers are not concerned at all with the abilities of the insured to pay the remaining out-of-pocket deductibles.
Those plans, my friend, are not worthless policies. Furthermore, you will not consider your policy worthless if you should have to submit a major claim.
Americans are overly taxed as it is. Now this president is pushing Obama"care". Why, no one is entitled to health care. We had the best health care in the world before Obummler took over with his socialized medicine. Poor people in America had free or very low cost health care, it AIN'T broke, so DON'T FIX IT! Oh no, our dictator in chief wants to revamp the health care system much to the WORST! Can't wait for him to get out of office!
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