500 Million Lines of Code

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Re: 500 Million Lines of Code

Post by nafod » Tue Feb 07, 2017 3:02 pm

Turdacious wrote:The deadline for March coverage on the exchanges was January 31. Trying to get last minute answers from HHS?
CMSStuff2.PNG
https://twitter.com/HealthCareGov/statu ... 6473524228

And we're back to where we started from: http://irongarmx.net/phpBB2/viewtopic.p ... 20#p762616
They should have done the Orbitz/Amazon type thing and let 3rd party companies compete to provide the best access to the insurance services.
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Re: 500 Million Lines of Code

Post by Turdacious » Thu Feb 09, 2017 2:21 pm

nafod wrote:
Turdacious wrote:The deadline for March coverage on the exchanges was January 31. Trying to get last minute answers from HHS?
CMSStuff2.PNG
https://twitter.com/HealthCareGov/statu ... 6473524228

And we're back to where we started from: http://irongarmx.net/phpBB2/viewtopic.p ... 20#p762616
They should have done the Orbitz/Amazon type thing and let 3rd party companies compete to provide the best access to the insurance services.
FWIW a short but good non-technical analysis along those lines: http://www.lifehealthpro.com/2017/02/08 ... ange-syste
(note- this site normally requires a subscription, but this link should work of you open it in Chrome).
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Re: 500 Million Lines of Code

Post by nafod » Thu Feb 09, 2017 2:58 pm

Turdacious wrote:
nafod wrote:
Turdacious wrote:The deadline for March coverage on the exchanges was January 31. Trying to get last minute answers from HHS?
CMSStuff2.PNG
https://twitter.com/HealthCareGov/statu ... 6473524228

And we're back to where we started from: http://irongarmx.net/phpBB2/viewtopic.p ... 20#p762616
They should have done the Orbitz/Amazon type thing and let 3rd party companies compete to provide the best access to the insurance services.
FWIW a short but good non-technical analysis along those lines: http://www.lifehealthpro.com/2017/02/08 ... ange-syste
(note- this site normally requires a subscription, but this link should work of you open it in Chrome).
Blocked, even with Chrome.

Does Trump have his own browser?
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Re: 500 Million Lines of Code

Post by Turdacious » Thu Feb 09, 2017 3:18 pm

Weird. It worked this morning. Here it is.
Here's my instinctive bias: Although writing about the possibility of the U.S. individual major medical market imploding in 2018 is interesting, and necessary, Seema Verma will probably come in and save us all.

Verma, an Indiana health care program consultant who is President Donald Trump's pick to be the next Centers for Medicare & Medicaid Services, sounds as if she's probably the sort of person who will talk sense into everyone and make it all OK. Maybe she'll also be a wonderful data wrangler who will find ways to answer all the health policy questions we've ever had — going back to what was up with that apple Adam and Eve tasted.

But so far, I think one big problem with all of the Obama administration love lavished on the Affordable Care Act exchange system, and the Republican hate smeared on it, is that the emotional debate over health policy has left important questions unanswered.

Overall ACA exchange plan enrollment for 2017 seems to be down a little, as opposed to up a little. But all that really proves is, if the Republicans in Congress really hate you, they can hurt your sales a little, by, for example, starving the health insurance risk management program subsidies that insurers were counting on. No surprise there.

What might be a little more interesting would be a clear, honest count that determines how much the ACA exchange system and coverage really cost when compared with likely alternatives.

One reason Congress looked into setting up a government-run version of eHealthInsurance.com to start with is that eHealth Inc., the Mountain View, California-based parent of eHealthInsurance.com, was too small to knock state regulator and insurance company heads together and get everything standardized, or create underwriting simplified enough to make instant web sales possible.

In most states, eHealth had a hard time selling health insurance through an instant sales process, the way Amazon.com would sell books, because consumers had to go through a medical underwriting process, and compare plans that were about as similar as chickens and lawnmowers.

So now that the rules have been standardized, and the exchange enrollment and administration systems are set up, after a fashion, how much does the ACA exchange enrollment process cost per enrollee?

How much does the account administration process cost per enrollee?

How much does the coverage cost the government, and how much does it cost the enrollee? (CMS has given us answers to this question for earlier years; now we just need the 2017 data.)

Then, how much do the enrollment and enrollee relationship administration processes cost for managed Medicaid plan enrollees, and how much does managed Medicaid coverage cost?

What if you beefed up the managed Medicaid plan coverage to be more comparable to exchange plan coverage. How much would benefits richness and provider network adjusted managed Medicaid coverage really cost for people now in the ACA exchange plan coverage?

What would the comparable costs be if we put everyone in Medicare Advantage plans?

Just for kicks, how much might the comparable costs be if eHealthInsurance.com and other web brokers and brick-and-mortar brokers crowded out the ACA exchange system? What would all the costs be then?

If we had nice charts comparing the costs of the different kinds of systems side by side, then we could choose an alternative based on facts, as opposed to emotion.

What we need, basically, is a national health care system selection website that would let us compare and select national health care systems on an apples-to-apples basis. Maybe we could rate the richness of national health care systems based on the level of actuarial value provided, with some kind of Summary of Benefits and Costs that would be like a milk carton nutrition label for national health care systems.

I think I've heard of something like this before. If I step away from the computer for a while, maybe the name of that concept will come to me...
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Re: 500 Million Lines of Code

Post by nafod » Thu Feb 09, 2017 3:27 pm

Turdacious wrote:Weird. It worked this morning. Here it is.
Here's my instinctive bias: Although writing about the possibility of the U.S. individual major medical market imploding in 2018 is interesting, and necessary, Seema Verma will probably come in and save us all.

Verma, an Indiana health care program consultant who is President Donald Trump's pick to be the next Centers for Medicare & Medicaid Services, sounds as if she's probably the sort of person who will talk sense into everyone and make it all OK. Maybe she'll also be a wonderful data wrangler who will find ways to answer all the health policy questions we've ever had — going back to what was up with that apple Adam and Eve tasted.

But so far, I think one big problem with all of the Obama administration love lavished on the Affordable Care Act exchange system, and the Republican hate smeared on it, is that the emotional debate over health policy has left important questions unanswered.

Overall ACA exchange plan enrollment for 2017 seems to be down a little, as opposed to up a little. But all that really proves is, if the Republicans in Congress really hate you, they can hurt your sales a little, by, for example, starving the health insurance risk management program subsidies that insurers were counting on. No surprise there.

What might be a little more interesting would be a clear, honest count that determines how much the ACA exchange system and coverage really cost when compared with likely alternatives.

One reason Congress looked into setting up a government-run version of eHealthInsurance.com to start with is that eHealth Inc., the Mountain View, California-based parent of eHealthInsurance.com, was too small to knock state regulator and insurance company heads together and get everything standardized, or create underwriting simplified enough to make instant web sales possible.

In most states, eHealth had a hard time selling health insurance through an instant sales process, the way Amazon.com would sell books, because consumers had to go through a medical underwriting process, and compare plans that were about as similar as chickens and lawnmowers.

So now that the rules have been standardized, and the exchange enrollment and administration systems are set up, after a fashion, how much does the ACA exchange enrollment process cost per enrollee?

How much does the account administration process cost per enrollee?

How much does the coverage cost the government, and how much does it cost the enrollee? (CMS has given us answers to this question for earlier years; now we just need the 2017 data.)

Then, how much do the enrollment and enrollee relationship administration processes cost for managed Medicaid plan enrollees, and how much does managed Medicaid coverage cost?

What if you beefed up the managed Medicaid plan coverage to be more comparable to exchange plan coverage. How much would benefits richness and provider network adjusted managed Medicaid coverage really cost for people now in the ACA exchange plan coverage?

What would the comparable costs be if we put everyone in Medicare Advantage plans?

Just for kicks, how much might the comparable costs be if eHealthInsurance.com and other web brokers and brick-and-mortar brokers crowded out the ACA exchange system? What would all the costs be then?

If we had nice charts comparing the costs of the different kinds of systems side by side, then we could choose an alternative based on facts, as opposed to emotion.

What we need, basically, is a national health care system selection website that would let us compare and select national health care systems on an apples-to-apples basis. Maybe we could rate the richness of national health care systems based on the level of actuarial value provided, with some kind of Summary of Benefits and Costs that would be like a milk carton nutrition label for national health care systems.

I think I've heard of something like this before. If I step away from the computer for a while, maybe the name of that concept will come to me...
I'm down with that.
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Re: 500 Million Lines of Code

Post by Turdacious » Thu Feb 09, 2017 3:33 pm

A big problem is that Medicaid is FUBAR, can't meet these standards, and 48 states aren't willing to spend the money to rectify it. Medicare Advantage isn't much better.
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Re: 500 Million Lines of Code

Post by Turdacious » Wed Apr 26, 2017 2:18 pm

Some of you might be interested in this. I haven't used it and don't know anyone who has.
Find-a-doctor site Amino has raised $25 million in a Series C round of venture funding, according to CEO and co-founder David Vivero. Highland Capital led the investment joined by Accel, Aspect Ventures, CRV, Northwestern Mutual Future Ventures, and Pilot Wall Group.

A ZocDoc competitor, Amino gives users the ability to search for doctors who are most experienced in treating their particular ailment and tend to deliver the best health outcomes to patients of a similar profile. The company ranks doctors based on analysis of insurance claims and medical billing records, not merely user ratings or availability of appointments.

Users can filter lists of doctors by different scores from the likelihood they’ll perform a certain procedure, like a C-section, to their location or whether or not they accept a certain insurance carrier. The site includes both a cost estimation tool and virtual assistant that can book and confirm appointments for patients.

Vivero said that he was inspired to start Amino after frustrations seeking treatment and insurance plans that would cover his own, relatively rare condition– hereditary hemachromatosis, a metabolic disorder where your body fails to filter out too much iron. Now, the CEO reports, Amino includes information about some 910,000 physicians working in the US, and the estimated costs for about 100 different types of common procedures like DTaP vaccines for infants, X-rays or MRIs.
https://techcrunch.com/2017/04/04/amino ... help-them/

This article has some numbers for the DC metro area.
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Re: 500 Million Lines of Code

Post by TerryB » Thu Apr 27, 2017 12:55 am

Turdacious wrote:Internist and public health professor at Harvard writes about his experiences with high deductible plans for family care:
Here’s my major takeaway so far from this ongoing experiment: Simply asking people to pay out of pocket for their health care doesn’t create a health care marketplace. If we are going to be serious about creating one, we have to generate much more innovation in care delivery models, including much more leeway on the scope of practice regulations, such as letting nurses do a lot of the things that only doctors can do today.

We must be much more aggressive about price transparency and make quality data ubiquitous. The way we’re doing it now, even I as a doctor and a health policy expert can’t figure out when I or my family’s needs are worth the expense. If we continue with high-deductible health plans the way they exist today, more and more people will experience what my family did — the stress of having to make medical decisions with little information and few choices. At best, we’ll have a health care system that might save a little money — but at the risk of harming the health of our citizens.
https://www.statnews.com/2017/02/06/hea ... xperiment/
This is interesting.

A marketplace could develop that would benefit us all, but people, including politicians, don't want to face the short-term hardships that will occur first.
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Re: 500 Million Lines of Code

Post by Turdacious » Mon Jul 24, 2017 3:31 pm

Because this trend might effect many of you...
Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.
https://www.nytimes.com/2017/07/24/upsh ... .html?_r=0

The article misses a key point from the paper it's based on.
In our data, we find that when EmCare – which has an average out-of-network billing rate of 62% - takes over the management of emergency services at hospitals with low out-of-network rates, they raise out-ofnetwork rates by over 81 percentage points and increases average physician payments by 117%. Consistent with our model, there are clear benefits for the hospital when EmCare takes over management of its ED. Following the entry of EmCare, facility payments increase by 11%. These increased payments are driven, in part, by increases in imaging rates of 5%, and a 23% increase in the rate that physicians admitted patients to the hospital. We also find that following the entry of EmCare, physicians were 43% more likely to bill for emergency visits using the highest paying and highest acuity billing code. Interestingly, TeamHealth – which has an average out-of-network billing rate of 13% - appears to have a somewhat different strategy. On average, in our data, when TeamHealth enters a hospital, out-of-network rates increase by 33 percentage points and physician payment rates increase by 68%. However, the entry of TeamHealth is not associated with an increase in the rate imaging studies are performed, the rate patients are admitted to the hospital, or the rate that physicians bill using the highest paying billing code for emergency care. Instead, we find that the entry of TeamHealth led to a 30% increase in the number of cases treated per year in entry hospitals’ EDs. Our finding that the two large management companies pursue such distinct strategies indicates that any policy response in this area should be nuanced.
http://www.nber.org/papers/w23623
It's not that you're likely to pay out-of-network rates, it's that there's tremendous variety in the ways you'll get hit by them.
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Re: 500 Million Lines of Code

Post by Herv100 » Fri Oct 13, 2017 5:30 pm

Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
=D>

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Re: 500 Million Lines of Code

Post by Turdacious » Fri Oct 13, 2017 8:11 pm

Herv100 wrote:
Fri Oct 13, 2017 5:30 pm
Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
That's cute. Nothing in the EO bends the overall cost curve down. Insurers will just pass those costs on (who do you think administers association plans?), and people in the individual market who don't receive subsidies will face even bigger cost increases next year.

The thing that gets me is the other thing that was announced yesterday: a nominee for Dept of Labor Assistant Sec for Employee Benefits Security nominee (i.e. the person who oversees the agency that will write these new association plan rules). The nominee needs to be confirmed by the Senate. The cart's a few miles before the horse on this one.
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Re: 500 Million Lines of Code

Post by DrDonkeyLove » Fri Oct 13, 2017 8:24 pm

Turdacious wrote:
Fri Oct 13, 2017 8:11 pm
Herv100 wrote:
Fri Oct 13, 2017 5:30 pm
Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
That's cute. Nothing in the EO bends the overall cost curve down. Insurers will just pass those costs on (who do you think administers association plans?), and people in the individual market who don't receive subsidies will face even bigger cost increases next year.
Seems like the one consistent feature of health insurance is paying more for less regardless of the administration. It's kind of hard to get excited about one administration's panacea over another's.
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Re: 500 Million Lines of Code

Post by Turdacious » Fri Oct 13, 2017 8:30 pm

DrDonkeyLove wrote:
Fri Oct 13, 2017 8:24 pm
Turdacious wrote:
Fri Oct 13, 2017 8:11 pm
Herv100 wrote:
Fri Oct 13, 2017 5:30 pm
Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
That's cute. Nothing in the EO bends the overall cost curve down. Insurers will just pass those costs on (who do you think administers association plans?), and people in the individual market who don't receive subsidies will face even bigger cost increases next year.
Seems like the one consistent feature of health insurance is paying more for less regardless of the administration. It's kind of hard to get excited about one administration's panacea over another's.
I really don't like the timing either. It increases uncertainty, which increases risk, which increases cost. I really hope noone here is in the individual market.
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Re: 500 Million Lines of Code

Post by DrDonkeyLove » Fri Oct 13, 2017 9:14 pm

Turdacious wrote:
Fri Oct 13, 2017 8:30 pm
DrDonkeyLove wrote:
Fri Oct 13, 2017 8:24 pm
Turdacious wrote:
Fri Oct 13, 2017 8:11 pm
Herv100 wrote:
Fri Oct 13, 2017 5:30 pm
Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
That's cute. Nothing in the EO bends the overall cost curve down. Insurers will just pass those costs on (who do you think administers association plans?), and people in the individual market who don't receive subsidies will face even bigger cost increases next year.
Seems like the one consistent feature of health insurance is paying more for less regardless of the administration. It's kind of hard to get excited about one administration's panacea over another's.
I really don't like the timing either. It increases uncertainty, which increases risk, which increases cost. I really hope noone here is in the individual market.
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Re: 500 Million Lines of Code

Post by dead man walking » Fri Oct 13, 2017 10:07 pm

waiting to see what my wife's indiv policy is going to cost.

universal health care is the only approach that makes sense. the "market" is a cruel joke.
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Re: 500 Million Lines of Code

Post by nafod » Fri Oct 13, 2017 10:34 pm

Herv100 wrote:
Fri Oct 13, 2017 5:30 pm
Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
=D>
Speaking of turds, Trump's been dropping these things all over the place this week. Been busy.

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Re: 500 Million Lines of Code

Post by Herv100 » Fri Oct 13, 2017 11:14 pm

Turdacious wrote:
Fri Oct 13, 2017 8:11 pm
Herv100 wrote:
Fri Oct 13, 2017 5:30 pm
Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
That's cute. Nothing in the EO bends the overall cost curve down. Insurers will just pass those costs on (who do you think administers association plans?), and people in the individual market who don't receive subsidies will face even bigger cost increases next year.

The thing that gets me is the other thing that was announced yesterday: a nominee for Dept of Labor Assistant Sec for Employee Benefits Security nominee (i.e. the person who oversees the agency that will write these new association plan rules). The nominee needs to be confirmed by the Senate. The cart's a few miles before the horse on this one.
Maybe those in the individual market will get off their ass this time and write their congressmen demanding for full repeal. Those customized/catastrophic plans from 09 that are now illegal are looking pretty nice right now, huh?
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Re: 500 Million Lines of Code

Post by Turdacious » Sat Oct 14, 2017 12:20 am

Herv100 wrote:
Fri Oct 13, 2017 11:14 pm
Turdacious wrote:
Fri Oct 13, 2017 8:11 pm
Herv100 wrote:
Fri Oct 13, 2017 5:30 pm
Insurance bailouts ended. EO allowing selling across state lines to Associations.
Secret Obamacare lover Turd has a sad.
That's cute. Nothing in the EO bends the overall cost curve down. Insurers will just pass those costs on (who do you think administers association plans?), and people in the individual market who don't receive subsidies will face even bigger cost increases next year.

The thing that gets me is the other thing that was announced yesterday: a nominee for Dept of Labor Assistant Sec for Employee Benefits Security nominee (i.e. the person who oversees the agency that will write these new association plan rules). The nominee needs to be confirmed by the Senate. The cart's a few miles before the horse on this one.
Maybe those in the individual market will get off their ass this time and write their congressmen demanding for full repeal. Those customized/catastrophic plans from 09 that are now illegal are looking pretty nice right now, huh?
It's not just the rules, it's the timeframes and capabilities. Exec agencies still have to write the regulations, and they're even more dysfunctional than ever. HHS doesn't even have a Secretary. Obamacare opened a lot of pandora's boxes that can't easily be closed and kicked a lot of cans down the road.
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Re: 500 Million Lines of Code

Post by Turdacious » Sat Oct 14, 2017 1:10 pm

Under the ACA, people who earn less than 400 percent of the poverty level receive tax credits that cap their premium payments at a certain percentage of their income. Trump can’t touch those premiums without passing legislation.

Cost-sharing reductions, by contrast, are provided to insurers — not consumers. Obamacare requires insurers to offer discounted rates on silver-level exchange plans (the second-highest-cost coverage package) to low- and moderate-income people (those who make 250 percent of the federal poverty level or less). The law then stipulates that the federal government will reimburse insurers for the cost of providing those discounts. But since it was impossible to know exactly how many nonaffluent people would sign up for silver plans — and thus, to predict how much the government would owe insurers — the ACA did not appropriate a specific amount of money for reimbursing them. It just made an open-ended guarantee.

House Republicans claimed that this fact rendered the payments illegal. The Constitution says that “[n]o Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.” But Congress never formally appropriated the $7 billion in reimbursements to insurers that the Treasury paid out last year. The GOP sued the Obama administration. A federal judge ruled in their favor — but allowed the White House to keep making payments while it appealed the decision to a higher court.

This is what gave Trump the unilateral power to cancel the payments. The minute his administration gives up on appeal, the cost-sharing reductions stop flowing. But here’s the crucial thing: Insurers are still required to give low-income people the discounts. Trump can’t change that regulatory requirement without passing a law. All he can do is stiff the insurers. (And according to health-care economist Nicholas Bagley, he can only do that temporarily. Insurers still have a legal entitlement to reimbursement — even if the Treasury can’t legally honor that entitlement without congressional consent. So, the insurers can sue the government and collect what they’re owed through a special fund dedicated to settling Uncle Sam’s lawsuits.)

For insurers, this drastically increases the (near-term) costs of participating in Obamacare. In response, some will exit the exchanges, while others will jack up the premiums on their silver-level plans by roughly 20 percent, according to the CBO. This is the part of Trump’s sabotage that will hurt some ordinary people: It’s possible that insurers will completely abandon some counties, and that people who earn too much to qualify for subsidies — but don’t get insurance through their employer — will see their health-care costs increase. While the CBO expects the cancellation of the cost-sharing reductions to (ironically) give more Americans insurance in the long-term, the budget office expects it to result in fewer Americans having insurance next year, amid these marketplace disruptions.

That said, the vast majority of people who use Obamacare do qualify for subsidies. And those subsidies are tied to the price of silver-level plans. Which is to say: The more expensive silver plans get, the bigger most Obamacare enrollees’ subsidies become. If you are an ACA enrollee who makes 200 percent of the poverty line, the law guarantees you a tax credit big enough to lower the cost of a silver-level plan to 6.43 percent of your annual income — no matter how expensive the silver plan gets. Critically, while the size of the tax credit is tied to the silver plan, enrollees can spend that credit on gold- or bronze-level ones, if they so choose.
http://nymag.com/daily/intelligencer/20 ... =feed-part
The article gets most things right, but gets some critical details wrong.

First, Obamacare gave HHS the responsibility to manage the individual market, and the responsibility to ensure they had enough money to make subsidy payments to insurers. The 'they can't know how many people will sign up' argument is a copout. Obamacare has mechanisms to help them learn (the 3 R's program), they just haven't been able to figure it out. Part of it is that the Obama administration undermined the individual market on several occasions, the other part is that HHS wasn't up to the task for a lot of reasons. IMHO this is the biggest argument against single payer-- a single payer system requires a high functioning health care bureaucracy and politicians who let the bureaucracy do its job. We have neither.

The second thing is that the author misses a key point in how the individual market works. What it does is it ties the non-subsidy receiving individual market to the subsidy receiving individual market into the same risk pool. Very few people in the individual market who don't qualify for subsidies buy from the Obamacare individual market. The people in the individual market who keep their policies all year tend to fall into two categories: sick people, and people who don't get subsidies. The people in the Obamacare individual market tend to stay about five months. Insurers know this and price accordingly-- it's a big reason prices keep going up.

For those of you in the individual market who don't receive subsidies, I recommend starting the conversation with your licensed insurance broker now.
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Re: 500 Million Lines of Code

Post by JimZipCode » Sat Oct 14, 2017 3:47 pm

Thanks, that was very informative.
Turdacious wrote:
Sat Oct 14, 2017 1:10 pm
IMHO this is the biggest argument against single payer-- a single payer system requires a high functioning health care bureaucracy and politicians who let the bureaucracy do its job. We have neither.
We don't have a high-functioning anything.
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Re: 500 Million Lines of Code

Post by DrDonkeyLove » Sun Oct 15, 2017 2:38 pm

Turdacious wrote:
Sat Oct 14, 2017 1:10 pm
Under the ACA, people who earn less than 400 percent of the poverty level receive tax credits that cap their premium payments at a certain percentage of their income. Trump can’t touch those premiums without passing legislation.

Cost-sharing reductions, by contrast, are provided to insurers — not consumers. Obamacare requires insurers to offer discounted rates on silver-level exchange plans (the second-highest-cost coverage package) to low- and moderate-income people (those who make 250 percent of the federal poverty level or less). The law then stipulates that the federal government will reimburse insurers for the cost of providing those discounts. But since it was impossible to know exactly how many nonaffluent people would sign up for silver plans — and thus, to predict how much the government would owe insurers — the ACA did not appropriate a specific amount of money for reimbursing them. It just made an open-ended guarantee.

House Republicans claimed that this fact rendered the payments illegal. The Constitution says that “[n]o Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.” But Congress never formally appropriated the $7 billion in reimbursements to insurers that the Treasury paid out last year. The GOP sued the Obama administration. A federal judge ruled in their favor — but allowed the White House to keep making payments while it appealed the decision to a higher court.

This is what gave Trump the unilateral power to cancel the payments. The minute his administration gives up on appeal, the cost-sharing reductions stop flowing. But here’s the crucial thing: Insurers are still required to give low-income people the discounts. Trump can’t change that regulatory requirement without passing a law. All he can do is stiff the insurers. (And according to health-care economist Nicholas Bagley, he can only do that temporarily. Insurers still have a legal entitlement to reimbursement — even if the Treasury can’t legally honor that entitlement without congressional consent. So, the insurers can sue the government and collect what they’re owed through a special fund dedicated to settling Uncle Sam’s lawsuits.)

For insurers, this drastically increases the (near-term) costs of participating in Obamacare. In response, some will exit the exchanges, while others will jack up the premiums on their silver-level plans by roughly 20 percent, according to the CBO. This is the part of Trump’s sabotage that will hurt some ordinary people: It’s possible that insurers will completely abandon some counties, and that people who earn too much to qualify for subsidies — but don’t get insurance through their employer — will see their health-care costs increase. While the CBO expects the cancellation of the cost-sharing reductions to (ironically) give more Americans insurance in the long-term, the budget office expects it to result in fewer Americans having insurance next year, amid these marketplace disruptions.

That said, the vast majority of people who use Obamacare do qualify for subsidies. And those subsidies are tied to the price of silver-level plans. Which is to say: The more expensive silver plans get, the bigger most Obamacare enrollees’ subsidies become. If you are an ACA enrollee who makes 200 percent of the poverty line, the law guarantees you a tax credit big enough to lower the cost of a silver-level plan to 6.43 percent of your annual income — no matter how expensive the silver plan gets. Critically, while the size of the tax credit is tied to the silver plan, enrollees can spend that credit on gold- or bronze-level ones, if they so choose.
http://nymag.com/daily/intelligencer/20 ... =feed-part
The article gets most things right, but gets some critical details wrong.

First, Obamacare gave HHS the responsibility to manage the individual market, and the responsibility to ensure they had enough money to make subsidy payments to insurers. The 'they can't know how many people will sign up' argument is a copout. Obamacare has mechanisms to help them learn (the 3 R's program), they just haven't been able to figure it out. Part of it is that the Obama administration undermined the individual market on several occasions, the other part is that HHS wasn't up to the task for a lot of reasons. IMHO this is the biggest argument against single payer-- a single payer system requires a high functioning health care bureaucracy and politicians who let the bureaucracy do its job. We have neither.

The second thing is that the author misses a key point in how the individual market works. What it does is it ties the non-subsidy receiving individual market to the subsidy receiving individual market into the same risk pool. Very few people in the individual market who don't qualify for subsidies buy from the Obamacare individual market. The people in the individual market who keep their policies all year tend to fall into two categories: sick people, and people who don't get subsidies. The people in the Obamacare individual market tend to stay about five months. Insurers know this and price accordingly-- it's a big reason prices keep going up.

For those of you in the individual market who don't receive subsidies, I recommend starting the conversation with your licensed insurance broker now.
How should I direct that conversation?
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Turdacious
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Re: 500 Million Lines of Code

Post by Turdacious » Mon Oct 16, 2017 2:20 am

DrDonkeyLove wrote:
Sun Oct 15, 2017 2:38 pm
Turdacious wrote:
Sat Oct 14, 2017 1:10 pm
For those of you in the individual market who don't receive subsidies, I recommend starting the conversation with your licensed insurance broker now.
How should I direct that conversation?
First thing I'd look at is an overview of your state if you haven't already done so. Louise Norris' work is probably the best resource:
https://www.healthinsurance.org/state-h ... exchanges/

For the most part, insurers in the individual market submitted two sets of rates for approval-- one for of the CSR payments continued, and another for if Trump cancelled them. Your broker should have a good ballpark idea of what you can expect for costs either way. The other thing I recommend talking to them about is if there are significant changes in your network that you should know about-- if you or anyone else on your policy has preexisting medical issues, or a family history of medical issues, that you really need to have good coverage for, a good broker can really help here. Depending on the medical condition, ask about changes to the formulary (drugs your plan will pay for).

My guess is that rates for FY18 will be released very late because state insurance commissioners will be waiting on court decisions. Once the enrollment period starts, your broker will be very busy.
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Re: 500 Million Lines of Code

Post by Shafpocalypse Now » Mon Oct 16, 2017 2:23 pm

So much for anything getting better here...not only is the ACA screwing people still, but the fuckery Trump and the republicans are up to is making things worse

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Re: 500 Million Lines of Code

Post by Turdacious » Tue Oct 17, 2017 4:23 am

Shafpocalypse Now wrote:
Mon Oct 16, 2017 2:23 pm
So much for anything getting better here...not only is the ACA screwing people still, but the fuckery Trump and the republicans are up to is making things worse
JMO, but I don't really blame Republicans here. They didn't have the votes to make significant changes, so they've made a show of trying to pass a repeal bill knowing that Collins, Murkowski could get reelected opposing it and that McCain was not running again. It's a weird quirk of US health care policy, but who pays for Native American health care really matters in eight Republican dominated states. Murkowski and McCain represent two of them.

The wild card here is really the Trump administration-- I never expected him withhold CSR payments because doing so would screw a core Republican constituency (people in the individual market who don't get subsidies).
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Re: 500 Million Lines of Code

Post by nafod » Tue Oct 17, 2017 10:44 am

At least he wants to increase coverage for venereal diseases
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