5 ms·

As just one anecdote for rebuttal, my insurance premium increased by 20% this year--not even mentioning the additional deductibles they hid in the renewal optio

by hellcow 10y ago

As just one anecdote for rebuttal, my insurance premium increased by 20% this year--not even mentioning the additional deductibles they hid in the renewal options. I, for one, am very much looking forward to purchasing insurance from the best provider in any of the 50 states, not just the few available to me in CA.

SomeCollegeBro 10y ago
I agree that opening up across state lines is a very good thing. However, if the marketplace goes away and there's not a good way to force companies to be competitive, we're really not in a better place either. Hopefully we can have the best of both worlds.
- ceejayoz 10y ago
  > I agree that opening up across state lines is a very good thing. When this was done with credit card companies, they all moved to the state with the least regulation and started instituting consumer-hostile stuff like mandatory arbitration. I'd really rather not have this happen with my health insurance.
jasonmp85 10y ago
Obviously 20% seems high, but they'd be higher without it, crazily: http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-premiums-20160726-snap-story.html http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamac...
willholloway 10y ago
The idea that the lack of competition between states is the reason for high health insurance premiums is a red herring. The reason premiums are high is that costs are high, and our population is obese, disease prone and litigious. If we want to contain costs we have some options: 1) Public option/Medicare for all could save us 10-20% in parasitical insurance company costs/administrative overhead. 2) We find solutions for obesity. Obesity is the #1 driver of increased health costs in America. 3) We stop holding doctors/pharma financially responsible for bad outcomes outside of their control through the legal system.
- mikeyouse 10y ago
  Premiums also saw a large increase due a cynical and intentional move by the GOP congress to withhold funds from insurers that were initially promised for the first few years while they sort their pricing out. Part of the initial law were "high risk corridors" to limit the losses for insurers that initially mispriced their ACA plans. The insurance companies had to make a ton of assumptions about the age, health, and wealth of the populations who would sign up for their plans. To make sure they didn't accidentally bankrupt themselves, the law provided funds to limit their losses for the first three years of the exchanges (2014-2016). In the first year, they had a shortfall as the population was older and sicker than expected, so CMS was going to cover the $2.5 billion gap but congress refused to let them pay these user fees. The GOP knew that the premium changes would come during the election season, so they denied funding for the high risk corridors last year. To give themselves room against mispricing, the insurance companies predictably raised premiums beyond where they would otherwise have been. Other insurance companies decided they didn't want the risk, so they pulled out of the marketplaces. The election season was rife with announcements about "20% premium increases" and "xx Insurance company exits the exchange market". Millions of people get to pay more for health insurance but at least their guy won the race.
  - willholloway 10y ago
    Theoden: So much death. What can men do against such reckless hate? Aragorn: Ride out with me. Ride out and meet them. Theoden: For death and glory. Aragorn: For Rohan. For your people. Theoden: The Horn of Helm Hammerhand will sound in the deep, one last time!
- analog31 10y ago
  The present state of affairs is that everything is a red herring. The health care system is so convoluted, with business entities inside business entities paying other business entities, that it's impossible to know where the money goes, so we have no idea what makes it so expensive. Somebody is gouging us, but we will never know who, and everybody can point to somebody else, or to "society," but we just don't know. Chances are, everybody who can make money while covering their tracks through a web of business entities, is gouging us. One potential advantage of the government owning the whole system, is that it would facilitate figuring out what the costs actually are. This may be why other civilized countries pay half what we pay. It's a saying in business, that you can't manage what you can't measure.
tunesmith 10y ago
Selling across state lines is a horrible idea. It's a race to the bottom in terms of regulation, which leads to adverse selection, and therefore more expensive premiums for the sick, poor, and elderly. There's a lot of material out there about the likely effects of selling across state lines. To the point it is not even actually seen as a viable option, it's more something that Republicans say because it sounds reasonable at first. But it's not workable.
- jbscpa 10y ago
  Tunesmith You say: "It's a race to the bottom in terms of regulation" Consider your assumption that regulation is good. In point of fact pernicious and arbitrary regulation within states brought us as a nation to this desperate situation. You say: "To the point it is not even actually seen as a viable option" Check your prejudice at the door and look at reality. You may need to understand markets and human nature more clearly. You may "see" and understand other, better options.
  - Blackthorn 10y ago
    We "see" and understand exactly what happened when this exact thing happened to credit cards and it universally sucked for the consumers.
  - fattire 10y ago
    What's the desperate situation you're referring to w/regard to health care? Do you mean the imminent dismantling of the "pernicious and arbitrary" system which brought 20 million people health care who didn't have it previously, saving untold thousands of lives per year?
BeetleB 10y ago
As another anecdote, the premium increases per year my company has to pay has (mostly) dropped since Obamacare - the highest increase was a year or two prior to ACA.
DougN7 10y ago
Insurance for just my family went from $1400/month (already expensive!) to $1850 per month. I live in the midwest, so it's not like we have crazy high prices. I keep thinking of the mansion I could live in with that much going towards a mortgage. AND, until we hit our $5K premium, it doesn't really pay anything. So we've got to pay $27K to get a real benefit. And it's not like we're young and healthy (nearly 50). Feels like we're getting shafted.
- Jtsummers 10y ago
  Where in the Midwest? Near a big city? I'd agree with your assessment (no crazy high prices). But if you live in a smaller city (like I do, not Midwest but Southeast), you may also have a disproportionately unhealthy population compared to the national average, along with being disproportionately poor. This means that our regional medical costs are higher both by need (unhealthy population needs more than average care) and scarcity of resources (difficulty in persuading doctors to come here).
xiaosun 10y ago
Allowing insurance to be sold across state lines only creates a short-term arbitrage opportunity. In practice rates are just going to meet at the middle - states with lower premiums will see rates go up and states with higher premiums will see go lower.
redler 10y ago
The problem is what "best" means. In an unregulated environment it would mean what's best for the insurance company, not the patient. There are substantial challenges. One is that insurance companies don't actually provide care, of course. Any company wishing to do business with people in a particular state would have to actually obtain a network in that state -- partner with an existing network, or negotiate deals and sign contracts with hospitals, urgent care centers, pharmacies, labs, and doctors. They'd presumably have to be licensed to do business in that state, and adhere to that state's own regulations and requirements for doing so. (Because the US is a federal system, the federal government itself is unlikely to be able to strip away all of each state's specific laws and regulations.) This process would have to be repeated for every state in which they plan to do business. Insurance companies would probably set up state-specific legal entities or subsidiaries to provide financial and legal compartmentalization. So selling insurance "across state lines", as a practical matter, may not differ much from the current system. State-specific legal work and shoe-leather network-building would still be required. There's nothing stopping a national company from setting up a state-specific entity and selling insurance this way right now. Another issue is that if local regulations were somehow stripped, as some in congress wish, insurance companies, as profit-seeking entities, would all gravitate to the most favorable and least regulated business environment. After the Supreme Court ruling in Marquette v First of Omaha, credit card providers migrated to Delaware, South Dakota, or Arizona because those states have the weakest usury laws and allow them to charge rates of 29% or more to borrowers in any other state. A similarly deregulated and "efficient" market for health insurance would have all the companies set up entities in whichever state would allow them to offer plans that provide the least care reimbursement (known internally as "loss control") and charge the highest premium. This could lead to a situation where a few very large companies offer only high-deductible plans without guaranteed issue, excluding procedures that carry risk of being expensive or are politicized, with lifetime or annual caps, thin networks, and retroactive drops. Lip service would be paid in the form of seemingly cheap policies that actually provide little real coverage, but allow insurance companies and politicians to claim "all Americans now have access to affordable health insurance". As bad as the credit card system may be, lending is at least a business that can be conducted at a distance. Health care is the most local of concerns. What's needed is not a guarantee of "access to efficient health insurance markets". What's needed is actual health care. In a moral society, everybody should have access to that actual care itself without risk of ruin. The US system forces people to make terrible decisions. People remainining in hated jobs, empowering employers and distorting the employer/employee market. Not taking medicine, or half-dosing, because, even with insurance, the costs are too high. Not visiting the doctor after an injured ankle because of fear of the costs, then suffering forever after due to a poorly healed fracture. Especially pernicious: seeing a doctor but not reporting problems because of fear they'd be labeled as pre-existing conditions for which future coverage would be denied. And employers themselves have higher costs because of the historical accident of employer-based insurance, reducing their competitiveness with foreign companies who have no such obligation. It's a huge political problem, but this focus on insurance, and access to insurance, begs the question.

by hellcow 10y ago

SomeCollegeBro 10y ago

I agree that opening up across state lines is a very good thing. However, if the marketplace goes away and there's not a good way to force companies to be competitive, we're really not in a better place either. Hopefully we can have the best of both worlds.

ceejayoz 10y ago
> I agree that opening up across state lines is a very good thing. When this was done with credit card companies, they all moved to the state with the least regulation and started instituting consumer-hostile stuff like mandatory arbitration. I'd really rather not have this happen with my health insurance.

jasonmp85 10y ago

Obviously 20% seems high, but they'd be higher without it, crazily: http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-premiums-20160726-snap-story.html http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamac...

willholloway 10y ago

The idea that the lack of competition between states is the reason for high health insurance premiums is a red herring. The reason premiums are high is that costs are high, and our population is obese, disease prone and litigious. If we want to contain costs we have some options: 1) Public option/Medicare for all could save us 10-20% in parasitical insurance company costs/administrative overhead. 2) We find solutions for obesity. Obesity is the #1 driver of increased health costs in America. 3) We stop holding doctors/pharma financially responsible for bad outcomes outside of their control through the legal system.

mikeyouse 10y ago
Premiums also saw a large increase due a cynical and intentional move by the GOP congress to withhold funds from insurers that were initially promised for the first few years while they sort their pricing out. Part of the initial law were "high risk corridors" to limit the losses for insurers that initially mispriced their ACA plans. The insurance companies had to make a ton of assumptions about the age, health, and wealth of the populations who would sign up for their plans. To make sure they didn't accidentally bankrupt themselves, the law provided funds to limit their losses for the first three years of the exchanges (2014-2016). In the first year, they had a shortfall as the population was older and sicker than expected, so CMS was going to cover the $2.5 billion gap but congress refused to let them pay these user fees. The GOP knew that the premium changes would come during the election season, so they denied funding for the high risk corridors last year. To give themselves room against mispricing, the insurance companies predictably raised premiums beyond where they would otherwise have been. Other insurance companies decided they didn't want the risk, so they pulled out of the marketplaces. The election season was rife with announcements about "20% premium increases" and "xx Insurance company exits the exchange market". Millions of people get to pay more for health insurance but at least their guy won the race.
- willholloway 10y ago
  Theoden: So much death. What can men do against such reckless hate? Aragorn: Ride out with me. Ride out and meet them. Theoden: For death and glory. Aragorn: For Rohan. For your people. Theoden: The Horn of Helm Hammerhand will sound in the deep, one last time!
analog31 10y ago
The present state of affairs is that everything is a red herring. The health care system is so convoluted, with business entities inside business entities paying other business entities, that it's impossible to know where the money goes, so we have no idea what makes it so expensive. Somebody is gouging us, but we will never know who, and everybody can point to somebody else, or to "society," but we just don't know. Chances are, everybody who can make money while covering their tracks through a web of business entities, is gouging us. One potential advantage of the government owning the whole system, is that it would facilitate figuring out what the costs actually are. This may be why other civilized countries pay half what we pay. It's a saying in business, that you can't manage what you can't measure.

tunesmith 10y ago

Selling across state lines is a horrible idea. It's a race to the bottom in terms of regulation, which leads to adverse selection, and therefore more expensive premiums for the sick, poor, and elderly. There's a lot of material out there about the likely effects of selling across state lines. To the point it is not even actually seen as a viable option, it's more something that Republicans say because it sounds reasonable at first. But it's not workable.

jbscpa 10y ago
Tunesmith You say: "It's a race to the bottom in terms of regulation" Consider your assumption that regulation is good. In point of fact pernicious and arbitrary regulation within states brought us as a nation to this desperate situation. You say: "To the point it is not even actually seen as a viable option" Check your prejudice at the door and look at reality. You may need to understand markets and human nature more clearly. You may "see" and understand other, better options.
- Blackthorn 10y ago
  We "see" and understand exactly what happened when this exact thing happened to credit cards and it universally sucked for the consumers.
- fattire 10y ago
  What's the desperate situation you're referring to w/regard to health care? Do you mean the imminent dismantling of the "pernicious and arbitrary" system which brought 20 million people health care who didn't have it previously, saving untold thousands of lives per year?

BeetleB 10y ago

As another anecdote, the premium increases per year my company has to pay has (mostly) dropped since Obamacare - the highest increase was a year or two prior to ACA.

DougN7 10y ago

Insurance for just my family went from $1400/month (already expensive!) to $1850 per month. I live in the midwest, so it's not like we have crazy high prices. I keep thinking of the mansion I could live in with that much going towards a mortgage. AND, until we hit our $5K premium, it doesn't really pay anything. So we've got to pay $27K to get a real benefit. And it's not like we're young and healthy (nearly 50). Feels like we're getting shafted.

Jtsummers 10y ago
Where in the Midwest? Near a big city? I'd agree with your assessment (no crazy high prices). But if you live in a smaller city (like I do, not Midwest but Southeast), you may also have a disproportionately unhealthy population compared to the national average, along with being disproportionately poor. This means that our regional medical costs are higher both by need (unhealthy population needs more than average care) and scarcity of resources (difficulty in persuading doctors to come here).

xiaosun 10y ago

Allowing insurance to be sold across state lines only creates a short-term arbitrage opportunity. In practice rates are just going to meet at the middle - states with lower premiums will see rates go up and states with higher premiums will see go lower.

redler 10y ago

The problem is what "best" means. In an unregulated environment it would mean what's best for the insurance company, not the patient. There are substantial challenges. One is that insurance companies don't actually provide care, of course. Any company wishing to do business with people in a particular state would have to actually obtain a network in that state -- partner with an existing network, or negotiate deals and sign contracts with hospitals, urgent care centers, pharmacies, labs, and doctors. They'd presumably have to be licensed to do business in that state, and adhere to that state's own regulations and requirements for doing so. (Because the US is a federal system, the federal government itself is unlikely to be able to strip away all of each state's specific laws and regulations.) This process would have to be repeated for every state in which they plan to do business. Insurance companies would probably set up state-specific legal entities or subsidiaries to provide financial and legal compartmentalization. So selling insurance "across state lines", as a practical matter, may not differ much from the current system. State-specific legal work and shoe-leather network-building would still be required. There's nothing stopping a national company from setting up a state-specific entity and selling insurance this way right now. Another issue is that if local regulations were somehow stripped, as some in congress wish, insurance companies, as profit-seeking entities, would all gravitate to the most favorable and least regulated business environment. After the Supreme Court ruling in Marquette v First of Omaha, credit card providers migrated to Delaware, South Dakota, or Arizona because those states have the weakest usury laws and allow them to charge rates of 29% or more to borrowers in any other state. A similarly deregulated and "efficient" market for health insurance would have all the companies set up entities in whichever state would allow them to offer plans that provide the least care reimbursement (known internally as "loss control") and charge the highest premium. This could lead to a situation where a few very large companies offer only high-deductible plans without guaranteed issue, excluding procedures that carry risk of being expensive or are politicized, with lifetime or annual caps, thin networks, and retroactive drops. Lip service would be paid in the form of seemingly cheap policies that actually provide little real coverage, but allow insurance companies and politicians to claim "all Americans now have access to affordable health insurance". As bad as the credit card system may be, lending is at least a business that can be conducted at a distance. Health care is the most local of concerns. What's needed is not a guarantee of "access to efficient health insurance markets". What's needed is actual health care. In a moral society, everybody should have access to that actual care itself without risk of ruin. The US system forces people to make terrible decisions. People remainining in hated jobs, empowering employers and distorting the employer/employee market. Not taking medicine, or half-dosing, because, even with insurance, the costs are too high. Not visiting the doctor after an injured ankle because of fear of the costs, then suffering forever after due to a poorly healed fracture. Especially pernicious: seeing a doctor but not reporting problems because of fear they'd be labeled as pre-existing conditions for which future coverage would be denied. And employers themselves have higher costs because of the historical accident of employer-based insurance, reducing their competitiveness with foreign companies who have no such obligation. It's a huge political problem, but this focus on insurance, and access to insurance, begs the question.