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View Diary: Half of states leave health insurance exchanges to the federal government (133 comments)

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  •  I am ignorant on HCA. (0+ / 0-)

    [1] So, as an individual, I will be able to negotiate a price?  I won't be in a pool.

    [3] Are insurance companies really going to participate with all of these coverage requirements?  

    [5] I don't see what subsidies have to do with the administrative side of establishing an exchange.  

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    by dfarrah on Mon Feb 18, 2013 at 09:41:05 AM PST

    [ Parent ]

    •  Sure, let me help (28+ / 0-)

      1)You will be in a pool in the exchange and the plans being sold there are the same for everyone. There will be 3 levels, Bronze, Silver, and Platinum. The exchange has "Community Rating", meaning you are not charged and rated as an individual and your health status is irrelevant. Because all exclusions like pre-existing conditions and gender rating for women have been banned, you're not really important.

      There is sort of a price and pre-clearance for insurance companies to sell in the exchange, so premiums are already set and they will be displayed for you and everyone to see without any of your health info needed. There are some variations for people who are still smokers, and for age, but thats been limited. So the overall experience with an insurance company is totally different, the exchange is the middle man and the insurance company doesn't see you as an individual.

      2)Insurance companies have no choice but to participate. Thats the new world they live in, the only place where you can sell plans to individuals and small businesses is in the exchange. Normally requirements this stringent would force insurance companies to simply leave the state, but these regulations and requirements  are nationwide. They have no choice on this issue.

      3)The subsidies are run through the exchange, you put your income level in there, and it tells your subsidy and the amount you will end up paying in premium after that. The subsidy doesn't go to  you, it goes directly to the insurance company and shows up in lower premiums. This is great for consumers because they have no up front cost with a rebate later.

      Now, the system isn't perfect. I would prefer a single-payer system to get rid of the clutter and contain health care costs. Now, if thats not doable, there is a framework with an individual mandate and private insurance used in Switzerland and Israel that are among the best healthcare systems in the world. The kicker is they have price controls on top of everything else. So,uUltimately, we either need a single payer system or the ACA will need to be amended to have price controls.

      •  Regarding premiums (8+ / 0-)

        Once in the exchange, insurance companies can still raise premiums, which I don't like, but they have to do it on the whole group cause everyone's treated the same.

        They have historically been much more wary of big group hikes cause it could cost them tons of business. Thats not a perfect system though, and still not enough of a clampdown for me.

      •  I think it's bronze, silver, gold and platinum.... (4+ / 0-)
        Recommended by:
        rabel, deepeco, musiccitymollie, tb mare

        There will be a basic level of required coverage, and we'll be able to select our level of risk tolerance vs. out of pocket expenses.   If you have it, a lot of money will buy lots of extra benefits with low out-of-pocket charges (platinum).   For employees, 8% of your paycheck will cover most families' annual needs, not without some co-payments, but this will be universally availble through most employers (silver).  You'll be able to pay a little more in premium for lower annual out-of-pocket, but if you don't use it you'll lose it (gold).     Most of us will be on the hook for some hefty co-payments, especially for things that we can control  (smokers will pay more).    The safety-net plans may stop covering "quality of life" services  (think: scooters for fat diabetics) (bronze).  

        Most working people who get their insurance through their employer won't see much change at all, at first........ then they'll notice that they can shop between two or three national companies for the same exact product.   If one company keeps screwing their subscribers, people will switch to another company next year.   Everybody will understand exactly what their policy is supposed to cover.   Everybody will understand if the insurance company tries to deny services they should be covering.  
           

        •   (0+ / 0-)

          Right now we get insurance through my wife's job at a state university.  It's a pretty good policy.  Is it safe to assume that if she takes early retirement and we go individual for a few years until Medicare kicks in our premium through the exchanges will be about the same as what employer & employee are paying now? (ie similiar to getting COBRA coverage).  Because that's still a lot of money ($20K/year).  And if they can charge older folks more, what sort of bill are we looking at?

          •  Why would you leave your wife's plan?! (0+ / 0-)

            Most state employees can carry their health insurance plan into retirement -- and it's much cheaper than going to an individual plan.

            I'm a retired civil servant, and I'm on the same plan I was on when I was working. When Open Season comes around, if I find a plan that better fits my needs, I'll switch to that one.

            When I'm eligible for Medicare, my current health insurance will become my supplemental plan.

      •  Question on subsidies (2+ / 0-)
        Recommended by:
        deepeco, musiccitymollie

        If I remember correctly, if you are older but pre-Medicare, you can be charged up to 3x what a young person will be charged. Do you know if subsidies are a flat amount or a percentage of the premium? Do the subsidies take into account the premium cost? Assuming both persons are single, consider the following hypothetical case:

        Person Y(oung) opts for a $200/mo plan and qualifies for $100/mo subsidy and ends up paying $100/mo for insurance.
        Person O(lder) has the same income and opts for same package, but it costs $600/mo. If the subsidy is a flat amount, O can still be on the hook for $500/mo, or effectively 5x rather than 3x the cost of the plan for Y. It is also likely that O will have higher out-of-pocket costs, and will that be taken in consideration for the amount of the subsidy?

        I'm safely on Medicare, but I have friends who won't qualify for several years and still might not be able to afford one of the exchange plans. As much as they want insurance, they might decide to pay the penalty instead.

        •  Subsides are income based (1+ / 0-)
          Recommended by:
          tb mare

          The subsidies are income based and scaled.
          In general, if a Silver level policy costs less than 10% of your income, you have to get insurance or pay a penalty.
          If your income is between 133% to 400% of the Federal Poverty Level, then you only have to pay between 2% and 9.5% of your income for the same plan and the Federal Government covers the rest.
          If you don't want to buy insurance, you don't have to because you still don't meet that 10% income requirement.

          KFF has all the info you could ever want on health care reform. http://www.kff.org/...

          •  That clarifies it (0+ / 0-)

            Many thanks. I hadn't realized the system is one where you pay up to your max % of income and the feds pick up the rest, no matter how much it is. So no matter what one's age, if your income is $9K pa, for example, you pay your % share, and the feds cover the remainder, with greater dollar subsidies going on behalf of older folks because their premiums are more.
            This makes me wonder if this will lead to the federal gov't paying more to subsidize a 60 year old's health insurance than a 65 year old on Medicare. Perhaps after a couple of years, there will be a realization that we should lower the age for Medicare eligibility instead of trying to raise it.

      •  very lucid explanation. thanks. (2+ / 0-)
        Recommended by:
        alkatt, tb mare

        To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

        by kareylou on Mon Feb 18, 2013 at 08:36:45 PM PST

        [ Parent ]

      •  Thank you (0+ / 0-)

        That's very helpful information, really well-explained.  All my research just gives me confusing double-talk as to what it all means.

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        by alkatt on Mon Feb 18, 2013 at 11:13:30 PM PST

        [ Parent ]

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