MORE Obamacare nightmares...

Discussion in 'Political Action Forum' started by stevena198301, Aug 10, 2016.

  1. eel river

    eel river Elite Refuge Member

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    It certainly seems that you are one of the folks that got really hit. First, healthcare was always to cheap for what was coming in regard to the baby booming aging. Then the development of better and better biotech drugs drive costs up significantly as well as the turnover rate in technology. It seems that there should be/could be a more goat effective plan in the private market assuming you don't have terribly high risk factors. My most significant medical cost has been cataract surgery a couple of years ago. Being only 7 months from going on Medicare, I'm facing a lesser impact although if I totally quit work I'll have to buy a private plan for the wife for a couple of years.

    Now, The dems and the republicans are and we're stupid saying that they have a plan that is better, lower cost, more coverage, more access, for ALL. It isn't going to happen. Unfortunately, at this point there is no turning back, as somewhat evidenced by the republicans problem in congress on repeal and replace. It's doable, but they know they will get hammered in the next elections and they obviously don't want that.

    I had a guy here two days ago talking healthcare. He had a heart attack and kidney cancer in the same year. Total costs over 600,000. He was complaining about his premium and deductible costs now, about $20,000 a year. But, he quickly said that if he had to cover healthcare out of his pocket, he'd have lost his business and had to file bankruptcy. I hope that something is provided by legislation to help folks like you that got hammered on premium costs. But, the approach of the ACA model will in the future be likely expanded to broader national healthcare.
     
  2. stevena198301

    stevena198301 Elite Refuge Member

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    Just looked, and it has changed this year (for the better, actually). I was going off last years. Our deductible went down to $2600, and out OOP max is $6000. Last year, it was $3000 deductible, with no OOP max. So there is a silver lining, I guess. I know that many, many employees at my company left 2 years ago, when the plan we currently have came around, because they couldn't afford a major medical event such as a kid getting cancer, etc. They all went to other companies. I'm guessing my company got the message, as all that left straight-up told them they were leaving due to our *****y health coverage. This ranged from low on the totem pole to middle/upper management. A few of our regional managers jumped. Some retired.
     
  3. eel river

    eel river Elite Refuge Member

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    Glad to hear they put in better protection for high cost issues. That said though, the folks who are healthy are still paying for those who aren't.
     
  4. The_Duck_Master

    The_Duck_Master Elite Refuge Member

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    The next shoe to fall will be how this will impact your salary and other benefits going forward. They go hand-in-hand.
     
    API likes this.
  5. API

    API Political Action Forum Moderator Flyway Manager

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    Given the outcomes of ACA, like with most (all?) goobermunt programs, enterprising folks will find a way to exploit the system. No doubt CA is not unique.

    Enriched By The Poor: California Health Insurers Make Billions Through Medicaid
    California Healthline By Chad Terhune and Anna Gorman November 6, 2017

    Medicaid is rarely associated with getting rich. The patients are poor, the budgets tight and payments to doctors often paltry.

    But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds their patient care is subpar.

    A unit of Centene Corp., the largest Medicaid insurer nationwide, raked in $1.1 billion in profits from 2014 to 2016, according to state data obtained and analyzed by Kaiser Health News. Anthem, another industry giant, turned a profit of $549 million from California’s Medicaid program in the same period.

    Overall, Medicaid insurers in the Golden State made $5.4 billion in profits from 2014 to 2016, in part because the state paid higher rates during the inaugural years of the nation’s Medicaid expansion under the Affordable Care Act. Last year, they made more money than all Medicaid insurers combined in 34 other states with managed care plans.

    “Those profits are gigantic — wow,” said Glenn Melnick, a health economist and professor at the University of Southern California.

    Alan Sager, a health-policy professor at Boston University, was surprised — and dismayed.

    “California is being wildly open handed and excessively generous with insurers,” he said.

    Jennifer Kent, California’s Medicaid director, said that health plan profits were higher than anticipated during the ACA expansion. But she said the state expects to recoup a significant amount of money within the next year, once audits are complete and retroactive rate adjustments are made.

    “We’re going to be taking a lot of money back. We’re talking billions of dollars,” Kent said in an interview last week. No one should think “these plans just made off like bandits and we’re not going to see them again … We are very mindful we use taxpayer money.”

    Health insurers who profited substantially from Medicaid, known as Medi-Cal in California, defend their good fortune. They say these surpluses follow losses in earlier years, and they always run the risk of red ink if medical costs jump.

    “The expansion may have been a little rich in the beginning,” said Jeff Myers, chief executive of the Medicaid Health Plans of America, an industry trade group. But “you are starting to see margins come back down.”

    More than 1 in 3 Californians, or 13.5 million people, are covered by Medicaid — more than the entire population of Pennsylvania. About 80 percent of those in California’s program are enrolled in a managed-care plan, in which insurers receive a fixed rate per person to handle their medical care. The goal is to control costs and better coordinate care.

    In anticipation of the Obamacare rollout, officials in California and elsewhere boosted their payments to managed-care companies because they expected Medicaid costs to increase as newly insured patients rushed to the doctor or emergency room after going years without coverage. But those sharply higher costs didn’t materialize — and insurers pocketed more money as a result.

    Moreover, California’s payments keep flowing steadily even when patients fare poorly. Two of the most profitable insurers in California — Centene and Anthem — run some of the worst-performing Medicaid plans, according to medical quality scores and complaints in government records.

    “If there is that much extra money sloshing around in California, then it’s worth asking whether you could expect more in terms of performance,” said Andy Schneider, a research professor with Georgetown University’s Center for Children and Families.

    California officials acknowledge they need to do a better job of connecting money and quality.

    “We are looking at alternative payment methods and those types of things that we can do to help improve and to tie quality to payment,” said Lindy Harrington, a deputy director at the California Department of Health Care Services, which runs Medi-Cal. “But as you can imagine, it’s a difficult ship to turn.”

    Medi-Cal Suddenly A Cash Cow

    Before the ACA expansion, California’s Medicaid plans collectively were barely in the black, with $226 million of net income for 2012 and 2013 combined. Traditionally, these insurance contracts have yielded slim profit margins of 2 percent to 3 percent. California said it aims for 2 percent when setting rates, based on prior claims experience and projected costs.

    But in the years since the health law took effect, many health insurers have posted margins two or three times that benchmark.

    Centene’s Health Net unit in California enjoyed a profit margin of 7.2 percent from 2014 to 2016. Centene acquired Health Net for $6.3 billion in March 2016. Anthem’s profit margin in California’s Medicaid program was 8.1 percent for 2014 to 2016.

    Investors have cheered those results. Shares in Anthem have more than doubled since January 2014, when the Medicaid expansion began. Centene shares are up 50 percent since the company purchased Health Net last year.

    “We have proven our ability to provide high-quality, cost-effective healthcare to state beneficiaries while saving states money and delivering strong returns to our shareholders,” Michael Neidorff, Centene’s chairman and chief executive, told investors in February.

    In a statement, Health Net said its profit margins are comparable to other Medi-Cal health plans and the company has made major investments to improve Californians’ health and access to care.

    Anthem declined to comment on its financial results. The company said in a statement that it has worked with the state to meet the needs of Medicaid patients by extending clinic hours and helping with transportation to appointments. The company said it’s committed to providing “high quality care to our Medi-Cal members.”

    Charles Bacchi, chief executive of the California Association of Health Plans, said they deserve some credit for making the Medicaid expansion work.

    “The expansion was an incredible lift and we can’t do it for nothing,” he said. “It would be a shame to look at one snapshot in time and ignore the success of California’s expansion that has helped millions of people.”

    Overall, Centene has 7 million Medicaid enrollees across the country, with about 2 million in California. Anthem is close behind with 6.4 million Medicaid members, about 1.3 million in the state.
     
  6. eel river

    eel river Elite Refuge Member

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    API, some states produce a profit, others don't. But, isn't it good that insurers are making money? They offset loses one place with profits another. It can swing wildly from year to year. Insurers are simply practicing for national healthcare from a global sense.
     
  7. API

    API Political Action Forum Moderator Flyway Manager

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    Reread the above. Major insurers nationwide are running circles around the ACA profit opportunity. The system users (customers) are getting skinned thanks to a bad idea forced upon them.
     
  8. stump

    stump Elite Refuge Member

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  9. pintail2222

    pintail2222 Elite Refuge Member

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    Over 600,000 people signed up for a plan through Obamacare's federal exchange in its first four days of open enrollment, significantly outpacing last year's sign-ups, according to official figures released Thursday...

    That makes me wonder why they needed to enroll... Everybody is supposed to have affordable coverage.... Was it because the over 600,000 people got notice last month that their current plan no longer qualifies and so it is going to be discontinued? Was it because the over 600,000 people got notice last month that their Health Insurance provider was leaving their State and would no longer offer Health Insurance to them? Was that because the over 600,000 people got notice last month what their 2018 premiums & deductibles were going to be going way up for the upcoming year and realized that they couldn't afford it so got on the exchanges to get a cheaper plan? Was it because the over 600,000 people have health issues that they've been putting off for a few years so they are signing up to finally get treated and then come March after they are good to go they will stop making payments?
     
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  10. stump

    stump Elite Refuge Member

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    The Centers on Medicare and Medicaid Services (CMS) said that 464,140 customers renewed their coverage while another 137,322 customers were new enrollees

    Majority were Renewed.... As I'm sure you read in the article ... the other 137 could be one of your theories, or they just became eligible that never had any due to age. The possibilities are endless.
     

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