Wednesday, November 20, 2013
The U.S. Trade Representative gave new meaning to the phrase, "magical thinking" at a Nov. 18 talk in San Francisco. And new urgency to the demand for an honest debate on the economy and on the Trans Pacific Partnership (TPP).
Saturday, November 9, 2013
Despite repeated assertions by President Obama that people who like their health insurance will be able to keep it under the new health care law, many people who bought insurance on their own — a small fraction of the insurance market — will have to buy new plans. Related Article »
Share of people with
10-15 million people
Policies must meet new standards ...
Beginning Jan. 1, new policies issued must cover a minimum share of health care expenses and offer 10 “essential health benefits”:
Rehabilitative and habilitative
services and devices
Emergency room visits
Maternity and newborn care
Preventive services and
chronic disease care
Mental health and
substance use treatments
Pediatric services, including
dental and vision
... unless a plan is grandfathered in ...
If a policy was in effect when the law passed in March 2010 and has not been changed significantly, people already on the plan could remain on it, and the plan would not have to meet the new requirements.
... but many people will need to purchase a new plan because:
• Many plans do not currently meet the law’s standards for coverage.
• Most people in the individual market do not keep their policies for more than a year, so most would not be eligible to be grandfathered.
• Insurance companies cannot change grandfathered plans or sell them to new customers, so they have incentive to cancel the policies.
Some people will also move to Medicaid coverage.
More than one million low-income adults currently in the individual market will be newly eligible for Medicaid in 2014 because they live in a state that has decided to expand the program.
Why Rates Are Increasing for Some People
The total cost of policies will be higher on average ...
Many plans offered on the individual market will have more benefits and more consumer protections than they did before. The pools will also cost more for insurance companies since they cannot deny people with pre-existing conditions.
In the individual market,
on average, rates for group will:
... but people will be affected differently ...
SEX The law bans insurers from charging women higher premiums than men of the same age.
AGE The law bans insurers from charging older adults more than three times the amount they charge younger adults.
HEALTH The law bans insurers from charging people with health problems more.
... and many people will be eligible for government subsidies.
An estimated 48 percent of people on the individual market will be eligible for tax credits to reduce their costs, based on their income level.
J. F. Wharam and Others
N Engl J Med 369:1481, October 17, 2013
The authors point out the real and predictable failings of a market-based health care system: it costs too much (duh). And they suggest more market-based reforms to fix the problems of unaffordably high deductibles and co-pays in the Obamacare health insurance exchanges (premiums could be lower too). California is perfectly poised to leverage the situation by taking the obvious next step towards a single payer system (a goal for 2017): authorize the elected Insurance Commissioner to set the prices of the health insurance plans. The legislation's been introduced and almost passed several times. The Exchanges have already whittled down the insurance plans to only a few left standing, and set compulsory enrollment, and standardized benefits. Chopping their rates and profits gets pretty close to the role health insurance plans already now play in Medicare, as third party administrators.