You are pointing at something which is not A, then saying, look how this is A! More things should be A!.
I don't know what made you think this last part.
I'm not saying the used car market is full of well informed people and the healthcare market should be like it. I'm saying the health care market is being made more like the used car market.
??? You said that prospective purchasers could inspect used cars and then use that information to properly price a used car, but the reality is that they can't. Most of the time, people can't inspect used cars in such a manner that they can properly price it due to logistical constraints, a lack of expertise, or deception by the seller. The used car market has always been broken, and then you rhetorically broke it a little more, and then said that the ACA was like the more broken version?
YES!
The prospective purchaser in the car analogy is the insurance company not a consumer, the practical issues for consumers buying a used car don't enter into it, the companies can do those things; 'pricing the used car' is what their entire business depends on. This entire tangent was about the companies(United HC in particular) and the market(not the exchanges but the insurance companies as a group trying to price/model their policies). Maybe this is what is hanging you up? I'm not talking about consumers, ACA has been okay for consumers.
For the insurance companies though, ACA is a huge negative change. They had information before that let them avoid the lemons very efficiently. Now they don't and one of them(United HC) ended up with a whole bushel full.
My argument was that this is something of an expected result, because pricing policies has been made harder because the companies are less informed. All though that isn't accurate, they are just prohibited from using certain information they have, in effect it is the same thing. Sticks didn't get what I meant by less informed, thus the car analogy. It wasn't a comparison of consumers buying cars vs consumers buying insurance, it was just to demonstrate how insurance companies are pricing with less information now than they were pre-ACA.
dun care when are we gonna be able to pay for gym memberships out of our FSA
Marty: The future, it's where you're going? Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
You are pointing at something which is not A, then saying, look how this is A! More things should be A!.
I don't know what made you think this last part.
I'm not saying the used car market is full of well informed people and the healthcare market should be like it. I'm saying the health care market is being made more like the used car market.
??? You said that prospective purchasers could inspect used cars and then use that information to properly price a used car, but the reality is that they can't. Most of the time, people can't inspect used cars in such a manner that they can properly price it due to logistical constraints, a lack of expertise, or deception by the seller. The used car market has always been broken, and then you rhetorically broke it a little more, and then said that the ACA was like the more broken version?
YES!
The prospective purchaser in the car analogy is the insurance company not a consumer, the practical issues for consumers buying a used car don't enter into it, the companies can do those things; 'pricing the used car' is what their entire business depends on. This entire tangent was about the companies(United HC in particular) and the market(not the exchanges but the insurance companies as a group trying to price/model their policies). Maybe this is what is hanging you up? I'm not talking about consumers, ACA has been okay for consumers.
For the insurance companies though, ACA is a huge negative change. They had information before that let them avoid the lemons very efficiently. Now they don't and one of them(United HC) ended up with a whole bushel full.
My argument was that this is something of an expected result, because pricing policies has been made harder because the companies are less informed. All though that isn't accurate, they are just prohibited from using certain information they have, in effect it is the same thing. Sticks didn't get what I meant by less informed, thus the car analogy. It wasn't a comparison of consumers buying cars vs consumers buying insurance, it was just to demonstrate how insurance companies are pricing with less information now than they were pre-ACA.
The limitations on information apply to all insurers, as well as the restrictions on exclusuon. United made a bet on how price insensitive the market would be, and wound up on the wrong side of it.
Marty: The future, it's where you're going? Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
You are pointing at something which is not A, then saying, look how this is A! More things should be A!.
I don't know what made you think this last part.
I'm not saying the used car market is full of well informed people and the healthcare market should be like it. I'm saying the health care market is being made more like the used car market.
??? You said that prospective purchasers could inspect used cars and then use that information to properly price a used car, but the reality is that they can't. Most of the time, people can't inspect used cars in such a manner that they can properly price it due to logistical constraints, a lack of expertise, or deception by the seller. The used car market has always been broken, and then you rhetorically broke it a little more, and then said that the ACA was like the more broken version?
YES!
The prospective purchaser in the car analogy is the insurance company not a consumer, the practical issues for consumers buying a used car don't enter into it, the companies can do those things; 'pricing the used car' is what their entire business depends on. This entire tangent was about the companies(United HC in particular) and the market(not the exchanges but the insurance companies as a group trying to price/model their policies). Maybe this is what is hanging you up? I'm not talking about consumers, ACA has been okay for consumers.
For the insurance companies though, ACA is a huge negative change. They had information before that let them avoid the lemons very efficiently. Now they don't and one of them(United HC) ended up with a whole bushel full.
My argument was that this is something of an expected result, because pricing policies has been made harder because the companies are less informed. All though that isn't accurate, they are just prohibited from using certain information they have, in effect it is the same thing. Sticks didn't get what I meant by less informed, thus the car analogy. It wasn't a comparison of consumers buying cars vs consumers buying insurance, it was just to demonstrate how insurance companies are pricing with less information now than they were pre-ACA.
Okaay. It still seems to me that choosing another example other than used cars would have been... at least a lot clearer.
But more specifically, with insurance, that's always been the case. Insurance is a product that is predicated on a lack of information and amortization of those risks. As a concrete example, insurance companies are not allowed to force their customers to get genetic screening, as part of the Genetic Information Nondiscrimination Act.
More generally, insurance companies have never been able to predict when an earthquake was going to happen or whose house would burn down, etc., with 100% accuracy. Their entire business model is predicated upon estimating the probability and scale of such incidents, add in a statistical margin of error and a profit margin, and then amoritze those costs over all policy-holders. That's what they have all those actuarials for. It is in no way crippling for an insurance company to be denied a certain amount of information, so long as they can compensate for it appropriately in their prediction models. With a single case in such a short-term history, it would be a stretch to say that the market is fundamentally broken as compared to saying that one particular player in this market didn't hedge properly and flopped due to their own failures.
That's distinct from the situation for an individual consumer who's buying any particular product. No individual consumer can, for example, properly amortize a non-zero chance of there being a critical manufacturing defect in their car. One cannot buy 1% of 200 cars each have a 50% chance of being defective and assemble a complete, functional car from that.
0
Magus`The fun has been DOUBLED!Registered Userregular
edited February 2016
I just wanted to add that even though I get insurance through my job it still feels kind of shitty. Most of my costs are monthly meds which our new provider, Cigna, are requiring a copay of at least 15 bucks. Not to mention a deductible of 2,000/2,500 dollars means I need to not need anything serious or it needs to be holy shit serious.
I had a friend who got healthcare through the ACA for 75 a month which had like $150 deductible and $550 out of pocket. Admittedly she needs it more than I do but the fact that I owe 1,600 to for an (turns out unneeded) ER visit WITH insurance makes me wonder why my $100 a month plan is so goddamn shitty.
You are pointing at something which is not A, then saying, look how this is A! More things should be A!.
I don't know what made you think this last part.
I'm not saying the used car market is full of well informed people and the healthcare market should be like it. I'm saying the health care market is being made more like the used car market.
??? You said that prospective purchasers could inspect used cars and then use that information to properly price a used car, but the reality is that they can't. Most of the time, people can't inspect used cars in such a manner that they can properly price it due to logistical constraints, a lack of expertise, or deception by the seller. The used car market has always been broken, and then you rhetorically broke it a little more, and then said that the ACA was like the more broken version?
YES!
The prospective purchaser in the car analogy is the insurance company not a consumer, the practical issues for consumers buying a used car don't enter into it, the companies can do those things; 'pricing the used car' is what their entire business depends on. This entire tangent was about the companies(United HC in particular) and the market(not the exchanges but the insurance companies as a group trying to price/model their policies). Maybe this is what is hanging you up? I'm not talking about consumers, ACA has been okay for consumers.
For the insurance companies though, ACA is a huge negative change. They had information before that let them avoid the lemons very efficiently. Now they don't and one of them(United HC) ended up with a whole bushel full.
My argument was that this is something of an expected result, because pricing policies has been made harder because the companies are less informed. All though that isn't accurate, they are just prohibited from using certain information they have, in effect it is the same thing. Sticks didn't get what I meant by less informed, thus the car analogy. It wasn't a comparison of consumers buying cars vs consumers buying insurance, it was just to demonstrate how insurance companies are pricing with less information now than they were pre-ACA.
They also got an individual mandate which means a lot of healthy, young people are now paying in premiums. Which is literally the exact way that the law was designed to work. More healthy people pay in so that more sick people can get covered.
More coverage = higher revenue and profits. UnitedHealth has outperformed the broader stock market by a wide margin since the Affordable Care Act, or Obamacare, was signed into law in March 2010.
The stock also beat the market last year as most of the provisions of the ACA went into effect and consumers started to receive coverage.
Simply put, greater access to health insurance has led to more customers for the insurance giants. And UnitedHealth is not the only company to benefit.
The other four members of the so-called Big Five health insurers -- Aetna (AET), Cigna (CI), Humana (HUM), and Anthem (ANTM) (formerly WellPoint) -- have all beaten the S&P 500 over the past five years or so as well.
Although previously feared by insurers, the changes and challenges put forth by the health care reform act haven't really caused any damage. On the contrary, health insurers have benefited from the enrollment of millions of new members that has in turn increased their sales. Big players like CIGNA Corp. (CI), Anthem Inc. (ANTM), Humana Inc. (HUM), Health Net, Inc. (HNT), UnitedHealth Group Inc. (UNH), Molina Healthcare, Inc. (MOH) and Centene Corp. (CNC) have reported unfaltering growth in premiums, fees and other income since health care reform was put into effect.
From the period 2010 to 2014, the revenues of these insurers, which control a major market share of the private health insurance industry, increased 45% to approximately $375 billion while operating profit increased 65% to $21 billion.
That UNH somehow fumbled a market with a 65% jump in operating profits over four years isn't the fault of the ACA, it's the fault of UNH leadership being dumber than a sack of wet hammers.
Also, analogies around health care do not work. They never have, they never will, especially with relation to cars. They get trotted out all the time and every single time they leave out the fact that we're talking about living people. They only muddle the issue. If you have a point to make, it's far, far better to just make it.
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
For fun, I looked up what health insurance costs on the exchanges. And it turns out they are pretty goddamn awful.
The cheapest Bronze plan available in my area (Queens, NY) is $3840 in premiums annually. You get no subsidy whatsoever if you make more than $45,000 a year. There is a $3500 deductible with a $6850 max out of pocket.
10/35/70 rx after deductible.
and everything outside of your physical is 50% coinsurance after you meet your deductible. For some reason this plan isn't HSA eligible.
So basically if you get into some serious medical shit, you need to pay $10700 out of pocket per year. What the fffuuuuccccccckkkkk
Silver plans have additional cost sharing provisions, out of pocket expenses are capped at ~10% of income (IIRC, its been awhile since I looked into stuff), and as with everything income is AGI not straight salary (so more like making over $52k++, not $45).
Not that you'll get much argument from me that it should be less stingy.
@moniker As far as I know, there is no out of pocket income cap. However, you're able to deduct out of pocket expenses that exceed 10% of your income if you itemize.
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
The problem is, again, that this isn't true.
The penalty fee is pretty small. Most people can pay it out if their tax return and still probably get something back.
On the other hand, the means to get a special enrollment exception is fairly generous.
I can go all year without insurance, then end up with like... A tumor in July or something and wiggle my way into special enrollment. Join up with the most expensive or blinged out platinum plans, and they will instant have to pay out thousands for treatment while I probably gave them like $200 for that first payment.
There is currently no way for an insurance company to avoid this. Anyone can game the system pretty hard.
Not that Im particularly sympathetic considering how long they've been fucking your average consumer, but there are some flaws to be looked at.
0
FencingsaxIt is difficult to get a man to understand, when his salary depends upon his not understandingGNU Terry PratchettRegistered Userregular
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
The problem is, again, that this isn't true.
The penalty fee is pretty small. Most people can pay it out if their tax return and still probably get something back.
On the other hand, the means to get a special enrollment exception is fairly generous.
I can go all year without insurance, then end up with like... A tumor in July or something and wiggle my way into special enrollment. Join up with the most expensive or blinged out platinum plans, and they will instant have to pay out thousands for treatment while I probably gave them like $200 for that first payment.
There is currently no way for an insurance company to avoid this. Anyone can game the system pretty hard.
Not that Im particularly sympathetic considering how long they've been fucking your average consumer, but there are some flaws to be looked at.
I mean, those flaws are mostly stem from "any sane and acceptable health insurance structure shouldn't be making a profit", but yes.
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
The problem is, again, that this isn't true.
The penalty fee is pretty small. Most people can pay it out if their tax return and still probably get something back.
On the other hand, the means to get a special enrollment exception is fairly generous.
I can go all year without insurance, then end up with like... A tumor in July or something and wiggle my way into special enrollment. Join up with the most expensive or blinged out platinum plans, and they will instant have to pay out thousands for treatment while I probably gave them like $200 for that first payment.
There is currently no way for an insurance company to avoid this. Anyone can game the system pretty hard.
Not that Im particularly sympathetic considering how long they've been fucking your average consumer, but there are some flaws to be looked at.
I mean, those flaws are mostly stem from "any sane and acceptable health insurance structure shouldn't be making a profit", but yes.
They also shouldn't be losing money, either, by this metric.
Especially because it can mean people losing their jobs and such. Since the peons are always the first to go.
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
The problem is, again, that this isn't true.
The penalty fee is pretty small. Most people can pay it out if their tax return and still probably get something back.
On the other hand, the means to get a special enrollment exception is fairly generous.
I can go all year without insurance, then end up with like... A tumor in July or something and wiggle my way into special enrollment. Join up with the most expensive or blinged out platinum plans, and they will instant have to pay out thousands for treatment while I probably gave them like $200 for that first payment.
There is currently no way for an insurance company to avoid this. Anyone can game the system pretty hard.
Not that Im particularly sympathetic considering how long they've been fucking your average consumer, but there are some flaws to be looked at.
Like? In your hypothetical scenario tomorrow you get super cancer what do you do to get a special enrollment period?
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
The problem is, again, that this isn't true.
The penalty fee is pretty small. Most people can pay it out if their tax return and still probably get something back.
On the other hand, the means to get a special enrollment exception is fairly generous.
I can go all year without insurance, then end up with like... A tumor in July or something and wiggle my way into special enrollment. Join up with the most expensive or blinged out platinum plans, and they will instant have to pay out thousands for treatment while I probably gave them like $200 for that first payment.
There is currently no way for an insurance company to avoid this. Anyone can game the system pretty hard.
Not that Im particularly sympathetic considering how long they've been fucking your average consumer, but there are some flaws to be looked at.
Like? In your hypothetical scenario tomorrow you get super cancer what do you do to get a special enrollment period?
Cancel my work insurance claiming it's too much of a financial burden.
Just quit. Hell, my job would never really schedule around that kind of sickness anyway.
Move to another town outside of my current insurances coverage.
Get a cheap marriage license ($76 where I live), then annulment after changing plans.
Those are just off the top of my head from when I skimmed the aca site. I'm sure if I dug a bit I could find even simpler ways, but all are way cheaper than the 10k+ surgery alone.
0
Gabriel_Pitt(effective against Russian warships)Registered Userregular
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
The problem is, again, that this isn't true.
The penalty fee is pretty small. Most people can pay it out if their tax return and still probably get something back.
On the other hand, the means to get a special enrollment exception is fairly generous.
I can go all year without insurance, then end up with like... A tumor in July or something and wiggle my way into special enrollment. Join up with the most expensive or blinged out platinum plans, and they will instant have to pay out thousands for treatment while I probably gave them like $200 for that first payment.
There is currently no way for an insurance company to avoid this. Anyone can game the system pretty hard.
Not that Im particularly sympathetic considering how long they've been fucking your average consumer, but there are some flaws to be looked at.
Like? In your hypothetical scenario tomorrow you get super cancer what do you do to get a special enrollment period?
Cancel my work insurance claiming it's too much of a financial burden.
Just quit. Hell, my job would never really schedule around that kind of sickness anyway.
Move to another town outside of my current insurances coverage.
Get a cheap marriage license ($76 where I live), then annulment after changing plans.
Those are just off the top of my head from when I skimmed the aca site. I'm sure if I dug a bit I could find even simpler ways, but all are way cheaper than the 10k+ surgery alone.
So in other words, you have no idea at all how to get a special enrollment period.
Or would you like to try again, but without the pants on head stuff?
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
yes moving on a whim is a quick, cheap, and easy process
:eh:
life's a game that you're bound to lose / like using a hammer to pound in screws
fuck up once and you break your thumb / if you're happy at all then you're god damn dumb
that's right we're on a fucked up cruise / God is dead but at least we have booze
bad things happen, no one knows why / the sun burns out and everyone dies
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
yes moving on a whim is a quick, cheap, and easy process
:eh:
I desperately need medical insurance right now. Best time to move!
0
Gabriel_Pitt(effective against Russian warships)Registered Userregular
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
Insurers straight up traded all the exception and pre-existing condition crap for the fact that every adult in the country has to buy insurance from them.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
I'm not seeing the privilege in most of those. Yea, there are definitely people who wouldn't be able to move away even if their life depended on it. The number of people who couldn't scrounge $76 to get "married"? That's going to be a ridiculously small number. Quitting your job would also be feasible for a lot of people, unless you're in an area with exceedingly high unemployment rates and you would be concerned about being able to find a new one.
Assuming gaming the system in this way is actually valid and won't land you in jail, that's an issue that deserves to be looked at.
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
I'm not seeing the privilege in most of those. Yea, there are definitely people who wouldn't be able to move away even if their life depended on it. The number of people who couldn't scrounge $76 to get "married"? That's going to be a ridiculously small number. Quitting your job would also be feasible for a lot of people, unless you're in an area with exceedingly high unemployment rates and you would be concerned about being able to find a new one.
Assuming gaming the system in this way is actually valid and won't land you in jail, that's an issue that deserves to be looked at.
Remember on all of these you will have a million if not billion dollar company with a strong incentive to prove that you were committing fraud. The marriage one will get you in trouble. The employment one is somewhat valid if you can get a new job with super cancer. That's a pretty big fucking if.
This is all ignoring that it may not be super cancer, it could be getting run over by an uninsured driver while walking down the sidewalk or a heart murmur that finally let go or any of a huge amount of other things that have sudden onset and you won't be in a condition to do much but lay on your back and rack up thousands of dollars an hour in bills.
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
I'm not seeing the privilege in most of those. Yea, there are definitely people who wouldn't be able to move away even if their life depended on it. The number of people who couldn't scrounge $76 to get "married"? That's going to be a ridiculously small number. Quitting your job would also be feasible for a lot of people, unless you're in an area with exceedingly high unemployment rates and you would be concerned about being able to find a new one.
Assuming gaming the system in this way is actually valid and won't land you in jail, that's an issue that deserves to be looked at.
Remember on all of these you will have a million if not billion dollar company with a strong incentive to prove that you were committing fraud. The marriage one will get you in trouble. The employment one is somewhat valid if you can get a new job with super cancer. That's a pretty big fucking if.
This is all ignoring that it may not be super cancer, it could be getting run over by an uninsured driver while walking down the sidewalk or a heart murmur that finally let go or any of a huge amount of other things that have sudden onset and you won't be in a condition to do much but lay on your back and rack up thousands of dollars an hour in bills.
That obviously isn't deterring some people from not getting coverage. Some of them will end up with super-cancer (or even regular cancer, or one of the many chronic diseases which can lead you into medical bankruptcy). If they are able to forego paying and then hop on a plan at the last minute via legal means, that is a loop hole worth investigating.
This entire system is predicated on the assumption that enough people are going to pay into it while healthy to keep it afloat for everyone who needs it. Anything that incentivizes gaming the system needs to be treated seriously to make sure it doesn't negate that assumption.
Of course this all probably a moot point. If we can't fix obviously broken things like the Medicaid gap, we probably can't muster the political will to fix any potential loop holes either.
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
I'm not seeing the privilege in most of those.
Quitting your job would also be feasible for a lot of people,
.
Are you serious?
+20
JuliusCaptain of Serenityon my shipRegistered Userregular
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
To be fair, the problem outlined is exactly one of privileged people. For those who need it the least, getting around it is the easiest. And it is that group that others actually need the most to participate.
That said, trying it sounds really risky and dumb.
Over here they just solve this issue by having the penalty be 130% of the price of basic insurance. So regardless of super cancer it is always dumber to not get insurance.
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
I'm not seeing the privilege in most of those.
Quitting your job would also be feasible for a lot of people,
.
Are you serious?
Should I not be? We're assuming a pretty drastic situation here, not a minor inconvenience. The only reason I can think of that you wouldn't quit your job to avoid being financially crippled is if you didn't think you could find another job at all, which I already acknowledged.
If that's off base, please enlighten me.
edit: Bleh nexus is right. This is a dumb hypothetical. I'm drastically overestimating the benefits of a good health insurance plan.
I know if I'm going to have major health problem my first instinct would be to cut off my source of income so I can buy a 2000 deductible health insurance plan.....
I mean, you can claim they won't work or that omg fraud but like, I got special enrollment last year because I literally crossed the road from one county to another.
So like, okay? I know how easy it is. I've done it.
Beginning in the next several months, all consumers who enroll or change plans using an SEP for any of the following triggering events will be directed to provide documentation:
Loss of minimum essential coverage,
Permanent move,
Birth,
Adoption, placement for adoption, placement for foster care or child support or other court order, or
Marriage.
These SEPs represented three quarters of HealthCare.gov consumers who enrolled or changed plans using an SEP in the second half of 2015.
I'm more than a little surprised they didn't require dependant verification? I've had to provide that stuff to change my employer plan for spousing up and such.
+2
jmcdonaldI voted, did you?DC(ish)Registered Userregular
I'm more than a little surprised they didn't require dependant verification? I've had to provide that stuff to change my employer plan for spousing up and such.
yeah. this list seems more like "leveling the playing field" than anything else.
any of those changes through my employee plan would require documentation. and I only get 30 days to do it from the major life event.
I'm more than a little surprised they didn't require dependant verification? I've had to provide that stuff to change my employer plan for spousing up and such.
yeah. this list seems more like "leveling the playing field" than anything else.
any of those changes through my employee plan would require documentation. and I only get 30 days to do it from the major life event.
Heh. Good thing I'll be getting married right around open enrollment for our employer (me and my fiance work for the same company.) So we shouldn't have to worry about SEP, thankfully.
I'm more than a little surprised they didn't require dependant verification? I've had to provide that stuff to change my employer plan for spousing up and such.
yeah. this list seems more like "leveling the playing field" than anything else.
any of those changes through my employee plan would require documentation. and I only get 30 days to do it from the major life event.
I got in a little fight with my employer because they were trying to deny coverage for a very brief period after my daughter was born.
"You had 30 days to submit her birth certificate."
"We submitted it after 32 because she was in the hospital after birth for heart surgery. You knew this."
"We said 30 days, you are past your limit."
"The rules on your fucking website and in the documentation we were provided said dependents under six months of age are exempt from the requirement!"
"..... we'll be in touch."
Sounds like more congressional fuckmuppery to me. "The law says we have to pay these people but we didn't technically set aside money specifically to do that. Neener, neener, ACA sucks."
Just remember that half the people you meet are below average intelligence.
After being let go as part of a "reduction of force" from my job, I waited for that last month of insurance I'd actually paid for to come to an end, and refiled my 2016 application on Healthcare.gov--unsurprisingly, the website works a great deal better when thousands rather than millions of people are swamping it (the difference between applying in May of 2016, and December of 2015, was marked--never mind when the website first went up).
I encountered something I was only vaguely familiar with: what's being called a "special exemption" for termination of work. Since I was laid off, if I'm unfortunately unable to find work that provides an insurance plan in a three month period (and I'm unwilling to bankrupt myself paying for the at best mediocre insurance while in between jobs), I'm exempt from the $695 penalty come filing my 2016 taxes in 2017. In fact, worst comes to worst, I'm exempt for the rest of the year, not just three months.
I can understand the implications of that--even if I am not joking in saying that, in the face of a serious medical crisis, I would literally buy the earliest available airline ticket for my homeland and hope I don't die before I can get treatment (which was true when I was insured as well)--and I realize that, regrettably, I'm contributing to the large-scale problem of costs and funding. On the other hand, I'm also between jobs, which seems as good a time as any to be greedy and frugal. And given that, in Georgia, I am simultaneously too wealthy to apply for Medicaid and too poor to apply for my state's insurance cost support, I'm very glad the exemption exists.
Also, when calling the Marketplace phoneline, I barely had to wait, and the specialist I was connected to explained everything very clearly. So top marks for that particular aspect.
EDIT: In case there was any doubt, Georgia is of course a state that did not expand medicaid. And the website correctly reminded me of such.
Posts
YES!
The prospective purchaser in the car analogy is the insurance company not a consumer, the practical issues for consumers buying a used car don't enter into it, the companies can do those things; 'pricing the used car' is what their entire business depends on. This entire tangent was about the companies(United HC in particular) and the market(not the exchanges but the insurance companies as a group trying to price/model their policies). Maybe this is what is hanging you up? I'm not talking about consumers, ACA has been okay for consumers.
For the insurance companies though, ACA is a huge negative change. They had information before that let them avoid the lemons very efficiently. Now they don't and one of them(United HC) ended up with a whole bushel full.
My argument was that this is something of an expected result, because pricing policies has been made harder because the companies are less informed. All though that isn't accurate, they are just prohibited from using certain information they have, in effect it is the same thing. Sticks didn't get what I meant by less informed, thus the car analogy. It wasn't a comparison of consumers buying cars vs consumers buying insurance, it was just to demonstrate how insurance companies are pricing with less information now than they were pre-ACA.
Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
The limitations on information apply to all insurers, as well as the restrictions on exclusuon. United made a bet on how price insensitive the market would be, and wound up on the wrong side of it.
Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
Okaay. It still seems to me that choosing another example other than used cars would have been... at least a lot clearer.
But more specifically, with insurance, that's always been the case. Insurance is a product that is predicated on a lack of information and amortization of those risks. As a concrete example, insurance companies are not allowed to force their customers to get genetic screening, as part of the Genetic Information Nondiscrimination Act.
More generally, insurance companies have never been able to predict when an earthquake was going to happen or whose house would burn down, etc., with 100% accuracy. Their entire business model is predicated upon estimating the probability and scale of such incidents, add in a statistical margin of error and a profit margin, and then amoritze those costs over all policy-holders. That's what they have all those actuarials for. It is in no way crippling for an insurance company to be denied a certain amount of information, so long as they can compensate for it appropriately in their prediction models. With a single case in such a short-term history, it would be a stretch to say that the market is fundamentally broken as compared to saying that one particular player in this market didn't hedge properly and flopped due to their own failures.
That's distinct from the situation for an individual consumer who's buying any particular product. No individual consumer can, for example, properly amortize a non-zero chance of there being a critical manufacturing defect in their car. One cannot buy 1% of 200 cars each have a 50% chance of being defective and assemble a complete, functional car from that.
I had a friend who got healthcare through the ACA for 75 a month which had like $150 deductible and $550 out of pocket. Admittedly she needs it more than I do but the fact that I owe 1,600 to for an (turns out unneeded) ER visit WITH insurance makes me wonder why my $100 a month plan is so goddamn shitty.
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They also got an individual mandate which means a lot of healthy, young people are now paying in premiums. Which is literally the exact way that the law was designed to work. More healthy people pay in so that more sick people can get covered.
Autoplay video, because CNN is CNN
Here, with no stupid autoplay video.
That UNH somehow fumbled a market with a 65% jump in operating profits over four years isn't the fault of the ACA, it's the fault of UNH leadership being dumber than a sack of wet hammers.
Also, analogies around health care do not work. They never have, they never will, especially with relation to cars. They get trotted out all the time and every single time they leave out the fact that we're talking about living people. They only muddle the issue. If you have a point to make, it's far, far better to just make it.
If they can't properly manage a captive marketplace, then maybe we shouldn't rely on them to.
They tried to bury us. They didn't know that we were seeds. 2018 Midterms. Get your shit together.
@moniker As far as I know, there is no out of pocket income cap. However, you're able to deduct out of pocket expenses that exceed 10% of your income if you itemize.
The problem is, again, that this isn't true.
The penalty fee is pretty small. Most people can pay it out if their tax return and still probably get something back.
On the other hand, the means to get a special enrollment exception is fairly generous.
I can go all year without insurance, then end up with like... A tumor in July or something and wiggle my way into special enrollment. Join up with the most expensive or blinged out platinum plans, and they will instant have to pay out thousands for treatment while I probably gave them like $200 for that first payment.
There is currently no way for an insurance company to avoid this. Anyone can game the system pretty hard.
Not that Im particularly sympathetic considering how long they've been fucking your average consumer, but there are some flaws to be looked at.
I mean, those flaws are mostly stem from "any sane and acceptable health insurance structure shouldn't be making a profit", but yes.
They also shouldn't be losing money, either, by this metric.
Especially because it can mean people losing their jobs and such. Since the peons are always the first to go.
American healthcare system, pretty awful!
Like? In your hypothetical scenario tomorrow you get super cancer what do you do to get a special enrollment period?
Cancel my work insurance claiming it's too much of a financial burden.
Just quit. Hell, my job would never really schedule around that kind of sickness anyway.
Move to another town outside of my current insurances coverage.
Get a cheap marriage license ($76 where I live), then annulment after changing plans.
Those are just off the top of my head from when I skimmed the aca site. I'm sure if I dug a bit I could find even simpler ways, but all are way cheaper than the 10k+ surgery alone.
So in other words, you have no idea at all how to get a special enrollment period.
Or would you like to try again, but without the pants on head stuff?
So like, okay? I know how easy it is. I've done it.
yes moving on a whim is a quick, cheap, and easy process
:eh:
fuck up once and you break your thumb / if you're happy at all then you're god damn dumb
that's right we're on a fucked up cruise / God is dead but at least we have booze
bad things happen, no one knows why / the sun burns out and everyone dies
I desperately need medical insurance right now. Best time to move!
No, you don't. The fact that you don't realize it is deeply disturbing.
I hate to say it, but given that you seem to think the list you gave above is actually a legitimate response? Check your privelege.
Free market at work
QEDMF xbl: PantsB G+
I'm not seeing the privilege in most of those. Yea, there are definitely people who wouldn't be able to move away even if their life depended on it. The number of people who couldn't scrounge $76 to get "married"? That's going to be a ridiculously small number. Quitting your job would also be feasible for a lot of people, unless you're in an area with exceedingly high unemployment rates and you would be concerned about being able to find a new one.
Assuming gaming the system in this way is actually valid and won't land you in jail, that's an issue that deserves to be looked at.
Remember on all of these you will have a million if not billion dollar company with a strong incentive to prove that you were committing fraud. The marriage one will get you in trouble. The employment one is somewhat valid if you can get a new job with super cancer. That's a pretty big fucking if.
This is all ignoring that it may not be super cancer, it could be getting run over by an uninsured driver while walking down the sidewalk or a heart murmur that finally let go or any of a huge amount of other things that have sudden onset and you won't be in a condition to do much but lay on your back and rack up thousands of dollars an hour in bills.
or let your shit get real fucked up while you wait for the next open enrollment.
That obviously isn't deterring some people from not getting coverage. Some of them will end up with super-cancer (or even regular cancer, or one of the many chronic diseases which can lead you into medical bankruptcy). If they are able to forego paying and then hop on a plan at the last minute via legal means, that is a loop hole worth investigating.
This entire system is predicated on the assumption that enough people are going to pay into it while healthy to keep it afloat for everyone who needs it. Anything that incentivizes gaming the system needs to be treated seriously to make sure it doesn't negate that assumption.
Of course this all probably a moot point. If we can't fix obviously broken things like the Medicaid gap, we probably can't muster the political will to fix any potential loop holes either.
Are you serious?
To be fair, the problem outlined is exactly one of privileged people. For those who need it the least, getting around it is the easiest. And it is that group that others actually need the most to participate.
That said, trying it sounds really risky and dumb.
Over here they just solve this issue by having the penalty be 130% of the price of basic insurance. So regardless of super cancer it is always dumber to not get insurance.
Should I not be? We're assuming a pretty drastic situation here, not a minor inconvenience. The only reason I can think of that you wouldn't quit your job to avoid being financially crippled is if you didn't think you could find another job at all, which I already acknowledged.
If that's off base, please enlighten me.
edit: Bleh nexus is right. This is a dumb hypothetical. I'm drastically overestimating the benefits of a good health insurance plan.
So they're making it less easy to claim an SEP:
yeah. this list seems more like "leveling the playing field" than anything else.
any of those changes through my employee plan would require documentation. and I only get 30 days to do it from the major life event.
Heh. Good thing I'll be getting married right around open enrollment for our employer (me and my fiance work for the same company.) So we shouldn't have to worry about SEP, thankfully.
I got in a little fight with my employer because they were trying to deny coverage for a very brief period after my daughter was born.
"You had 30 days to submit her birth certificate."
"We submitted it after 32 because she was in the hospital after birth for heart surgery. You knew this."
"We said 30 days, you are past your limit."
"The rules on your fucking website and in the documentation we were provided said dependents under six months of age are exempt from the requirement!"
"..... we'll be in touch."
First story I could find:
http://www.modernhealthcare.com/article/20160512/NEWS/160519949
Should note this is a bit of a suicide option as it's fucking insurers who wouldn't be getting paid cost adjustment payments.
I encountered something I was only vaguely familiar with: what's being called a "special exemption" for termination of work. Since I was laid off, if I'm unfortunately unable to find work that provides an insurance plan in a three month period (and I'm unwilling to bankrupt myself paying for the at best mediocre insurance while in between jobs), I'm exempt from the $695 penalty come filing my 2016 taxes in 2017. In fact, worst comes to worst, I'm exempt for the rest of the year, not just three months.
I can understand the implications of that--even if I am not joking in saying that, in the face of a serious medical crisis, I would literally buy the earliest available airline ticket for my homeland and hope I don't die before I can get treatment (which was true when I was insured as well)--and I realize that, regrettably, I'm contributing to the large-scale problem of costs and funding. On the other hand, I'm also between jobs, which seems as good a time as any to be greedy and frugal. And given that, in Georgia, I am simultaneously too wealthy to apply for Medicaid and too poor to apply for my state's insurance cost support, I'm very glad the exemption exists.
Also, when calling the Marketplace phoneline, I barely had to wait, and the specialist I was connected to explained everything very clearly. So top marks for that particular aspect.
EDIT: In case there was any doubt, Georgia is of course a state that did not expand medicaid. And the website correctly reminded me of such.