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Many See I.R.S. Penalties as More Affordable Than Health Insurance

nytimes.com

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Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#311

Post by white-flame »

methodover wrote: post #17

> But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. They say they sorely need more healthy customers to balance out the costs of covering the sicker, older people who have flocked to exchange plans. Ah, the tragedy of the commons at work. Healthy people don't buy insurance because it's too expensive. Insurance i…

I'd have no problem with an actually centralized single-payer plan.

However, the ACA is shoehorning private, for-profit insurance companies into the middle of this, all the while constraining them and driving everybody's costs up by approximately 3x to most observations I've seen of myself and others.

To properly implement a government health care system would be to effectively destroy most if not all the for-profit insurance companies* and set up a system with a mandate for national health. Nobody's going to want to do that, politically.

* = Having a central system covering a lot of the basics, and insurance companies to provide "upsell" coverage could still exist, but those insurance companies would likely not be in the same ballpark of financial movement as they are today.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#312

Post by white-flame »

exabrial wrote: post #86

Obama said no one is losing their coverage. He didn't lie.

That is the one flag-waving thing they can say about this, that more people are eligible or covered (but that ≠ "no one lost their coverage"). Obama will wave that raw number flag hard to try to tout his legacy.

Literally everything else in all aspects of the American health care & health insurance industries is worse off because of it.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#313

Post by magicalist »

DrScump wrote: post #291
YokoZar wrote: post #268

Earlier quoted context omitted.

By preventing them from selling their insurance on the state-run exchange if they don't meet the standards.

OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.

> OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients

It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some area to meet its obligations it will then have to (though undoubtedly that will be eventually passed on to its customers).

Meanwhile it's an agonizingly slow process to get justice for the people that need it, but insurance companies forced to refund money for not meeting their network coverage requirements is in the news right now, specifically because "more than 25% of physicians listed by Anthem and Blue Shield weren't taking patients in the Covered California health exchange or were no longer at the location listed by the companies, according to the state's investigation."

http://www.latimes.com/business/healthcare/la-fi-obamacare-n...

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#314

Post by zo1 »

HarryHirsch wrote: post #130
Frondo wrote: post #116

Earlier quoted context omitted.

You know what? My pre-existing condition was that I'd had my gallbladder removed in the early 2000s. That's it. Uninsurable for 10 years because of an operation which I recovered from fully in less than a week. Telling me it's "regulations" that had every insurer reject me? Pull the other one, it's got bells on.

Citizen Frondo, you don't understand. If the market says you must not be insured it is right because the market is always right. Why, on this board you had people tell with a straight face that one should not bother to eradicate schistosomiasis and malaria in the African continent because if the continent was meant to be productive people would be spending money in the project right now.

If the OP is correct, then it is not the market that is enforcing the insurance scheme to reject cover for him based on pre-existing conditions, but rather the state that is making it illegal for schemes to be tailor-made for specific (pre-existing) conditions.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#315

Post by zo1 »

MCRed wrote: post #105
Frondo wrote: post #67

Earlier quoted context omitted.

When I read this stuff, I'm a little astounded about how bad the situation must be in other states. Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better. The provider I was on did go out of business so I had to switch, and I'm now paying less for more services. And, to be totally frank, having had a pre-existing condition that kept me from buying any insur…

The reason nobody could sell you insurance with your pre-existing condition before is that regulations prevented making plans for conditions. EG: You couldn't make a national diabetes insurance plan for people with diabetes (and the economies of scale that go along with a pool of all people with diabetes) because it was effectively illegal. If the ACA had merely fixed that, then your premiums would be going down more…

>"The reason nobody could sell you insurance with your pre-existing condition before is that regulations prevented making plans for conditions"

I didn't know about this, but it changes quite a bit regarding pre-existing conditions. Could you please point me to a citation or something about this?

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#316

Post by azinman2 »

DrScump wrote: post #249
azinman2 wrote: post #184

Earlier quoted context omitted.

In CA, that's not the case. Our insurance went up maybe $50/person, but we got mental health care, acupuncture, and various other benefits we didn't have before. Oh and we have pre-existing conditions that would prevent us from being insured if we didn't have employer-based. And this is all PPO.

You have coverage , but having care is a little different. For each of those features, do you have local providers who are willing to take on new patients and provide that care at the offered reimbursement rates? In much of CA, the answer is no.

For me in SF, it hasn't been an issue. We are PPO blue shield which everyone takes.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#317

Post by DrScump »

magicalist wrote: post #313
DrScump wrote: post #291

Earlier quoted context omitted.

OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.

> OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some are…

That article talks about fines for overstating their networks -- stating in marketing materials that they had more participating doctor availability in given region(s) than they actually had availability for all policies offered. False advertising, in a sense.

That is very different from the problem statement: how do you make a network offer inducements at a loss to recruit additional providers?

I'd guess that most people buying off CoveredCA.org don't even bother to look at participating providers accepting new patients before buying a policy. There is no element of law that says to an underwriter, "Hey, you gotta add more providers in this area and that area now, or we will punish you." The law doesn't give government that power.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#318

Post by DrScump »

magicalist wrote: post #313
DrScump wrote: post #291

Earlier quoted context omitted.

OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.

> OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some are…

  If a insurance network can't meet its obligations
  it will be fined or shut down
What are you claiming its obligations are? Its obligations are to pay valid claims made by covered parties. It does not have a legal obligation to add provider capacity to a given region.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#319

Post by akulbe »

Frondo wrote: post #67
mgkimsal wrote: post #40

Earlier quoted context omitted.

I understand premiums going up annually. I don't understand 30-50% increases year on year.

When I read this stuff, I'm a little astounded about how bad the situation must be in other states. Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better. The provider I was on did go out of business so I had to switch, and I'm now paying less for more services. And, to be totally frank, having had a pre-existing condition that kept me from buying any insur…

Who's your carrier currently? I'm in Oregon as well, and I'm not impressed with the offerings here, at all.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#320

Post by DrScump »

magicalist wrote: post #97
gscott wrote: post #2

I work with someone who has health insurance from the California exchange. His assigned doctor is about a 2 hour drive away. Maybe he has picked the cheapest plan but such a situation shouldn't really happen if this was well run.

FWIW as of 2015 California requires there be "primary care network providers with sufficient capacity to accept covered persons within 30 minutes or 15 miles of each covered person's residence or workplace", specialists within 60 minutes or 30 miles, and that there be sufficient capacity for doctors within those limits to accept new patients[1]. Getting that enforced isn't easy, but that situation not only shouldn't…

If you read the document in your link, you will see that that regulation expired last July.
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