THCB

Mr. President, I Like My Health Insurance. I’d Like to Keep It. Can You Please Help Me Out?

How many times have I talked about rate shock, the millions of people who would be getting cancellation letters from their current health plan, and the problem of people having to put up with more narrow networks?

And, how many times have those predictions been met by push back and spin: Today’s policies are just junk and people will be better off finding lower cost health insurance under Obamacare.

I have been in this business for 40 years. I know junk health insurance when I see it and I know “Cadillac” health insurance when I see it.

Right now I have “Cadillac” health insurance. I can access every provider in the national Blue Cross network––about every doc and hospital in America––without a referral and without higher deductibles and co-pays. I value that given my travels and my belief that who your provider is makes a big difference. Want to go to Mayo? No problem. Want to go to the Cleveland Clinic? No problem. Need to get to Queens in Honolulu? No problem.

So, I get this letter from my health plan. It says I can’t keep my current coverage because my plan isn’t good enough under Obamacare rules. It tells me to go to the exchange or their website and pick a new plan before January 1 or I will lose coverage.

First, the best I can get in a Blue Cross network plan are HMOs or HMO/Point-of-Service plans. In the core network those plans offer, I would have to go to fewer providers than I can go to now in the MD/DC/VA market. And, the core network has no providers beyond my area. I can go to the broader Blues network but only if I pay another big deductible for out-of-network coverage.


Now, my plan covers about everything. Never had a procedure for either my wife or myself  turned down. Wellness benefits are without a deductible. It covers mental health, drugs, maternity, anything I can think of.

The new plan would have a deductible $500 higher than the one I now have and a lot more if I go “out-of-network” inside the rest of the Blue Cross national network.

And, wait all you people telling me rate shock does not exist, it far more restricted plan costs 66% more than our current monthly premium. Mr. Rate Shock got rate shocked––and benefit shocked to boot.

Now here’s the real corker: Maryland has been bragging they have the lowest premiums of all of the exchanges. More, I figured being an old fart the age rating rules, that force younger people to pay more so older people pay less, would help me. Didn’t work out.

There are other plans on the exchange but every comparable plan had much higher premiums.

Thankfully, my Blue Cross plan is offering me an “early renewal” which means I can keep this plan I really like until December 2014––at which point my beloved health plan is toast. My health insurance company is doing everything they can––this is not their fault.

Mr. President: I really like my health plan and I would like to keep it. Can you help me out here?

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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  2. I lost my insurance today. I am self employed and have been paying it for years, I mean years. They didn’t renew it because I wasn’t a group and according to NY law I have to be an individual. Am I going to be fined ? And worse yet what happens if I get hit by bus tomorrow? Are there any lawyers out there that think I have a case of breach of contract? Im going to pursue it, I’m all for people having health care, but it shouldn’t effect mine.

  3. Anyone who says only the rich are complaining is in total denial and refusing to look at the facts.
    After taxes make I make $37,000, I live in the SF Bay Area, hardly rich. Under ACA, out of that $37,000 I have to spend almost $7,000 in insurance premiums per year! This is for catastrophic insurance. If god forbid I actually get sick, I have to spend over $11,000 (on top of the $7,000) before my policy starts paying for everything. This will drive many middle class people into poverty.
    I am a leftist, and I say to my fellow progressives/leftists: Stop saying only rich people are complaining! Stop saying you know that my new ACA policy is way better than my old policy, and that my old policy was crap in comparison. You’re totally wrong, you don’t know what you’re talking about. You’re damaging your credibilty, and your pissing off millions of working people who are really struggling with this.

  4. It is interesting how people seem to blame the insurance companies for our high cost of health care. What about the providers? Here is my own personal experience with health care costs. I had a baby in 2003, the total amount billed to my insurance by my Dr. and the hospital, all costs, was only $2500. That same child went to the ER with abdominal pain and vomiting in 2010. We were in the ER for only 3hrs, 8oz of IV fluid and an abdominal CT scan. She was diagnosed with a kidney stone. We were sent home and told to follow-up with our pediatrician in the morning. The hospital billed our insurance company over $15,000. Just the CT scan was $7400. Who is monitoring the providers?

  5. I believe those who like their non ACA compliant plans should be able to keep them if they so desire. I personally like my families coverage. We are a family of 5, and our premiums and deduct/max out of pocket are reasonable, and our coverage is great. Unfortunately, our plan is not ACA compliant and it is not grandfathered, we missed it by 2 months. At the end of 2014, we will have no option but to transition to an ACA compliant plan. Per the healthcare exchange, a similar plan would cost our family almost 400% more and the max out of pocket is actually higher. In an attempt to make health care more accessible and more affordable, those of us who were already making sacrifices to make sure our families were insured are now the ones being punished. I understand the benefits of ACA, but why should those who are happy with their current plan need to change. Where is the freedom of choice? Perhaps insurance carriers could offer ACA and non ACA compliant plans, perhaps food for thought.

  6. It’s not Obama care…it’s is simply the insurance companies and doctors who demand way to much to give you the right treatment you need . It’s Saad that the doctors who ” supossibly became doctors to help and cute the I’ll… Want so much money to do it.. While taking up with insurance companies to rob us.. It’s not Obama… It’s all about money..Obama is trying to make it affordable for us all..I myself would be a different person had I had the choice of health care when I was younger.. Wake up people..only the Rich are complaining…. Ours simpler..if we all work as one community then we all succeed..

  7. I’m self employed. I’m one of those kicked off my previous plan. My premiums will go up from $285/mo to $545/mo. My deductibles will be much higher and coverage will be worse. If you believe I’m being saved from a “bad” plan, you’re wrong, I’ll be getting a far “crappier” policy. The (un)Affordable Care act still allows lots of crappy policy clauses. If I have to be taken to an emergency room out of my system its the same as if I have no insurance. Under Obamacare I do get pregnancy insurance (I’m a 50 year old male) and my non-existent children can get dental care, but I don’t get any dental care. Nice, makes lots of sense.
    I’m on the left, but I’ve always been suspicious of this fake reform since it started. This is beyond left and right. Americans have been getting screwed by health care/insurance corporations, where we in the U.S. pay almost twice as much per capita for health care and get less for it than anywhere else in the industrialized world. Obama just helped them turn the screws on us a little bit more and make even more money. I’m glad some uninsured people now have insurance but making the middle class pay for it by cranking up already outrageously high health premiums is untenable. This is having a very negative effect on my life and many others’ lives. Individuals in the health care market are now getting totally f*cked over.

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  9. All those accusations of whining from the comfort of their cushy employer provided plans. Well, many of them will be in for a shock next year as they get tossed by their employers into the exchanges, and learn the definition of crap plans.

  10. “1. People were promise they were going to see their premiums GO DOWN by an average of $2,500 a family. Lie. They are going up.”

    Well for those getting subsidies coverage cost did go down. For pre-exist they can now get covered at less cost due to community rating. For older people their cost went down as younger peoples cost went up. So not a lie.
    For those who don’t get subsidy and buy their own the cost went up because of above factors and more comprehensive coverage.

    “2. People were repeatedly told they could keep their existing insurance (period). Lie. These implementing the law know that most of these existing policies would be cancelled.”

    A bad mistake by the President who still fails to explain why costs go up. I’m not sure they knew, but they were at least stupid not to have foreseen it. The ACA was never meant to give something for nothing.

    “3. People were told they could keep their existing doctors. Lie.”

    Even before ACA you were not guaranteed that all insurance companies had your doctor as “in network” due to insurance networks. I don’t agree with networks, hope ACA can change that in my lifetime. But you still would have out-of-network coverage at higher cost.

  11. “Note to Peter 1:
    For what it is worth, the cost of health care has been coming down all over the place for 20 years. The problem is that the prices have stayed high!”

    When I was insured that was well represented by my 6% – 10% premium increase per compounded year! along with she bump every so often.

  12. Boy, if your medical diagnoses are as acute and well-reasoned as your political opinions, you’re one doctor I hope I never have to consult.

  13. Insurance Verification Service is said to be a key comfort in the medical billing cycle. In this service, the patient’s active coverage is checked with the insurance company to make sure that he/she is eligible for the procedure scheduled in hospital.

  14. This is turning into kind of a showcase of the amazing condescension of the left. Here is a recap:

    1. People were promise they were going to see their premiums GO DOWN by an average of $2,500 a family. Lie. They are going up.
    2. People were repeatedly told they could keep their existing insurance (period). Lie. These implementing the law know that most of these existing policies would be cancelled.
    3. People were told they could keep their existing doctors. Lie.

    So, now that the law is being implemented we see that (a) it was sold with lies and (b) millions of people are being harmed along the way.

    The response is to tell the victims they are “whining”.

    Typical…

  15. I genuinely look forward to reading and hearing every stalwart democrat supporter who gets harmed by this legislation as is , be it financially or health care wise, scream about being screwed or harmed. This reflexive and dismissive dialogue by all these apologists and shrill defenders, simply because this is democrat driven legislation, deserve pain and inconvenience.

    It is the only way rigid and inflexible people can possibly learn and change responsibly. And, most partisan hacks don’t and won’t.

    Sorry, harsh and rude. As is this law and implementation.

  16. Note to T:

    I think that a few states have firm protection against balance billing in the ER. Colorado and California come to mind.

    Furthermore, the ACA did have some language about limits on balance billing — but CMS has made this a very low priority, and it was not going to apply to all hospitals.

    Why there is no national leadership on this is depressing to me also.

    Note to Peter 1:

    For what it is worth, the cost of health care has been coming down all over the place for 20 years. The problem is that the prices have stayed high!

    The treatment of kidney stones, heart attacks, compound fractures, and many other ailments has come down rapidly.

    But we allow hospitals and drug companies to charge prices far, far in excess of costs. The villains are local monopolies, and an unwillingness to asset legal antitrust muscle against medical providers.

  17. “If you want to control healthcare costs, do it by controlling healthcare costs. Don’t do it by surprising people with outrageous bills.”

    Patients have always been surprised by outrageous bills. I agree with actually controlling costs, not back door smoke and mirrors, but how do you get past the lobbyists and corporate funders?

  18. I love how almighty pie in the sky people talk about winners and losers. It’s easy to do that when someone else is a loser, not you.

    Well, *I* am a loser in the ACA and I find such discussions disgusting, heartless, cruel and elitist.

    But such a good Democrat you are.

  19. So you’ll also be happy when someone goes out of network to an ER and gets the balance bill for the out of network services. The law does not protect against balance billing, even in the ER.

    If the politicians were up front about the narrow networks then maybe what you’re saying would have some merit. But they are lying about these networks too. They are lying about every aspect of this law.

    If you want to control healthcare costs, do it by controlling healthcare costs. Don’t do it by surprising people with outrageous bills.

  20. Still no word from Robert L on precisely why his plan was not renewed. . . maybe it was the lack of OB coverage. Sure doesn’t sound like a “minimum essential coverage” problem.

  21. Of all the troubling news in health insurance these days, the exclusion of high priced hospitals from networks is one thing that gives me pleasure.

    In these hospitals, the number of doctors and administrators making over $500,000 tends to be relatively very large.

    Any health insurance move that involves reference pricing and cost control is going to penalize these institutions. Either patients will avoid them when they find out what they will have to pay over and above the insurer’s price, or the insurance plan will avoid them by network exclusion.

    Way too much of American medicine has been cost-driven pricing…i.e. our budget is this, so we must charge patients as follows.

    Meanwhile the rest of America has had to live on price-driven costing….
    i.e. the customer will only pay $2.50 for toothpaste, we had better get our costs down.

    I have no problems seeing the big hospitals humbled.

  22. In Southern CA, all 13 insurers offering plans on the exchange are excluding Cedars Sinai from their hospital networks and 12 of the 13 are excluding UCLA Medical Center. Physician networks are also narrower than in the broader network off exchange plans. Not contracting with the most expensive hospitals and doctors results in a significantly lower premium than would otherwise have to be charged.

  23. GH that may be true in California that’s not true everywhere.

    I’m virtually certain that providers (at least hospitals) contract for exchange products separately from other products the carrier sells. I know of a hospital executive who decided not to contract for any exchange insurance even though obviously they’re contracted for other products from that carrier.

    Reimbursement rates are expected to be lower for exchange contracts than standard ones.

  24. Just verified with Blue Shield on their PPO plans both through covered california and their non ACA plans the doctors are the same. No separate list of docs.

    Those that really don’t want ACA have not investigated the shortcomings of their existing plans or have not logged on to see what kind of plans are available. I know the troubles with healthcare.gov but really, give it a chance.

  25. I agree. I need to kow porecisely why is was cancelled. My bet it is that it didn’t meet all of hte minimum standards for care or it had a change in the premium/copays,etc.

    Fess up!

  26. The healthcare system before the ACA had clearly been failling many peiople for many years, esp[ecially those who could simply not afford it. It might still continue the fail after ACA is fully implemmented and we won’t know that until it is tested and used for a significant time period. If it does fail, then we will have to try and fix it once again. It has never been a rational option to not try to fix that which was failing.

  27. … redone in the hopes it won’t pass a second time. I suspect you don’t really care if it works or not, you just don’t anybody to have it from an ideological point of view.

  28. … and yet, we really are at the highest level a social society made up of many peolple who intereact with each other every day in many ways that reduce our individuality whether we want to or not.

  29. Have you scheduled your heart attack?

    How do you know that you already don’t need mental healthare?

  30. It would have just been better all around long term to eliminate the age requirement in Medicare and let anybody who to to sign up for it, do just that. The problem is that every business would eventually abandon their employees in pursuit of the almighty dollar in process and create all sorts of havoc. If they lower their product costs to reflect lower losts to produce that probaqbly would be OK, but I really do not trust businesses all that much.

  31. Not “nationalized” healthcare. For that to be true , we wouldn’t be relying solely on private health insurance providers. It does try to make it sound like socialized medicine which it clearly isn’t.

  32. 51 out of 100 is a majority. Partisanship only counts when you loose.

    No bill that becomes law will operate as expected when first implemented. To believe otherwise, would be very naive, at best. To believe that a bill that had been debated in Congress on and off for decades has never been read by teh Senator, Representative, or their staffers is also extremely hard to believe. when the Congressmen say that, it is all political theather. You would be naive to believe what they said.

    You do realize that Congress was lied to by the Bush administration. Those people voted on what they thought they knew as fact. I think I would have voted yes based on the information provided. Many of those same people would have voted no had they had the real facts. I know that is an inconvient detail, but it is a well documented factual detail.

    I find it strange that you would imply the Republicans are for the aveage Joe when everythign they do is to give an advantage to the wealthy. when i look at the voting demgrtaphics, it is the average citizen voting Democratic.

  33. Bob, here’s a timely and well laid out piece on the ‘trade offs’ inherent in ACA with sound links for additional context: http://www.businessinsider.com/your-private-health-insurance-is-really-a-government-program-2013-10

    Too many health wonks who’ve never negotiated a master HMO or PPO, risk, non risk, partial or global contract let alone managed their mercurial networks, shape shifting sands of leadership or affiliate MSOs/PPMCs think they’re smiled and dialed in on the correct narrative here. Sometimes a little humility from the 30k view pays off….

    The ACA is what we got flaws and all. If significant blowback from the spammy, scammy churn and burn individual market is allowed to derail ACA, this is one mega dis-service to the american public. Again, the privileged whining that started this thread is exactly one of the trades we must be willing to make.

  34. All Health Care plans are going to change – and should change- Isn’t that painfully obvious?

    The heady days of the past are gone unless, Mr Laszewski, you wish to pay out of your own pocket for a health care service that you believe that you need

    Dr Rick Lippin
    Southampton,Pa

  35. “Casinos understand their long term future survival depends on their patron’s perception that their gaming is not “fixed”.”

    So does private insurance in America. Nobody publishes the actuarial odds.

    “Do you believe your health or even your health insurance falls into the realm of any certainty under The Act?”

    Well it does for those with pre-exist, or for those getting subsidies.

    “I wonder if Peter1 will be buying any ACA lottery tickets.”

    Fundamentally I don’t oppose a mandate, I just appose being forced to buy into the most expensive rigged system in the world. I support single-pay, or at least a public option – where is that option in this country of options?

    I hedge my bets by saving for future health needs, I would rather not exercise that risk and have “affordable” health coverage – but this system does not understand the meaning of affordable.

    The ACA attempts to reduce the number of risk pools, but it does it within a system of insurance mind set – no wonder we’re talking about winners and losers.

  36. “The ACA is founded on the concept that your health should not be gambled with.”

    Mr. Hertz, I respectfully disagree. I have read comments from folks attempting to simply log on to the HealthCare.gov website comparing the moment when they got past the security questions page to winning the lottery. People voluntarily patronize a casino. Casinos understand their long term future survival depends on their patron’s perception that their gaming is not “fixed”. This administration does not have that same concern.

    Again, The Act was never meant to work. This administration is not interested in the private insurance survival; in fact, quite the opposite. I would gladly take my chances with an “honest” casino then this administration. Casinos usually do not change the rules in the middle of the game or tax you if you do not participate at their casino.

    Do you believe your health or even your health insurance falls into the realm of any certainty under The Act? I wonder if Peter1 will be buying any ACA lottery tickets.

  37. The individual market up until now has been a kind of casino. You could buy cheap insurance or no insurance, and take the chance that you would not get sick this coming year.

    The ACA is founded on the concept that your health should not be gambled with.

    Leaving aside the political agendas, I wonder if we should see this debate as part of a structural conflict in America — between individualism and paternalism.

    As a nation we let individuals refuse to buy life insurance, or to buy inadequate amounts. The ACA wants to prevent this from happening in health insurance.

    It is not a simple conflict — it runs through all attempts to prohibit drugs and sugary foods and (in the past) to prohibit alcohol.

    Joseph White points out in his writing that American health policy has been different, because unlike Europe, America has a large group which really believes in individualism. We are seeing this play out in health policy today.

  38. Wow. Block that metaphor. Don’t think United killed the Medicare buy-in option. They have gone aggressively after MA lives, and would have been the largest beneficiary of voluntary buy-in by boomers. Don’t agree that private insurance is doomed. . . They are a lot more adaptable to local conditions than Medicare is and have way better IT. . .

  39. I was cancelled from my Healthnet policy and then told to apply for ACA plan. I am now going to pay 30% more in premium and my out of pocket goes from $4500 to $6350. Both of these are moving in the wrong direction and for what mental health coverage? Free physicals? I don’t need those things and I resent being told I HAVE TO HAVE a plan that does. People did not clearly think this through. It needs to be re-done.

  40. Thanks Bob. A testimony to the power of special interests?

    Might I add that HR 676 ‘Single Payor’ Conyers – MI, never even saw the light of day as it was DOA politically. Ergo we got ACA (you know politics is the ‘art of compromise’ even under so called super majority rule?) at first with the possibility of a public option only later to have it stripped from consideration. ACA ain’t pretty but it’s what’s in front of us. We can try to make it work – the many flaws and all – or hunker down into our opinion silos and watch it implode.

    I completely agree with Richard Merkin, MD, the founder of Heritage Medical Systems and Heritage Provider Network, the CMMI is ‘the hidden gem in Government’. As you know the Center for Medicare and Medicaid Innovation (CMMI) is part of the ACA. Innovation won’t come from legacy players responsive to legacy incentives. It will come from the disruptors dancing at the margins. Jeff has never been a fan of ‘statutory ACOs’ (MSSP, perhaps the Pioneers) and I assume by extension their unregulated commercial derivatives. Yet, this comes with the ACA package. We’re either part of the solution or we’re just another feature of failure. The healthcare ecosystem is much like a ‘tapeworm economy’ simply feeding on itself… a sad commentary into which many wittingly and unwittingly play. Healthcare.Gov failure to launch is indefensible, yet Laszewski’s privileged whinning, the origins of this thread, seem rather hollow in the grand scheme of things.

  41. Jeff, didn’t United Healthcare by proxy deliver unto Cesar the ‘ACA architecture’? This is pure and simple a sausage rendering of special interest voices who opposed Medicare ‘E’ or any other derivative public option. This is/was the last kiss at the apple for the public/private partnership with a headlock on the legacy infrastructure of our imploding house of cards. This Titanic was long ago taking on water, the bump into the iceberg merely accelerated the inevitable cratering process.

  42. To be clear, I only suggested letting baby boomers buy into Medicare on a voluntary basis after age 55 as a more affordable way of getting them coverage than going thru all this nonsense. http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/

    It would have been a cheaper way to cover the nearly 13 million uninsured boomers, the most high risk group we needed to cover. This would have taken the pressure off rates for younger people in the private market, and made coverage much more affordable for them and their parents. I was not proposing “Medicare for all”.

    The idea basically was shot down by the hospitals. . . who didn’t want the currently well insured boomers to have a potential MUCh lower cost option that paid them much less than they charge the privately insured.

  43. Thanks Barry. You are right about tough politics for a true high risk pool….
    but just looking at raw numbers, it is not such a bad deal for healthy people.

    If taxes went up by $125 billion, that would be a tax increase of about 1.5% depending on whether income or payroll taxes are used.

    On that basis, a person making $50,000 a year would owe $750 in extra taxes a year, or $62 a month.

    $62 a month is cheap compared to the premium increases that many Americans will see under the ACA.

    In general, direct taxes are better than market manipulation and unfunded mandates. Harder to sell, though, I admit.

  44. As to what is happening to premiums try no more lifetime caps, 26 year olds covered, more mandated benefits and more demand for services due to the ACA driving costs up further. Glad to hear you say that the cancellations were predictable. Any thoughts about why the Administration continued to lie about it?

  45. I would like to see as many people as possible get adequate health insurance at reasonable cost and I’m perfectly willing to contribute toward subsidies for those who can’t afford to pay the full premium. I do expect, however, that there will be a robust effort to accurately verify income and there should be significant penalties for people caught hiding or underreporting income.

    What troubles me the most about the underlying attitude toward the development of the ACA, which is common among Democrats, is that government knows best and individual people can’t be trusted to act in their own best interests. I think they can and should be trusted even though some will make what turn out to be poor choices.

    Uncompensated care primarily impacts hospitals and doctors not employed by a hospital who treat patients there. However, the Kaiser Family Foundation tells us that uncompensated care only causes hospital prices to be about 6% higher than they would otherwise be which isn’t huge, in my opinion. For the uninsured, potential exposure to bankruptcy due to medical bills they can’t pay is a separate issue. Even there, though, for those with no or few assets, the consequences of bankruptcy aren’t very severe aside from maybe finding it hard to get credit on decent terms afterward.

    Bob Hertz — The problem with the public option is that insurers wouldn’t trust early claims that it would be required to compete on a level playing field with private insurers meaning that it would have to cover its medical claims and administrative costs from beneficiary premiums, including subsidies, alone. If sick people could just pile into it at premiums that didn’t come close to reflecting their actuarial risk, it would quickly sink into an adverse selection driven death spiral.

    The other option is high risk pools for the 4-5 million people in the U.S. estimated to be uninsurable under traditional underwriting standards. It could easily cost $100-$125 billion per year to cover this small percentage of the population with very high medical costs. It’s highly unlikely that even liberal politicians would vote to spend this much money on such a small population of people many of whom are too sick to even vote.

  46. Gregg, yours is one of several posts on this blog that deal with the very thorny question of winners and losers under the ACA.

    It is easy to forget that there was a way to help the uninsured that did not make ‘losers’ of people who had inexpensive underwritten policies.

    This way would have been a public option, funded in part by higher taxes.
    (or the expansion of Medicare, which amounts to the same thing and was suggested by Jeff Goldsmith about 4 years ago.)

    People who were uninsured or faced crippling rates could have gone to the public option. People who were happily insured could have stayed that way.

    I am not saying that such a plan would create no anger. The wealthier taxpayers would have lots of anger.

    But instead of this direct approach, the ACA tries to shoehorn every American into the private insurance pool, with the disruptive consequences described in this string of posts.

  47. I’m not debating how or why his plan was cancelled. The regulation was written tightly enough that it was predictable that many plans would be cancelled.

    The question is why the new premiums would be so much more expensive. It doesn’t follow. The only good explanation I can come up with is that it was heavily underwritten and Bob is the healthiest 62-year old on the planet.

  48. After watching you on PBS News hour last night, I retract my earlier comment.

    Seriously, you of all people know that the actuarial balancing act (with many more moving parts most professionals let alone the general public can reasonably follow) required here will create winners and losers as the deck is shuffled to achieve the multi-dimensional aims of the ACA. To call it ‘actuarial science’ is a bit of a misnomer anyway…

    Bottom-line, if your loss (ie., at best a pro-forma budgetary inconvenience) of a cadillac plan fulfills the insurance of the uninsured, and closes gaps of the exponentially growing pool of the under-insured via HDHP or so called ‘consumer directed’ schemes, I say its more than a fair trade.

    Let’s be clear. Health care is not a privilege in the U.S. only accessible to those with means and the periodic bully pulpit.

  49. You may have a misunderstanding of what cause cancellation of existing policies. For instance, if you have adequate coverage as defined by the ACA but your deductible has gone up since 2010 you are nonconforming. If your premium remains the same but you do not have maternity coverage, even if you are a single male, you have a nonconforming policy. In both cases, you will be cancelled and have to pay more for a substitute plan.

    The HHS regulations were designed to force as many individual plans as possible into nonconformity and that is why the Administration knew in advance that 50-75% of existing policies would be cancelled.

    The people I know who have been cancelled are informed consumers who spent a lot of time comparing policies before purchase and who were very satisfied with their existing plans and doctors.

  50. The only losers should be people who liked swiss cheese coverage and wanted to keep it. Throw in the new MLR requirement of 80% in the individual market and it just defies logic how a more closed network with equivalent benefits could be more expensive on both premiums and deductibles than a more open network plan that wasn’t regulated with an MLR requirement.

  51. Every comment on The Act should begin with the understanding that it was never meant to work. However, it’s not just an expensive boondoggle. It is meant to distract and to expand a relatively small problem (3 million Americans that actually want to buy insurance now but cannot due to pre-existing conditions; less than 1%) into an end of the earth crises that can only be avoided by nationalized government health care with no choice. Please be prepared to argue and fight against rewarding this administration’s epic failure to implement The Act, with their ultimate goal of government run nationalized health care. I choose to believe there is not a majority of Americans that want to work for the government or not work for the government but be dependent on the government for their welfare. Optimist I guess.

  52. I am blogging the Sebelius testimony (REC Blog). Sworn in under Oath, 18.USC.1001. Ranking Member Rep. Waxman, in his opening statement, asks the Republicans to stop hyperventilating. No chance.

    “What did the President know, and when did he know it?”

  53. It should be obvious by now that the Administration had no idea of the actual consequences of what it signed into law. There’s a combination of idealism, arrogance, lack of practical knowledge and paranoia in the crew attempting to do this, and a fundamental lack of respect for complex phenomena. Too bad so many people are going to get hurt in the course of helping so many others.

    The US private health insurance risk pool is a TRILLION DOLLARS. It’s the size of Turkey, a gigantic, very shallow lake of money whose topography was completely rearranged by this law. (I actually show people a photo of Lake Superior taken from space . . .). The individual insurance market is a particularly shallow bay in this lake. ACA completely altered the flow of funds into the bay and also dredged the bottom of the bay. And now people are looking for the new navigational maps.

    There are about fifteen million people in this part of the lake, going to maybe 40 million, and it is very stormy just now. . . Have we heard from Bob yet about precisely why his policy didn’t comply?

  54. The core premise of insurance is spreading risk across the population.

    Patients pay only 30% of hospital bills on average. That means the money comes out your pocket if someone’s plan doesn’t cover chemical dependency and then their teenager becomes addicted to drugs and needs psychiatric hospitalization. We have all been paying for that. We also have all been paying for pediatric dental emergencies for people who don’t have that covered on their plans.

    Some people have gotten a great deal from healthcare for years while the rest of us have been paying higher premiums covering these other people.

    Some people will have higher premiums and some will have lower as the risk burden is more evenly spread across the population.

  55. gh —

    “have blue shield before, have it now. doctors would have to opt out of the entire Blue Shield program for my doctors to change. nice try though”

    I don’t think this is correct. In CA, all insurers offering plans through the exchange are offering narrow network products. This includes the non-profit CA Blue. I’m not sure if Anthem is offering exchange based plans or not but if they are, they include narrow network products. It could be that this is a rule that varies among Blue licensees but presumably they have the power to change it to reflect changing circumstances like the passage and implementation of the ACA.

    As for Bob’s plan, I’ve read that to retain grandfathered status, there can be no changes in benefits from what was offered prior to the passage of the ACA. The way the final regulations were written, as I understand it, require that this includes no changes in deductibles, copays, out-of-pocket maximum amounts, limits on PT or mental health visits, etc. Just increasing the deductible to reflect medical inflation which Medicare Part B does routinely would apparently disqualify it from grandfathered status. Perhaps Bob can clarify this point for us.

  56. have blue shield before, have it now. doctors would have to opt out of the entire Blue Shield program for my doctors to change. nice try though

  57. Wait until the Obamacare lovers see their provider networks and try to get doctor access. They may not be so thrilled.

  58. “pass the bill and let’s find out what’s in it”’

    Documentably not what she said.

    “100% only partisan passage is not a majority rule passage”

    60 out of !00 Senate votes is majority rule by any arithmetical definition, notwithstanding the partisanship.

    Oh, and, btw, I opposed Iraq. But, then, I was not a “Democrat.”

  59. okay I get it now. Only people that don’t benefit from Obamacare should post here. sorry for the dose of reality.

  60. The Administration knew that 50-75% of all individual plans would be cancelled and yes it can be canceled for something as simple as lacking maternity coverage for a 60 year old male. I know people who’ve been canceled and told their replacements will cost substantially more.

    GH keeps saying there are winners and losers. The problem is the Administration promised everyone that they would be winners – keep your plan if you like it! lower premiums for everyone! keep your docs if you like them! They lied so that GH could get his subsidy. Glad he’s a winner – wonder where his compassion and empathy are for the losers.

  61. Maybe Robert’s plan is a good plan, but the Democrats aren’t interested in the average citizen having a good plan. Only themselves, separate from the peasant masses they rule. Hey, you PPACA supporters just grabbed Nancy Pelosi’s skirt and smiled proudly when she told you “pass the bill and let’s find out what’s in it”, and now you don’t like it so much.

    Buyer beware. 100% only partisan passage is not a majority rule passage, just a partisan rule one. Betcha all you Democrats were so happy with the passage of the Iraq War approval 10 years ago. Oh, that’s right, a sizeable portion of your party reps agreed on it, because conscience was left in the garbage cans outside the House and Senate chamber doors.

    Can you spell hypocrite with less letters? Democrat!

  62. There are always winners and losers. Problem is for those that are never sick and think they are 100% covered they perceive they are the losers. Just like if I had never gotten sick I too might have thought I was a loser in this system. Difference is, I’ve lived it and know that the ignorance I was experiencing would have never been discovered unless I really got sick.

    No plan that is super comprehensive is outlawed. Just doesn’t pass the smell test.

  63. GH, just because you are a subsidy winner does not mean there are not losers in this. Be careful about assuming all the facts of your situation also apply to everyone else.

    Obama is creating his own reality while ignoring the potential political reality of oversell.

  64. Spike, your assertions are completely correct. But the true answers won’t play into the hate ACA playbook so best to leave out real details.

    Bob Hertz, Aurthurs comments were pure supposition. Not indicative of what the real computation or reason is. Makes good theatre though.

  65. I don’t think what he’s saying is garbage, but it definitely doesn’t add up.

    Insurance companies aren’t stupid. They just don’t offer PPO plans to people in their early 60s in the individual market with low deductibles and low premiums that cover virtually every service you’d need.

    So what’s the story? Is his current plan a hidden “easter egg” of sorts that they give to health industry analysts so BCBS gets better press?

    It just seems like there are only two logical explanations. 1) Bob is leaving out a lot of key details to make his point. 2) Bob Hertz is right and his plan fell in some kind of adminstrative black hole where they forgot to increase his premiums on schedule.

    The ACA may be proximally responsible for the sticker shock, but it seems like there’s a different underlying reason behind the whole story.

  66. Can a plan be cancelled as non-compliant for the sole reason that it lacks pediatric dental coverage?

    that would be nuts.

  67. Well, my plan isn’t as nice as Mr. L’s, however all it lacked was pediatric dental and chemical dependency, for which it was cancelled and replaced with a MUCH MORE expensive plan.

    People who think what he’s saying here is garbage are simply in denial. The so-called Affordable Care Act is destroying affordable insurance on the individual market and replacing it with something that does not cover catastrophe because, with the narrowness of networks, the chance that catastrophe will occur outside of network is HUGE.

    It really is as simple as that

  68. Obviously, Mr Lazcewski, you are a poorly educated consumer unfamiliar with our healthcare system and the details of insurance. In contrast, our President is brilliant and much better able to determine your life needs than you are. As His disciple, Valerie Jarrett, said “I think Barack knew that he had God-given talents that were extraordinary. He knows exactly how smart he is. … He knows how perceptive he is. He knows what a good reader of people he is. And he knows that he has the ability — the extraordinary, uncanny ability — to take a thousand different perspectives, digest them and make sense out of them”.

    We are blessed to have Him and we, as citizens, should do our best to live up to his expectations.

    I believe that in his last press briefing, Jay Carney, expressed the Administration’s official position on the pathetic complaints of people like you and those who claim that the President promised you could keep your plan if you liked it when he quoted Otter from Animal House: “you f**k*d up, you trusted us!”

  69. Ouch! speechless…

    Been saying @healthcareGov criticism is ‘target rich’ but this is a deafening indictment…

    FWIW, this smack down narrative is playing at the same time the monkey court is exploiting any reported gaff, soundbyte or vignette (real or anecdotal) they can use to nail into either (both) Tavenner’s or Sebelius’ coffin.

    If you are a wonk addict like me, here’s the three hour plus theatrics: http://www.c-spanvideo.org/program/ActImplem

    Bob, all I can say is might this be a faulty result based on faulty algorithm assignment into ‘options’.

    Gregg

  70. For good or bad this will kill Obamacare faster than anything with the next election if those loosing their cherished plan vote. Reality will not matter.

    The administration has sold the sizzle, now it’s time to sell the steak.

  71. I know at least 2 people that have had this kind of Blue Cross plan.

    For the last 5 years they have been in a moderate death spiral, and their premiums climbed to $900 per month per person.

    The ACA exchanges look great to them — even a platinum plan is cheaper than what they have now.

    How did Robert’s plan avoid the rate hikes of the past 5 years?

    There are a LOT of entries on health care blogs from persons in the individual market who are worse off on the exchanges. Frankly I did not foresee this either.

  72. Some educated guesses:

    1) Mr. Laszewski’s current plan does not cover pediatric vision or dental (therefore crap plan).

    2) Mr. Laszewski’s current plan has an actuarial value of 93%. You see, the metal value assignments are not a pass fail proposition. To qualify as Platinum, the actuarial value must be certified between 88% and 92%. An actuarial value of 93% is not in compliance for a platinum plan or a gold plan or any other ACA authorized plan (therefore does not pass the Goldie Locks Test).

    3) Mr. Laszewski’s current plan could be part of an associated health plan or MEWA that is not allowed anymore thanks to The Act (again, crap plan).

    Could be hundreds of other reasons being invented each day through the regulations within the 25,000 or so pages of regulations being churned out by Ms. Website guru Sebelius that make the plan he wants to keep unkeepable.

    Or, Mr. Laszewski simply could be attempting to misedumacate all the pure spirited ACA cheerleaders (did I forget to mention tea party, for profit, Fox News, 1% ers, extremists, or Rush Limbaugh). It’s all that I can do to keep from crying…

  73. My experience tells me that I bet you have a catastrophic plan. My bet is you think it covers everything you think you need. I think you should ask specifically why this plan is not good enough for the ACA. You may discover as I did once I got a cancer diagnosis that none of the diagnostic scans Pet-Scans etc will be covered. Further once treatment began (after paying for all my own diagnostics) that radiation and chemo coverage was only applicable while I was hospitalized. On the face my policy looked good. That is until I tried to use it. Find out what in specific made your policy not make the cut before making a judgement that they just want to screw you out of great plan. You might just find out that something very real that could happen to you won’t be covered.

  74. What’s the real story behind this? You’re going from a PPO to an HMO, but getting a higher premium, even though your current plan covers “just about everything”. What wasn’t covered under your current plan? What insights do you have for why the premium went up?

    Articles like this show that you’re just piling on the ACA at this point, not trying to educate anyone. You’ve been a vocal critic of the ACA all along so are hardly objective when it comes to analyzing it at this point, you just want to prove you were right.

  75. Robert, did BCBS offer up any details for why your “Cadillac” plan isn’t good enough? It truly does sound like your current individual coverage would fall under the Gold or Platinum ACA levels. Is it possible that BCBS is picking some small detail about your plan that technically puts it below Bronze in order to force you into the new coverage pool?

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