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Gaming Obamacare
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Topic Started: Jan 12 2016, 05:26 PM (158 Views)
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George K
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Jan 12 2016, 05:26 PM
Post #1
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It's not like we didn't warn you, is it?
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Obamacare customers are gaming the system, buying coverage only after they find out they’re ill and need expensive care — a trend insurers warn is destabilizing the fledgling health law marketplaces and spiking premiums for everyone.
Insurers blame the problem on lax rules that allow more than 900,000 people to sign up for coverage outside the standard enrollment season — for instance, when they change jobs or move — without sufficient proof they are eligible. No one knows precisely how many might be manipulating the system, but the plans say they run up much higher medical bills and then jump ship, contributing to double-digit rate increases and financial losses.
Health plans also complain some customers are exploiting a three-month "grace period" — when they can keep getting subsidized coverage even if they’ve stopped paying their share of premiums.
Both those trends make the risk pools skew toward sicker, costlier customers — and under Obamacare, plans can no longer deny coverage to those with expensive medical conditions. That problem has been exacerbated by the large numbers of healthier people who are choosing to stay uninsured rather than shell out money for coverage...
UnitedHealth Group, the country’s largest insurer is threatening to pull out if the problems aren’t addressed. Others are demanding that loopholes be limited or closed, saying they fear the marketplaces could unravel. "Unless some fundamental flaws are corrected, we believe there is a grave risk that the federal exchange will not operate as a viable, competitive market in 2017," Aetna wrote to the Obama administration about proposed marketplace rules for 2017.
The Blue Cross Blue Shield Association, whose members dominate many of the exchanges, offered a stark warning. "Current rules and procedures allow millions of consumers who enroll through [special enrollment periods] to have an adverse effect on the overall market stability because they can purchase coverage only when they need medical care,” the trade group wrote the administration.
BCBSA calculates that exchange customers who sign up during special enrollment periods are 55 percent more expensive than their counterparts who enroll during the regular season. Aetna estimates that 25 percent of its HealthCare.gov enrollments last year came through special enrollments and those members have “unusually high claims generation” and remain on the rolls for less than four months on average — less than half the time of other Obamacare consumers.
UnitedHealth Group said last year that it expected 30 percent of its exchange enrollments to come outside the normal sign-up window — and that those customers were 20 percent more expensive than other Obamacare enrollees.
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"Now look here, you Baltic gas passer... " - Mik, 6/14/08
Nothing is as effective as homeopathy.
I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18
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Copper
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Jan 12 2016, 05:59 PM
Post #2
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Sure, I've done this myself.
The insurer is no longer able to calculate risk.
And of course that is exactly what insurers do - calculate risk.
Now they are becoming simple conduits for charity with no limits on liability, the most essential elements of insurance hardly exist. There are, in theory, no more lifetime limits, no more limits on pre-existing conditions without these limits the risk becomes incalculable.
Without the ability to manage risk they just collect the tax and pass it through to the dependents.
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The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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Jolly
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Jan 13 2016, 06:09 AM
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As somebody who worked with indigent patients for many years, let me state that our patients knew the rules as well (or better) than we did. Many of the would whip-saw the system nine ways from Sunday.
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The main obstacle to a stable and just world order is the United States.- George Soros
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Mikhailoh
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Jan 13 2016, 06:10 AM
Post #4
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If you want trouble, find yourself a redhead
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Indigent and stupid are not necessarily synonymous.
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Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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George K
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Jan 13 2016, 08:28 AM
Post #5
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Forget about all the increased premiums and high deductibles. Here's another way it's costing more.
The Obamacare Pay Cut.- Quote:
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Among the law’s few popular features, even among Republicans, is the mandate to cover adult children through age 26 on the insurance plans of their parents. This benediction is sold as a gratuity, but somebody must ultimately pay, and new research suggests the hidden costs—in the form of lower take-home pay—are far higher than advertised.
In a working paper, Gopi Shah Goda and Jay Bhattacharya of Stanford and Monica Farid of Harvard exploit the fact that some 37 states had extended dependent-coverage mandates of varying rigor and comprehensiveness before the Affordable Care Act. They explore these differences to estimate the results of the uniform national mandate that was imposed in 2010.
“We find evidence that employees who were most affected by the mandate, namely employees at large firms, saw wage reductions of approximately $1,200 per year,” the researchers observe. As a wave of young adults hit the employer-based insurance rolls, the cost of coverage inevitably climbed and businesses were obliged to dial back cash wages as a share of overall compensation to accommodate the influx. Large businesses were a particular casualty because before ObamaCare they were largely exempt from state-level mandates.
The study also found that the costs of the adult-kid mandate weren’t “only borne by parents of eligible children or parents more generally.” They’re spread over all workers including other young people, the childless and late middle-aged.
No study is definitive, though the authors are careful about their methods and assumptions. The eternal lessons are that no alleged government benefit is free and people should be allowed to make the trade-offs for themselves.
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A guide to GKSR: Click
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
Nothing is as effective as homeopathy.
I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18
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