The Commonwealth Fund released a study a few months back that just came across our desk this morning. It deals with whether or not the ACA had an effect on declining uninsured rates.
I believe in the end, yes, the ACA lowered the uninsured rate but it wasn't because of anything purchased. What the ACA did was pass off the costs from the consumer to the government making health insurance "affordable". How did they do that, you ask? Well, the ACA made provisions for subsidies to be paid out for lower income Americans which took a normal $400-600 premium and through subsidies made it under $100. The American taxpayer ate the rest. For the truly low income individuals, the expansion of Medicaid created a $0 premium plan with (in most cases) $0 copays, coinsurances and deductibles.
So of course people are going to sign up for something free. In that case, yes, the ACA did indeed lower the uninsured rate.
The flip side of that coin was the ACA drove people into the marketplace who were happy with their group plans by rewriting the rules on who can qualify for group coverage. One of the biggest crimes of the ACA was the destruction of the two life group. The vast majority of small group insurance was written on businesses with under seven lives and for the most part were two life "mom and pop" groups. When the ACA said no greater than 51% of a single family could make up a group health plan roster, that essentially killed small group health insurance and drove people to the marketplace. The participation as you can see is not because of the quality of the plans or the desire to go to the marketplace, it was because of legislation that destroyed the plans they liked and could no longer keep.
The bottom line is you can not pass off costs to government be it state or federal and then crow about the "success" of your plan when the fact is without the government handouts, no one would have gone to the marketplace. We are burdening our children with a debt tomorrow to fuel our socialist desires today.
Take a look at the study and see first hand how they made this horrible piece of legislation seem all sweetness and light.
http://www.commonwealthfund.org/publications/issue-briefs/2016/dec/aca-declining-uninsured-rate
Friday, February 24, 2017
Wednesday, February 15, 2017
Responsibility Is Now Hell?
I found this piece on Real Clear Politics today and felt it needed discussing. This column shows why any real health reform is a pipe dream. When the only method of properly rating a plan or managing risk towards a carrier is called "A Circle of Hell", we have problems.
As usual, my comments will be in red.
By John McDonough and William Seligman
February 15, 2017 Real Clear Health
All leading Republicans who are committed to repealing all or key parts of the Affordable Care Act (ACA) also emphasize their commitment to maintaining the law’s most popular part: banning pre-existing condition exclusions and medical underwriting by preserving the ACA’s (also known as Obamacare) policy of “guaranteed issue.” But the fine print in Republican proposals betrays that commitment, including legislation filed on January 26 by House Energy and Commerce Committee Chairman Greg Walden (R-OR) threatening health security for tens of millions of Americans.
Medical underwriting is the insurance industry practice of issuing and pricing health insurance based on an individual’s current or prior medical condition. Insurers use medical underwriting and pre-existing condition exclusions to avoid covering anyone who might cost them money. The Walden bill, called the “Preexisting Conditions Protection and Continuous Coverage Incentive Act,” pretends to continue the ACA’s ban on medical underwriting, but would, in reality, do the opposite.What are pre-existing conditions that can prevent you from obtaining coverage?
Excuse me, but Medical Underwriting and Risk Management are the only ways to effectively the level of risk a carrier is taking on with this member. Guaranteed Issue with coverage for pre-existing conditions is what is causing your 200% rate increases as the carriers chase prior year losses.
What are pre-existing conditions that can prevent you from obtaining coverage? Here is a list of hundreds that are used to exclude or limit health insurance: acne, cancer, domestic violence, leukemia, pregnancy, sleep apnea, and much more.
Not every Pre-X gets you a decline letter. Some pre-X conditions will get you a premium increase to cover the increased risk. Some Pre-X conditions will get you limited coverage but considering we have plans with $2500 deductibles and $8500 Out of Pocket limits, this will probably never be an issue.
Walden’s bill would require that insurers not use medical underwriting and pre-existing condition exclusions against applicants for insurance, though with provisos. For example, though insurers couldn’t refuse to issue a policy because of someone’s current or past medical condition, nothing in his draft prevents insurers from using medical underwriting in setting premiums. In other words, health care consumers could acquire insurance despite their medical history, yet still see huge increases in month premium expenses.
This makes sense. The carrier won't decline the applicant but will instead rate the policy just like they do with life insurance, disability insurance, long term care insurance and even auto and homeowner insurance. For an insurance company to remain solvent, they must have a reasonable understanding of the risk they are taking on. That doesn't change in a single payor system either. Risk Management and Actuarial Science exist no matter who is adjudicating those claims.
Even more important are the bill’s final words: “Title II – Continuous Coverage Incentive [Placeholder].” That’s it, there is no more. What does Walden mean by “continuous coverage”?
Just about every ACA replacement proposal advanced by Republicans since 2013 includes this “continuous coverage” provision. It means that you are protected from pre-existing condition exclusions only if you are able to maintain coverage for the minimum required period and have no gaps longer than allowed by law. The proposed time periods vary between 6 to 18 months. Walden’s new Republican draft is silent on this detail and everything else. Under Speaker Paul Ryan’s “Better Way” plan released last summer, those who fail to maintain “continuous coverage” will be newly subject to medical underwriting and pre-existing exclusions when they try to purchase coverage. In other words, they get a one-way ticket to the medical underwriting circle of hell.
Continuous Coverage prevents Adverse Selection, plain and simple.
How many Americans might fall into this circle of hell? It's hard to say, but it is likely that most of the 28 million to 29 million currently uninsured Americans would fall into it, plus a large share of the 20-22 million who gained coverage under the ACA. Most people in the latter group receive subsidies through Medicaid or tax credits for private insurance. But Republicans want to replace these income-scaled subsidies with a flat tax credit. This would harm the tens of millions of Americans at the bottom of the income ladder, many of who have health coverage under the current law.
In other words, some of these folks don't have money to provide coverage and want an already bankrupted government to pay their premiums for them. Using pretend money to pay for real services has always been a really bad idea.
Guaranteed issue with continuous coverage is the Republicans’ favorite path to repeal the ACA’s unpopular individual mandate. However, the mandate was built into the health care law to ensure the workability of guaranteed issue, among the most liked parts of the ACA. The irony here is that both continuous coverage and individual mandates try to get at the same thing: to create broad insurance risk pools that attract healthy and younger enrollees to keep premiums as low as possible.
The risk pools aren't for the young and healthy. The state High Risk Pools are for the folks who utilize their coverage. To pool these less than healthy members into a government system is asking for the taxpayers to "buy claims". That is the fast track to insolvency.
Which is more punitive – the individual mandate or continuous coverage? In 2015, about 6.5 million Americans paid the individual mandate penalty of $325 dollars (which rose to $695 in 2016) versus tens of millions who would be vulnerable to medical underwriting under Republican continuous coverage provisions, and left with no other option but to buy insurance through re-invented state “high risk” pools in which premiums are often as much as 50 percent higher than in regular markets.
Asking people to have continuous coverage is not punitive. Ok, no problem. Let's say I agree with you gentlemen that Continuous Coverage is punitive and the only compassionate idea is to eliminate this draconian policy, then lets restrict what activates a Special Election Period. We eliminate the Continuous Coverage provision while reducing and nearly eliminating the opportunity for Adverse Selection.
The health insurance industry – though they are willing to work with congressional Republicans to modify the ACA – don’t want to return to medical underwriting, and many in the field advise against it. Most of the industry does not appreciate being the bad guys who deny coverage. Typically, health insurance providers prefer the Affordable Care Act, so long as the market ensures a broad risk pool, and mechanisms such as reinsurance are set in place to prevent excessive costs.
Who the hell told you that nonsense?!?!?!? We are ALL ABOUT underwriting. It is the only way a carrier can protect itself against catastrophic loss. Oh and about reinsurance, can you guys please stop using that silly talking point? No worthy Reinsurance carrier is going to take on a secondary payor role on non underwritten risks. A Reinsurance carrier is even more restrictive than your standard risk management company. Do you know what health insurance carriers "typically" liked? They liked the idea of the individual mandate until they saw what a train wreck it was now they don't "typically" like it.
It’s the Republican Party, standing alone, who wants America to return to the medical underwriting circle of hell. Across the country, Americans are saying “no.” Let’s hope members of Congress listen.
And it was the Democrats standing alone who shoved this mess down our throats. What Americans are saying No? Donald Trump was elected on repealing this abomination. The people did indeed speak, let's hope Congress does in fact listen to them.
John McDonough and William Seligman are with the Harvard TH Chan School of Public Health in Boston.
Tuesday, February 14, 2017
High Risk Pools, They Still Don't Get It
I found this on one of my insurance industry news sites. Just more clueless band-aid ideas with nary a shot at ever having a realistic shot of success.
My comments, as usual, will be in red.
My comments, as usual, will be in red.
GOP Pushes ‘High-Risk’ Pool In ACA Replacement
Sunday, February 12, 2017
Physician Poll On the ACA = Made Up News
The news media has picked up a poll conducted by the New England Journal of Medicine that shows a low number of medical providers (15.1%) approve of repeal of the Affordable Care Act. I found these numbers hard to believe as I hear the complaints all the time from providers who are dropping managed care networks and refusing to increase patient panels. Digging deeper, I saw that 73.8% of polled providers favor making changes to the law which is on par with the numbers I have seen from the population at large. The bottom line, a complete repeal will be nearly impossible but we can get to repeal through changing laws that hinder healthcare and reduce consumer choice because let's face it, if you "replace" enough of the law making it unrecognizable did you not in essence "repeal" it?
I have copy and pasted the entire piece. My comments will be in red.
I have copy and pasted the entire piece. My comments will be in red.
A View from the Front Line — Physicians’ Perspectives on ACA Repeal
The recent election of Donald Trump as President of the United States has created substantial uncertainty about the future of U.S. health policy. The incoming administration has sent mixed signals about the Affordable Care Act (ACA) — embracing some aspects of the law while campaigning against it and pledging to repeal it. The provisions that may be repealed or modified and the new policies that may be enacted are still unknown.
The perspectives of primary care physicians (PCPs) on the potential repeal of the ACA are important for informing the public debate, given PCPs’ central role in the health care system. Patients are most likely to have long-standing relationships with their PCPs and to rely on them to help make health-related decisions that affect their health care costs, quality of care, and outcomes. Moreover, proponents of repealing the ACA, including the nominee for secretary of health and human services, Tom Price, have argued that the law places an undue burden on physicians.1Although much is known about the general public’s perspective on the ACA, less is known about physicians’ attitudes toward health care reform and its potential repeal.
In a survey conducted between January and March 2015, PCPs were split, with approximately half having a favorable view of the law (48%) and the other half unfavorable (52%).2 A majority reported that they had seen an increase in the number of Medicaid or newly insured patients, without a decrease in their ability to provide high-quality care.
Given that the political and policy landscape changed dramatically over the ensuing months, and that physicians were gaining more experience with the ACA’s provisions, we performed our own survey, by mail, of PCPs from December 2016 through January 2017 to assess their perspectives on the ACA and specific policy options put forth in recent public debate. One thousand physicians, including physicians trained in internal medicine, pediatricians, geriatricians, and family practitioners, were randomly sampled from the American Medical Association (AMA) Masterfile, which contains information on AMA members as well as nonmembers. Physicians received up to two mailings and a telephone call, with an option to complete the survey online. A $2 incentive was provided in the first mailing. Overall, 426 physicians responded to the survey. After we excluded ineligible physicians, our adjusted response rate was 45.1%. Our survey has several limitations: nonresponse may limit the generalizability of the findings, and PCPs may have views that differ from those of other physicians, given differences in political affiliation according to specialty.3
So you polled less than 1,000 members of the premier association for America's health providers?
We found that in response to the question, “What would you like to see the federal policy makers do with the Affordable Care Act?,” 15.1% of PCPs indicated that they wanted the ACA to be repealed in its entirety. Responses varied according to the physicians’ self-reported political party affiliation; no Democrats wanted to see the ACA repealed, whereas 32.4% of Republicans did. Among physicians who reported voting for Trump, only 37.9% wanted the ACA repealed in its entirety. PCPs were less likely than the general public to want the law repealed. A Kaiser Family Foundation poll conducted after the election that used a question and response options similar to those in our survey showed that 26% of the general public wants the law repealed in its entirety.
I am very interested in this number because it doesn't match reality. Only 15.1% of respondents favored outright repeal but yet look to your own world. How many times have you had to switch a PCP because they didn't take your plan due to network participation? Granted that doesn't happen with Medicare Supplement but Medicare members who have Medicare Advantage have to deal constantly with network issues. If providers were that satisfied with the operations of the ACA, I doubt we would be dealing with such network issues.
When asked about aspects of the ACA as it currently exists, the physicians we surveyed almost universally supported the insurance-market regulations that prohibit insurance companies from denying coverage or charging higher prices on the basis of preexisting conditions (95.1% stated that the prohibition was “very important” or “somewhat important” for improving the health of the U.S. population). There was also strong support for other key provisions of the law, including allowing young adults to remain on their parents’ insurance plan until 26 years of age (87.6%), providing tax credits to small businesses (90.8%) and tax subsidies to individuals (75.2%), and expanding Medicaid (72.9%). A lower proportion — just under half — favored the tax penalty for individuals who do not purchase insurance (49.5%).
I do not for one second believe that 72.9% of responding providers favor expanding Medicaid. Try finding a provider that will accept NJ Family Care. It is nearly impossible. That's because Medicaid will only compensate Medicaid doctors and those reimbursements are so low it was said to me once by a provider "the minute that patient walks through my door, I am losing money". I have no doubt the providers support the Age 26 law because here in NJ, we used to have Age 31.
Among both physicians and the general public, there is a large gap in support between provisions that allow people to obtain insurance without respect to preexisting conditions and mechanisms for ensuring that both healthy and sick people enroll in coverage.4 These results point to an important need to educate health care providers and the public about the fundamental inseparability of these provisions: policies that do not address adverse selection would lead to increased and unsustainable health insurance costs.
Oh my goodness, this is so void of reality, it borders on malpractice. Once you mandate coverage for Pre-X, adverse selection doesn't matter because that carrier has now purchased that claim regardless. Your unsustainable costs stem from covering everyone and everything under the sun and then not charging the correct amount of premium based on risk management and actuarial science.
Although only 15% of PCPs want the ACA repealed, nearly three quarters (73.8%) favor making changes to the law. Physicians responded most favorably to policy proposals that might increase choice for consumers, such as creating a public option resembling Medicare to compete with private plans, providing tax credits to allow people who are eligible for Medicaid to purchase private health insurance, and increasing the use of health savings accounts. Physicians responded most negatively to policies that would shift more costs to consumers through high-deductible health plans. Less than half were in favor of proposals to decrease insurance-market regulations (by allowing insurance companies to sell across state lines), require states to expand Medicaid, or expand Medicare to adults 55 to 64 years of age.
This is far more realistic and even I have proposed expansion of Medicare to folks Age 55 and above with certain caveats. Physicians like the broker community oppose high deductible plans for consumers as they do not work. The member does not want to use their coverage because of that high deductible that needs to be met and so the opportunity for preventative care or getting ahead of an illness before it progresses is eliminated. No, there are better ideas out there.
In the next few months, the country will embark on another major debate about the future of U.S. health policy. According to recent estimates, the health insurance coverage of nearly 30 million people could be at risk if critical elements of the ACA are repealed and the nongroup-insurance market is disrupted.5 As policymakers consider changes to the ACA, they might consider the views of PCPs, given their unique role in the U.S. health care system. We found that PCPs strongly endorse key elements of the ACA that enable individuals to obtain insurance coverage and that very few support repealing the law.
While I support having the providers in this conversation, I also support having the insurance broker community in this conversation as well. We, like the providers are on the front line and see the results of this law on a daily basis. I think many of us support the replacement mores than the repeal because like I stated above, if you change the law enough to make it unrecognizable did you not in essence repeal it.
Thursday, February 2, 2017
Carriers To Withdraw From ACA Market By 2018
Of course they are going to withdraw!!! They have to as utilization costs are going to bankrupt them. You can not have an entity designing plans and approving rate structures who have no vested interest in the success of those plan designs or rates.
https://www.washingtonpost.com/national/health-science/health-insurers-warn-of-wider-defections-from-aca-marketplaces-for-2018/2017/02/01/c507ec78-e807-11e6-bf6f-301b6b443624_story.html?utm_term=.90112b812657#comments
https://www.washingtonpost.com/national/health-science/health-insurers-warn-of-wider-defections-from-aca-marketplaces-for-2018/2017/02/01/c507ec78-e807-11e6-bf6f-301b6b443624_story.html?utm_term=.90112b812657#comments
Wednesday, February 1, 2017
Answering the Reciprocity Argument in Health Insurance Offerings
I found this column, saw some points that needed addressing and my rebuttals will be in red beneath the paragraph I wish to discuss. Enjoy, this was one of my favorite posts to write.
Interstate Health Insurance: Sounds Good, But Details Are Tricky
Jan. 18-President-elect Donald Trump has repeatedly pledged to allow health insurers to sell policies across state lines to spur competition and lower premiums.
On his campaign website, Trump proclaimed that, "by allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up." He also touted the idea during the second presidential debate, and since the election, Vice President-elect Mike Pence has made the same argument.
The implication is that federal law prevents insurers from selling policies across state lines. That isn't the case.
Between 2008 and 2012, five states -- Georgia, Kentucky, Maine, Rhode Island and Wyoming -- passed laws specifically allowing out-of-state insurers not licensed in their states to sell health insurance policies within their borders.
And yet NY, NJ and CA still have the highest insurance rates in the country. What's your point?
Nevertheless, no insurers have taken advantage of the laws. That's because entering an unfamiliar territory and creating a network of medical providers is exceedingly difficult and expensive, health policy analysts say.
Maybe, maybe not. What has made it expensive for insurers in the past to enter the reform states was the high capital reserve needed to guarantee coverage of claims. Yes, you may have to entice a provider at first with a higher reimbursement rate but with limited competition in many states, a new carrier may be most welcome.
But many health insurance analysts say that even if insurers were able to build provider networks in new states, it's not a good idea. The cross-state sale of health insurance would undermine the states' ability to regulate insurance, they warn, destabilizing their insurance markets and driving up premiums.
Nope, that's a straw man. The rules are clear that any carrier offering product in a state would have to comply with state law. In the reform states, that is a competition crusher because some of the smaller carriers can't afford the high MLR and the restrictiveness of the "mandated plan" structures.
"It sounds great in a campaign to say we're going to get rid of the lines," said Gerald Kominski, director of the UCLA Center for Health Policy Research. "But what they're really saying is we're going to get rid of state regulations and consumer protections."
Again, say hello to Mr. Straw Man. See Above.
All states license the insurers selling policies within their borders and regulate the health plans sold there. Each state has its own rules on the benefits insurers operating in their state must offer, the extent to which insurers can charge different premiums to older customers, and the financial assets insurers must maintain in order to do business in the state. The five states that have moved to encourage cross-border sales have indicated a willingness to set aside some of their own regulations.
They will set aside regulations to meet ACA compliance. NJ's insurance market took a big hit when the ACA was implemented. NJ had a better MLR, NJ had Age 31 on dependents and we still had catastrophic care and lost all of that when the ACA became law. NJ had it figured out (albeit at great expense to the consumer) but NJ was at the cutting edge of health insurance reform.
Some larger insurers, such as Aetna, do sell policies in multiple states, but any company that does so must be licensed in every state where it operates, and must comply with each state's laws. (This isn't the case with "self-insured" employer-based plans that operate in multiple states, or plans in which the employer assumes the financial risk of providing health care benefits to its employees instead of paying a fixed premium to an insurer.)
And an insurer breaking into a new state likely would have to pay providers higher than prevailing rates to lure them into joining a new network.
As discussed above, that may or may not be the case.
"It takes a huge investment to get established in the health insurance market," said Deborah Chollet, a senior fellow at the policy research organization Mathematica Policy Research. "Outsiders would have a hard time getting a foothold."
That's the nature of competition. It takes a huge investment to build presence in any market. I don't care what you are selling, you need an investment to build presence and time to build credibility. I would also argue that health insurance as long as it is regulated, people will go for a new carrier especially if it is affordable. A perfect example would be Geisinger Gold. They were a new player in the Medicare market that cleaned up in less than 5 years on the market because they offered up a $0 premium plan in a member rich environment. A newcomer can do well with the right business model and the right plan.
With cross-state sales, insurers would be subject to the regulations in the state where they choose to base their operations. Critics say the proposal would encourage insurers to locate in lightly regulated states, but sell their policies nationwide.
That is happening now. Not every carrier offers in all 50 states.
If the Affordable Care Act is repealed and cross-border sales proceed, insurers would be free to sell inexpensive, less comprehensive policies to relatively young and healthy people. That would leave behind older, sicker people with greater medical needs, who would end up paying higher premiums for the coverage they need.
How would they do that if they have to meet that states requirements on community rating, guaranteed issue and limited to non-existent Pre-X. Whether or not the ACA survives, these issues will all be part of any future healthcare plan. So the answer is to instead spread the misery equally and "fairly"? We are currently doing that now and it isn't working. Why not let younger people benefit from their youth and health? Why should they be obligated to pay more to cover claims they did not incur?
"This is just a veiled attempt to allow insurance companies to shop for the most industry-favorable states with the least consumer protections and requirements and allow them to sell those products everywhere in the country," said UCLA's Kosinski.
Again, states already do that. In states where they can't, they make deals to get better payouts on large group or other "non-reform" markets.
Kristine Grow, a spokeswoman for America's Health Insurance Plans, which represents health insurers, said her group hasn't taken a position on Trump's proposal.
Supporters of the idea acknowledge that interstate competition would create some problems, but insist they can be overcome.
Thomas Miller, a resident fellow at the right-leaning American Enterprise Institute, said interstate sales might lead to higher premiums for many Americans, but that new federal or state regulations might be crafted to prevent price-gouging and protect people with pre-existing health conditions.
"People like to put out cartoon, extremist versions of the other side," Miller said. "Yes, there are nettlesome problems with this idea, but not ones that can't be solved with a sophisticated approach."
A Long History
States' authority to regulate insurance dates back to the mid-19th century, when New Hampshire appointed the first state insurance commissioner. In 1944, the U.S. Supreme Court ruled that the "business of insurance" was subject to federal antitrust laws. To preserve states' authority, Congress in 1945 passed the McCarran-Ferguson Act, which exempts insurance from most federal antitrust laws but gives states the ability to regulate the industry.
Many state officials fear that interstate sales of health insurance would undermine their ability to regulate the insurance sold in their state. The insurance commissioner in, for example, California, would be unable to take action against, say, a Wyoming insurer whose products were sold to California residents. Similarly, Wyoming regulators might be disinclined to investigate complaints lodged by out-of-state consumers.
No, the state would still have the right to regulate that carrier just like the state's have the ability to regulate, oversee and discipline agents both on a resident and non resident basis. McCarran-Ferguson would still be law and the states will still have overwatch on their markets.
That helps explain the opposition of the National Association of Insurance Commissioners to the idea of cross-border sales. Interstate sales of health insurance, according to the NAIC, would "make insurance less available, make insurers less accountable, and prevent regulators from assisting consumers in their states."
Trump isn't the first Republican to propose the cross-state sale of health insurance during his presidential campaign. Sen. John McCain of Arizona did so in 2008 when he was the GOP presidential nominee, and former Massachusetts Gov. Mitt Romney did the same in 2012 when he was the nominee.
Linda Blumberg, senior fellow at the Urban Institute, said it's peculiar that Republicans, who tend to be the party most concerned about states' rights, would want to diminish states' ability to regulate insurance.
Yeah, it's an interesting point but a non-starter because the states will still have the right to oversee and enforce their states insurance laws and markets.
"One state should not be allowed to undermine the regulatory environment of another state, and that's exactly what would happen here," Blumberg said.
But Michael Tanner, a senior fellow at the Cato Institute, a libertarian think tank, said allowing cross-state sales would advance another Republican goal: eliminating excessive regulation. He said the shift would discourage state regulators from implementing overly burdensome rules that would put in-state insurers at a disadvantage.
The result for consumers, according to Tanner, would be more choices and lower premiums.
I fully agree
"It's only insurance companies and regulators who dislike people's ability to go out-of-state," he said.
Tanner acknowledged that some sick Americans might not pay lower premiums. But he said those with the most serious health issues probably should not have traditional insurance coverage, but instead be enrolled in special, high-risk pools that would be created and subsidized by government.
People are already paying higher through no fault of their own other than a zip code.
Repealing the Affordable Care Act
Trump and Republicans in Congress have vowed to "repeal and replace" the Affordable Care Act. But keeping the law in place would mitigate some of the feared negative consequences of interstate sales.
The ACA requires all health insurers to cover "essential health benefits," which include maternity care, treatment for mental illness and substance abuse, rehabilitative therapy, laboratory testing and prescription drug benefits. The ACA also prevents insurers from denying coverage to people with pre-existing health conditions or charging them higher premiums and prohibits higher premiums for women.
As we have previously discussed. Keeping the ACA mandates in place will result in higher premiums. One only has to look at NY, NJ and MA to see that.
Without the ACA mandates, some states might allow the sale of cheaper policies with more limited benefits. If unfettered interstate sales were allowed, states desiring higher standards wouldn't be able to ensure that policies sold within their borders would include them.
The lack of regulation, some insurance analysts caution, would lead to a "race to the bottom" in terms of the quality of the policies, enabling companies to sell plans with limited benefits, yearly and lifetime limits on payouts for medical expenses, and high deductibles and cost-sharing provisions.
And if someone chooses to buy them, isn't that choice and freedom? Yes, I agree that paying hard earned money to put a piece of plastic in your pocket that you can't use is not good but then again, we can't be the Health Nanny for entire population. We have to allow people to make their own choices and frankly having Congress make those decisions on a plan they themselves do not use is a horribly bad precedent.
Health policy experts say the arrival of those policies would disrupt the insurance markets in the states where they were sold.
Of course, it would and that's good. We need shake-up, we need competition. In NJ, our 3 companies sit fat, dumb and happy knowing that the state's residents will come to them every three or four years as renewal increases get too much and they switch to the next carrier. It's a merry go round of futility.
"It would create a very skewed kind of competition," said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group. "What it would do would be to create a very uneven playing field."
We currently have an even playing field of misery and no one wants it.
With the healthiest part of the market migrating to policies offered by out-of-state insurers, in-state insurers would have no choice but to compensate for that loss of business by raising premiums for everybody else.
Or the in state carrier can perform an actuarial investigation to figure out why they are so expensive and then adjust accordingly.
"It could send the market into a death spiral," said Eric A. Cioppa, superintendent of the Maine Bureau of Insurance.
The ACA is already in a death spiral. Time for a new idea.
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