Obamacare and rate increases - report your results here

[JohnRoberts]

I saw an article about an insurance program in CA (Calpers state employee plan), that was disturbed by price differences for same knee operation across the state. The same surgery was billed between $20k and $120k, with similar outcomes depending on which  hospital the patient used.

The patients had no motivation to use the cheaper hospital, without any exposure to this cost. Even the common co-pay didn't make a difference because they paid the same co-pay for $20k or $120k surgery.

Calpers responded with "reference" pricing, where the patient is free to use any hospital they want, but they will only be reimbursed up to $30k per knee. After one year, some 68% of patients we using the lower cost hospitals, and a number of the higher cost hospitals reduced their price.

Before we utter a group sigh and say alas we have an ultimate answer, this is old school price fixing, and we should revisit how that turned out in the '70s when the government fixed the price of gasoline below where the free market was willing to sell unlimited amounts. Therefore we ended up with odd-even gas rationing and long gas lines on the good days.

So while reference pricing is better than co-pays for involving the patient in cost decisions it is still flawed because there is no incentive for providers to price lower than reference pricing, and if their costs are higher they will just stop providing the service. This is in fact already going in for Medicare where reference pricing has been in effect for a while, and some doctors and hospitals just refuse to accept medicare patients. Just like the closed gas stations back in the '70s. Economic history can repeat itself if reference pricing is unrealistic. I guess the next step it force the doctors/hospitals to take unprofitable patients, and when they go broke they become wards of the state too. 

Perhaps some combination of reference pricing, where the patient gets to keep any savings they find beneath the reference pricing. This could be applied as a credit to their plan costs. Once a year the insurance plans could re-price the reference costs based on "market" experience. This would encourage both competition between providers to be lower cost, and incentivize the health care consumers to be thrifty.

or not... what would I know?  8)

JR

 

[walter]

I went without health insurance about half my life, didn’t need it and it wasn’t part of my income. Now my employer pays $600 a month for me. If I add my partner and our baby I would pay $600 each per month under that plan. Instead of that I am covering the COBRA cost from my partner’s former employer. When the baby is born next month, I’ll get some affordable insurance for them, but not through my employer. When I did not have insurance and went to my doctor, they would inform me that I had to pay on the spot. With insurance, they don’t ask twice and bill me later for the co-pay. The insurance company sends me a statement of how much money they saved by only paying one third of what the hospital billed. This shows me that the un-insured have to pay much more than the insurance pays. Now that I have health insurance, I can’t get a simple exam from my family doctor, I have to see a specialist, because they know the insurance will cover it. In fact the last time I had a health issue, my doctor didn’t examine me, and suggested what could be going on. I then saw a specialist who suggested the same thing, but said he would not examine me because his colleague had previously performed a procedure on me, and he did not want to take away any of his buddy's patients. It is obvious something needs to happen, both for my personal health, and for the health care system. Last year I looked into claiming medical expenses as a deduction on my income tax, but I didn’t spend enough, I think the threshold was $2,000.00.

 

[JohnRoberts]

I went without health insurance about half my life, didn’t need it and it wasn’t part of my income. Now my employer pays $600 a month for me. If I add my partner and our baby I would pay $600 each per month under that plan. Instead of that I am covering the COBRA cost from my partner’s former employer. When the baby is born next month, I’ll get some affordable insurance for them, but not through my employer. When I did not have insurance and went to my doctor, they would inform me that I had to pay on the spot. With insurance, they don’t ask twice and bill me later for the co-pay. The insurance company sends me a statement of how much money they saved by only paying one third of what the hospital billed. This shows me that the un-insured have to pay much more than the insurance pays. Now that I have health insurance, I can’t get a simple exam from my family doctor, I have to see a specialist, because they know the insurance will cover it. In fact the last time I had a health issue, my doctor didn’t examine me, and suggested what could be going on. I then saw a specialist who suggested the same thing, but said he would not examine me because his colleague had previously performed a procedure on me, and he did not want to take away any of his buddy's patients. It is obvious something needs to happen, both for my personal health, and for the health care system. Last year I looked into claiming medical expenses as a deduction on my income tax, but I didn’t spend enough, I think the threshold was $2,000.00.

I have heard anecdotes about people negotiating cash prices for procedures that are a fraction of the listed price. Apparently the provider values cash in hand over waiting for the insurance company to haggle them down. But I do not have any first hand evidence of this working. My experience reflects yours that uninsured who try to pay out of pocket get hosed. but I did not try to negotiate price and many are not in the mindset to negotiate prices when needing medical attention. If there was an open market with published prices I would have shopped. I tried to shop and found that I could have broke even or even saved a little money by flying to Nevada where the MRI scans were advertised cheaply, but that was not worth the time and hassle, just to break even.

JR

 

[Gold]

I'm waiting to see how it shakes out.  I have a feeling that bare bones major medical insurance with a medical savings account may be the way to go.

 

[sodderboy]

I welcome the return of MM in NYS for individual purchasers. That is medical insurance. Everything else is just what we've been brainwashed by guv and pharma to believe.  Still no response for me at nystateofhealth.gov

I am a consumer of alternative treatments. Most doctors in that realm have been cash only for years- kind of under the radar for government hacks and Big Pharma.  Are iv drips like hydrogen peroxide or "Meyers" cocktails available for cash in the UK or Canada?  Does anyone with "healthcare as a civil right" have access to UBI or other alternative treatments either in or out of the government system?  UBI is hardly a new technology but it is a true healer for people with serious infection. It will become more mainstream as antibiotics are over prescribed.

Has anyone here had any experience with UBI treatment?  I have seen firsthand what it can do to heal people with tick and mosquito borne illnesses.  Machines are made in Canada and Germany but are they illegal to use there?  They are very common in Russia. It is against the law to make and sell a UBI unit in the US.
Mike

 

[bruno2000]

I'm waiting to see how it shakes out.  I have a feeling that bare bones major medical insurance with a medical savings account may be the way to go.

I don't believe you will be able to purchase a "bare bones" since it won't be compliant.
Best,
Bruno2000

 

[Gold]

I don't believe you will be able to purchase a "bare bones" since it won't be compliant.

I believe there is a lot of shaking out to do. Straight answers are hard to come by. I've heard a lot of stories. I've been paying somewhat close attention and I have no idea what it will look like.

With such a major overhaul there are bound to be many unintended consequences. They will have to be addressed

 

[JohnRoberts]

I'm waiting to see how it shakes out.  I have a feeling that bare bones major medical insurance with a medical savings account may be the way to go.

I don't believe you will be able to purchase a "bare bones" since it won't be compliant.
Best,
Bruno2000

I wasted a bunch of time trying to find a clear description of what "essential" coverage is. Mainly they point to general insurance programs that they say are ACA compliant. I won't repeat the anecdotes I've heard but a suggestion that they are more comprehensive with mental health, prescription medicines, hospitalization and more coverage than bare bones plans..

An executive from one of the big companies. Aetna IIRC, was asked about the anticipated average cost increase from expanded coverage and he went down the list of changes and predicted something like 30-40% average increase. Of course individuals can see much larger increases or drops depending on their specific circumstances, like low income price support, or extra taxes on Cadillac plans..  In all the public messaging about cost savings they mention the credits or rebates for low income people not actual savings for the healthcare system..

If the government reduces the cost of healthcare for some people by charging other people more, they didn't actually reduce the cost of healthcare they just engineered another wealth transfer.  I started yelling back at my TV set today when a speech at an ACA pep rally in Boston today said that ACA would reduce our federal debt.  Arghhh

There are several good things in the insurance reforms so I will stop on that positive note. 

JR

 

[Gold]

Of course individuals can see much larger increases or drops depending on their specific circumstances, like low income price support, or extra taxes on Cadillac plans..  In all the public messaging about cost savings they mention the credits or rebates for low income people not actual savings for the healthcare system..

If the government reduces the cost of healthcare for some people by charging other people more, they didn't actually reduce the cost of healthcare they just engineered another wealth transfer. 

Since you can't access any information it's hard to get a picture of what's going on. Credits and rebates have to be factored in.

Transfer of wealth is a big part of civilization. I'm not aware of God's law of wealth distribution.

 

[sodderboy]

I wasted a bunch of time trying to find a clear description of what "essential" coverage is. Mainly they point to general insurance programs that they say are ACA compliant. I won't repeat the anecdotes I've heard but a suggestion that they are more comprehensive with mental health, prescription medicines, hospitalization and more coverage than bare bones plans..

Just rest assured that whatever you are forced to get to avoid a fine that it will include free female birth control.  How is that for Fluked-up?

Mike

 

[Spiritworks]

I wasted a bunch of time trying to find a clear description of what "essential" coverage is. Mainly they point to general insurance programs that they say are ACA compliant. I won't repeat the anecdotes I've heard but a suggestion that they are more comprehensive with mental health, prescription medicines, hospitalization and more coverage than bare bones plans..

Just rest assured that whatever you are forced to get to avoid a fine that it will include free female birth control.  How is that for Fluked-up?

Mike

I'd rather pay for birth control now, than to pay for ever-increasing numbers of non-achievers, who demand a free ride from society, to be exponentially added to the dole.

 

[emrr]

I already paid for permanent birth control, now I have to keep paying for it on a monthly basis.  This is not a probability question. 

 

[JohnRoberts]

Treasury just announced a change to FSA for 2013  where up to $500 unused at the end of the year can be rolled over into the next year.

JR

 

[dandeurloo]

Our premiums and deductible went up about 33% for my whole family.  Not cool.

 

[dmp]

Treasury just announced a change to FSA for 2013  where up to $500 unused at the end of the year can be rolled over into the next year.
JR

Also looks like a yearly maximum of $2500. Several at my company pay their individual health insurance premiums with the FSA to make it tax deductable; now that is going to be limited evidently.

 

[Mbira]

Here's a rate decrease to report.  From my girlfriends mother in Florida who has a pre-existing medical condition.  This was on October 3rd:

Yey!!! We just signed up for Obamacare with Blue Cross.

It was very easy to navigate the website. Great selection of coverage.

We qualify for a $600 reduction monthly (we were paying $1450 a month) So now we will be paying $850 for two adults!

There are 87 plans available in our area.

The one we chose is one of the more expensive platinum plans and covers dental, vision and many out of network services. It has much lower deductibles and out of pocket expenses.

Some of the other lower medical plans start as little as $200 and they ALL cover
many preventive services at little or no cost!!!

 

[JohnRoberts]

I think we found a winner....  congrats.  ;D

JR

 

[fazer]

There have been reports of problems with the online offer rate and the final delivered rate after you have applied show up higher in colorado.  Be interesting to see where the final rates end up.

 

[hodad]

Also on the positive side:  I was speaking to a friend yesterday.  One of his musician chums in Nashville went through the federal site, got the same BCBS coverage he already had at a slightly lower rate.  And he apparently managed to get through the process pretty quickly as well. 

 

[pucho812]

As part of the latest with the ACA, BCBS has just informed me that the plan I was purchasing will no longer be offered in 2014 and I will be removed. I have the option to enlist to another plan of theirs.  So much for I get to keep the plan I have if I  like it. Thanks a lot Obama