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View Diary: Koch brothers vs. the truth on Obamacare: Real benefits for women's health (90 comments)

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  •  The Health Insurance Exchanges (4+ / 0-)

    We have heard about the refusal of some Republican Party governors to set up Health Care Exchanges, in defiance of the Affordable Care Act.

    They have made all sorts of untrue claims about costs. As it turns out, those states that refuse to set them up are just delaying the inevitable for political purposes. First they want to make political hay out of the cost, and then make themselves out to be heroes by "standing up to Obama."

    But eventually, the federal government will set the Exchanges up in states that don't have them. The governors who refuse to set them up are just stalling to give some more time for the anti-Obamacare campaign to continue misleading the public.

    No doubt, the Republican Party will make a big TO-DO about the cost to the federal government because the federal government has to set up the Exchanges where Republican Party governors refuse to set them up.

    But, in the end, the Health Care Insurance Exchanges are going to be ENORMOUSLY successful in creating universal benefits, national premium standards and affordable health care, AND market competition that spells the end of the "health insurance cartel" system we have today.

    Here's why. There are smaller, regional insurance plans all over the country. They can offer insurance TO ANYONE IN THE COUNTRY through the Exchanges. The state barriers are coming down. THAT'S what the Health Care Insurance Exchanges DO.

    Larger insurers can no longer set prices state by state based upon their actuarial interest. Instead, they have to offer insurance based upon actuarial risks that include everyone in the country. Why? Because no one is going to have a take-it-or-leave-it choice by four insurers (or less!) in their state. They can join a risk pool in another state.

    Smaller insurance carriers are going to grow, and larger ones are going to get smaller, and market forces are going to universalize benefits and maximize the cost savings and spread risk to larger and larger pools.

    I'm surprised more progressives aren't talking about this. Maybe I'm an insurance nerd?

    •  Is that true? (3+ / 0-)
      Recommended by:
      Amber6541, Ian Reifowitz, tardis10

      I have not heard anything about coverage across state lines; on the contrary, my understanding from all the articles is that coverage and costs will vary widely from state to state, and you're stuck with the choices that your insurance department approved -- and that individual companies are being very choosey about which states they're willing to sell in. (Carving up the market in order to pressure prices higher? probably. . . .)

      Regional markets would make all kinds of sense, especially here in New England. But my understanding is that the exchanges do not actually provide for this -- that you can only buy what's offered inside your state through the exchange in your state.

      If I'm wrong, I'd like a link --

      •  Insurance companies already have regional (1+ / 0-)
        Recommended by:
        Ian Reifowitz

        Markets. They have to for smaller states, otherwise there'd be no coverage in them at all.

        And in many cases, people live in one state and work in another. Especially in areas bordering one or many other states.

        It wouldn't make sense for an insurer to only pay for care in one state, when the hospitals often transfer patients to a specialized care center in another, or when the local hospital doesn't offer the care you need but the one in the nearest larger city, across the state line, does.

        So while they might be technically in one state, the coverage they offer often covers more than just that state. And the rates tend to be the same as well.

        •  You're WRONG (0+ / 0-)

          Until the Affordable Care Act, the health insurance cartel was able to pretty much dictate the market in each state, having successfully lobbied to set up the health insurance markets on a state-by-state basis and, basically through bribery, keep the policies they desired in place and the regulators they desired in place.

          I can tell you, as a former insurance agent, that there is not a multi-state insurance system. If you don't believe me, then go ahead and try to buy health insurance, right now, in a neighboring state. You can get an indemnity plan, but you can't get actual insurance. It's a fact. It's a fact that is about to change because of ACA and the Health Care Insurance Exchanges.

          Your "doesn't make sense" scenario IS EXACTLY one of the scenarios that ACA corrects. Don't believe me? Read your current Health insurance policy. Unless you have supplemental insurance that covers you in another state or overseas, YOU'RE SCREWED if you get sick or hurt outside your state. Most people buy traveler's insurance when they travel. WHY? Think about it.

      •  You're misinformed (0+ / 0-)

        And I'm not surprised.

        The fact that state barriers will come down via the Health Care Insurance Exchanges is EXACTLY what the big insurance companies don't want you to know.

        It is the market force mechanism that is the heart of the plan to create universal benefits.

        Listen carefully. The big insurance companies aren't telling you what Health Care Insurance Exchanges ARE.

        The biggest winners will be smaller, regional insurance companies and consumers in general.

        If you want a link, try reading the Affordable Care Act.

        I am a former insurance agent (just recently got out of that business), and I can tell you that what I claim is 100% correct. Check the law yourself.

    •  "actuarial interest" == denial of coverage (1+ / 0-)
      Recommended by:
      Ian Reifowitz

      We were self-insured for a long time, 15 years or so, and it was a bitch getting any kind of coverage in Oregon, even from Blue Cross/Blue Shield.

      The galling thing is, BC/BS was set up by the state to do exactly what they were denying b/c of my wife's supposed pre-existing condition.

      Good info, btw, about the coming down of state barriers. I know we had almost no choice when we were self-insured. Nearly tossed into the state's high-risk pool which would have cost a fortune.

      When we finally got coverage with a local physician's group, we thought fine. Then BC/BS bought up the pool and there went our coverage - nearly. Had to fight tooth and nail to keep covered. These are very hateful business people in charge of the insurance companies and all they care about is making more and more and more money.

      Screw 'em.

      What stronger breast-plate than a heart untainted! Thrice is he arm'd, that hath his quarrel just; And he but naked, though lock'd up in steel, Whose conscience with injustice is corrupted. King Henry, scene ii

      by TerryDarc on Sun Jul 14, 2013 at 11:59:38 AM PDT

      [ Parent ]

      •  screw 'em indeed. (1+ / 0-)
        Recommended by:
        TerryDarc

        The industry can only prosper by denying care.

      •  The Self-insured (0+ / 0-)

        These pools will win big from setting up Health Care Exchanges, IF THEIR ADMINISTRATORS understand what the exchanges ARE.

        They can offer benefits to people from out of state who can't get those benefits at those prices. The premium collections will go up, and because ALL INSURANCE COMPANIES are in the same boat because of the 80/20 rule, benefits will level out somewhere in the middle, even while costs and premiums fall.

        The smaller, self-insured entities (labor unions, credit unions, municipalities, some small businesses) will actually GROW due to demand, and the larger companies will be forced to meet the prices and benefits. or lose customers.

        The ACA has the most libertarian mechanism of reform in any industry, yet, the so called defenders of libertarianism are fighting tooth and nail for anti-capitalistic cartels.

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