The Problem With Obamacare Is Obamacare

Gentlemen, There's a lot we all agree on.

Seriously, I believe you're focused on a couple of trees and missing the forest....... Originally Posted by Tiny

@Tiny, when looking into an issue dealing with insurance, i try to take an underwriter's perspective. No Insurance company is going to make a profit selling insurance for an event that has ALREADY occurred! With the ACA this is the exact scenario that exists for health insurance companies who are trying to do business on the government exchanges (HealthCare.Gov for most states). No easy task selling an insurance policy to a lot of people who are ALREADY sick and make a profit at the end of the year. You wonder why the ACA (Obamacare) has issues. I don't think I missed the forest at all.

I get group health insurance thru my employer. My premiums have not doubled or tripled in price over the years. I have worked for this company for six years. The health insurance company is Aetna. It was the only company one can choose. You could pick the Silver, Gold or Platinum plan. I took the silver.

Group health insurance thru the employer does not have the same issues that the ACA has despite selling the same type of policies with the ten minimum benefits. The risk pool is neutral or balanced. In the ACA the risk pool is negative or upside down.

The wiki does a good job explaining why the individual mandate and risk corridor were put into the ACA legislation to prevent the death spiral that the ACA is now in.

https://en.wikipedia.org/wiki/Risk_corridor

https://en.wikipedia.org/wiki/Affordable_Care_Act

@Tiny, when looking into an issue dealing with insurance, i try to take an underwriter's perspective. No Insurance company is going to make a profit selling insurance for an event that has ALREADY occurred! With the ACA this is the exact scenario that exists for health insurance companies who are trying to do business on the government exchanges (HealthCare.Gov for most states). No easy task selling an insurance policy to a lot of people who are ALREADY sick and make a profit at the end of the year. You wonder why the ACA (Obamacare) has issues. I don't think I missed the forest at all.

I get group health insurance thru my employer. My premiums have not doubled or tripled in price over the years. I have worked for this company for six years. The health insurance company is Aetna. It was the only company one can choose. You could pick the Silver, Gold or Platinum plan. I took the silver.

Group health insurance thru the employer does not have the same issues that the ACA has despite selling the same type of policies with the ten minimum benefits. The risk pool is neutral or balanced. In the ACA the risk pool is negative or upside down.

The wiki does a good job explaining why the individual mandate and risk corridor were put into the ACA legislation to prevent the death spiral that the ACA is now in.

https://en.wikipedia.org/wiki/Risk_corridor

https://en.wikipedia.org/wiki/Affordable_Care_Act Originally Posted by adav8s28

Hey Adav8s28, I don't know anything about risk corridors, but reading about them in your links, my impression is that they would contribute to health care inflation. Couldn't the drug companies and the healthcare providers jack up costs? And the insurance companies go along because they don't have skin in the game, as they can pass higher costs onto the government? As to doing something so that an insurance plan covers a big risk pool, like it would for a big company, so that you don't have smaller pools of less healthy individuals covered by plans, that intuitively makes sense to me. But I haven't studied this.

I don't have a good handle on the nuts and bolts of the ACA. I just know we should have universal coverage, lower healthcare costs, and better healthcare outcome. And I suspect the ACA took us farther away from achieving the second and third goals.

As to doing something so that an insurance plan covers a big risk pool, like it would for a big company, so that you don't have smaller pools of less healthy individuals covered by plans, that intuitively makes sense to me. But I haven't studied this.

I don't have a good handle on the nuts and bolts of the ACA. I just know we should have universal coverage, lower healthcare costs, and better healthcare outcome. And I suspect the ACA took us farther away from achieving the second and third goals. Originally Posted by Tiny

@Tiny, as for doing something to manufacture bigger risk pools on the Obamacare market-place exchanges, I agree with you. I have been trying to say this for the last week. Bigger risk pools would bring down the premiums and copays for Obamacare policyholders.

Senator Rand Paul (Republican - Kentucky) is thinking the same thing. His proposal is to have several risk pools nation wide that have at least one million policy holders each. So, for 20 million people who get an Obamacare private plan you would need about 20 risk pools. The health insurance companies would compete for these large risk pools. Here is the link.


https://www.msn.com/en-us/news/polit...93d79377&ei=56

I also agree with you that there should be a single payer or Universal Healthcare system. Perhaps for the USA, two single payer systems. I would leave Medicare as it is. For People under 65 replace the employer based insurance and the ACA with a Single Payer system for all USA citizens under age 65. Once you hit age 65 you go over to Medicare like we do today.

I suspect Rand Paul’s idea makes a lot of sense. It would be good to know more about it.

Actually ideally I’d like to see the ultimate consumers of healthcare, individuals, calling the shots as to where their healthcare dollars are spent. The system would be much more competitive and prices transparent. Employee and employer contributions to something
like HSA’s would fund the majority or most of the spending, and government would backstop much of the rest. We’d have universal healthcare but not necessarily a single payer system. We would however greatly diminish the role of insurance companies. Please see earlier posts in the thread.

the current Obamacare premiums fuckery-Republicans willful choice to go against the desires of the electorate by not even scheduling a vote-has created an opening for a new push for Medicare for All. polls show that the idea is popular. people are sick and tired of our fucked up healthcare system.

https://www.ms.now/opinion/pramila-j...ts-health-care

Obamacare is not to blame. it did what it could, while staying within our existing system of private health insurance coverage.

while price transparency would be helpful, it alone is insufficient to deal with the fundamental problem of healthcare inflation. whatever system is designed, it has to deal with provider billing fuckery. when Medicare went to fixed payments per enrollee, suddenly patients were being undertreated and discharged too soon. when payment was based on coding, suddenly upcoding became an issue. when payment was based on procedures, there were too many unnecessary procedures being done.

doctors should be on salary. that way their only concern is delivering high quality care. and it's not doctors who are bankrupting Medicare anyway; it's hospitals. their billing practices can only be described as abuse of the system. that's why our current system of care is totally unaffordable and marked by extreme inequity. people talk about the horrors of the government rationing care, but the fact is that care is already being rationed. let's at least ration care sensibly, given that healthcare dollars are a limited resource.

the private insurance market should be left to those individuals who want basically concierge care. if a basic government plan isn't good enough for you and you want something better, you should be able to purchase that on the private market with your own funds just like any other commodity.

and the payer always needs to be able to negotiate reimbursements and decide on the best use of healthcare funds. anything else is pure insanity, which is in part of why we are where we are.

the current Obamacare premiums fuckery-Republicans willful choice to go against the desires of the electorate by not even scheduling a vote-has created an opening for a new push for Medicare for All. polls show that the idea is popular. people are sick and tired of our fucked up healthcare system.

https://www.ms.now/opinion/pramila-j...ts-health-care

Obamacare is not to blame. it did what it could, while staying within our existing system of private health insurance coverage.

while price transparency would be helpful, it alone is insufficient to deal with the fundamental problem of healthcare inflation. whatever system is designed, it has to deal with provider billing fuckery. when Medicare went to fixed payments per enrollee, suddenly patients were being undertreated and discharged too soon. when payment was based on coding, suddenly upcoding became an issue. when payment was based on procedures, there were too many unnecessary procedures being done.

doctors should be on salary. that way their only concern is delivering high quality care. and it's not doctors who are bankrupting Medicare anyway; it's hospitals. their billing practices can only be described as abuse of the system. that's why our current system of care is totally unaffordable and marked by extreme inequity. people talk about the horrors of the government rationing care, but the fact is that care is already being rationed. let's at least ration care sensibly, given that healthcare dollars are a limited resource.

the private insurance market should be left to those individuals who want basically concierge care. if a basic government plan isn't good enough for you and you want something better, you should be able to purchase that on the private market with your own funds just like any other commodity.

and the payer always needs to be able to negotiate reimbursements and decide on the best use of healthcare funds. anything else is pure insanity, which is in part of why we are where we are. Originally Posted by pxmcc

Pxmcc, The system you're describing works well in a number of places. Hong Kong comes to mind as one of them.

One thing's for damn sure though, you simply can't just expand Medicare and expect it lower costs and improve outcomes. It's as fucked up as the rest of the system.

^^+1 sir, unfortunately..

I don't think I missed the forest at all. Originally Posted by adav8s28

You missed the forest for the trees every time you answered one of my posts pointing out that the fundamental problem here is the lack of any measure of cost containment by deflecting to the "risk corridor" issue, as mandating or subsidizing risk corridors would do nothing to reduce aggregate spending on health care.

I suspect Rand Paul’s idea makes a lot of sense. It would be good to know more about it.

Actually ideally I’d like to see the ultimate consumers of healthcare, individuals, calling the shots as to where their healthcare dollars are spent. The system would be much more competitive and prices transparent. Employee and employer contributions to something
like HSA’s would fund the majority or most of the spending, and government would backstop much of the rest. We’d have universal healthcare but not necessarily a single payer system. We would however greatly diminish the role of insurance companies. Please see earlier posts in the thread. Originally Posted by Tiny

I agree that the goal should be to achieve near-universal healthcare coverage with a system wherein individuals have choices regarding how and where their dollars are spent. To that end, Rand Paul has proposed a market-based system based on greatly expanding "association health plans." It could be based on almost any type of membership group. In addition, anyone could heavily fund an HSA and use it to pay for premiums as well as all manner of other health-related expenses.

https://www.paul.senate.gov/senator-...s-for-all-act/

Pxmcc, The system you're describing works well in a number of places. Hong Kong comes to mind as one of them.

One thing's for damn sure though, you simply can't just expand Medicare and expect it lower costs and improve outcomes. It's as fucked up as the rest of the system. Originally Posted by Tiny

As I understand it, the Hong Kong system is a bifurcated "dual-track" structure that provides universal access to heavily subsidized health care, while maintaining a parallel private sector option for those who want faster or better access to high-quality treatment. In any event, Hong Kong (as well as other affluent countries) keep costs down by preventing the sort of pricing shenanigans permissible in the US. (I assume that there is no "K Street" in Hong Kong!)

I think there will be a big push next year for a Jayapal-style "Medicare-for-all" plan if Republicans continue to block the extension of Obamacare subsidies. (And a HUGE push in 2017 if Democrats take back the House.) But I don't think implementation on a cost-reducing basis would be so easy.

https://www.cbo.gov/system/files/202...ngle-payer.pdf

https://pmc.ncbi.nlm.nih.gov/articles/PMC7329236/

https://www.crfb.org/blogs/how-much-...icare-all-cost

But the "reform" I'd most like to see would be to deep-six that fucking 3.8% surtax on investment income!

TC, I haven't looked at your links yet but honestly am looking forward to that.

I also haven't had time to fully comprehend what follows. I suspect it confirms LustyLad's suspicions. This is a research letter published last week by the Journal of the American Medical Association. It was co-authored by people at Johns Hopkins' and TCU's schools of business, medicine and public health.

https://jamanetwork.com/journals/jam...rticle/2843117

They're used a different data set, from insurance company reports, which is more accurate and up to date than IRS and CBO data which prior analyses used. They found that the CBO's estimates of the Obamacare tax credits understated the actual amounts of the credits.

Ever since the Obamacare plans were introduced, they've cost a lot more than non-Obamacare plans. And the taxpayer has progressively had to pick up more and more of the cost. The first year, in 2014, the government paid for 28.6% of the premiums through tax credits. In 2023 (latest year available) government paid 74% of the premiums.

When Biden expanded coverage, plan enrollment spiked.

Two of the authors wrote an editorial that appeared in the WSJ. Some of their comments,

Congress may yet extend ObamaCare “enhanced” premium subsidies. A new study shows why that would be a reckless act toward taxpayers.

Using health insurers’ mandatory filings, our study, published Friday in JAMA Health Forum, shows that the ObamaCare individual market has become a money pit for taxpayers. In 2024 they paid nearly 80% of the premiums for subsidized plans—compared with only 30% in 2014.

Taxpayers paid more than $114 billion directly to insurers in 2024—one-third more after inflation than in 2023, more than double the amount in 2020 (before the enhanced subsidies), and more than six times as much as in 2014. According to the Congressional Budget Office, this acceleration continued in 2025.

Why? Through regulations, ObamaCare banned affordable insurance options and destroyed independent physician practices, damaging the insurance and provider markets. Consolidation, administrative bloat, high prices and soaring premiums followed. Our study shows the correlation between premium growth and subsidy growth is nearly perfect.

That’s by design. Subsidies are calculated so that the premiums paid by subsidy-eligible enrollees for benchmark plans fall within a set percentage of their income, thereby transferring the financial exposure from rising premiums to taxpayers. In 2021 Congress expanded subsidy eligibility to higher-income households and lowered income caps for others, further burdening taxpayers. In August 2022, it extended these Covid-era subsidies through 2025.

Zero or near-zero premium plans proliferated as the subsidies approached or exceeded the premiums. In 2024, 90% of subsidy-eligible enrollees had access to plans with net premiums of $10 a month or less.

Higher enrollment brings more taxpayer dollars to insurers and brokers] while providing political talking points for Democrats. It also creates incentives for fraud, as evidenced by findings from the Justice Department, the Paragon Health Institute and the Government Accountability Office. In a GAO report, 23 of 24 fictitious applications were approved for premium subsidies, and 18 were still covered a year later.

Reckless subsidies lured legitimate enrollees into ObamaCare plans who would otherwise have used employer-sponsored insurance, crowding out private funding with taxpayer dollars. We found that the market size for unsubsidized ObamaCare plans shrank by a quarter, from $23 billion in 2014 to $17 billion in 2024. ObamaCare is a poor value, a product few Americans would voluntarily purchase without subsidies.[

Congress has thrown taxpayers under the bus—forcing them to pay for nearly the entire ballooning cost of subsidized ObamaCare plans, including fraudulent ones. Taxpayers in employer-sponsored plans are also saddled with higher premiums, higher prices and stagnant care delivery caused by ObamaCare’s market distortions.

What Congress sold to the American people as targeted assistance for lower-income families has become a broad entitlement with no spending limit.

https://www.wsj.com/opinion/obamacar...nion_lead_pos8

Anecdotal on the state of employer sponsored healthcare insurance. YMMV

About a year before I retired, got a letter from CMS regarding my wife's coverage under my employer's insurance no longer being 'creditable'. She had already retired but was covered under my employee insurance, so she had only signed up for Medicare Part A.

The letter stated my wife would need to sign up for Medicare Part B and Part D coverage now (or later pay penalty coverage)as my employer's insurance was not longer 'creditable'.

Meaning my employer insurance had degraded to the point it was not as good a standard Medicare Part B.