Do you have an extra $3000 in your pocket? Then, vote for Pres. Obama

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And more: http://www.forbes.com/sites/johngoodman/2013/05/30/when-it-comes-to-healthcare-issues-paul-krugman-is-wrong-100-of-the-time/

When It Comes To Healthcare Issues, Paul Krugman Is Wrong 100% Of The Time Writers sometimes worry if a day will come when they have nothing more to say. As long as Paul Krugman is around, I will never have that worry. Boston University professor, Lawrence Kotlikoff has suggested that Krugman return his Nobel Prize. I hope he doesn’t. As long as someone with Krugman’s professional status gets his facts wrong in column after column, and does so in an arrogant and pompous manner, attacking the integrity and hurling insults at all who disagree with him…well, there will always be a market for a writer who is able to show that the scourge of sensible people everywhere has written one more erroneous editorial. Krugman may not always be wrong. On some economic issues he may actually be right. But when it comes to health care, he almost never misses. He is wrong 100% of the time. In Monday’s New York Times column Krugman pronounced ObamaCare a success before it has even been tried. Why? Because the premiums to be charged in California health insurance exchange are apparently lower than what the experts thought they would be: Well, the California bids are in — that is, insurers have submitted the prices at which they are willing to offer coverage on the state’s newly created ObamaCare exchange. And the prices, it turns out, are surprisingly low. A handful of healthy people may find themselves paying more for coverage, but it looks as if ObamaCare’s first year in California is going to be an overwhelmingly positive experience. I did a quick check and discovered that if a 25-year-old in Los Angeles chooses the least expensive plan offered on the California health instance exchange, the premium will be $142 a month. Yet the cheapest plan offered on eHealth today is only $92 a month. Aah…let’s see…Everybody thought health insurance premiums would be 100% higher. In fact, they are only 60% higher…Hooray…Break out the champagne! I’ll come back to these price comparisons in a minute. For the moment, I would ask: what kind of an economist would celebrate an expected price decline without asking what happened to quantity or quality? This is an Econ 101 mistake. As it turns out the health insurance to be sold in the California exchange excludes some of the best hospitals and the best doctors. Also, the fees paid to providers will not be the same as commercial insurance are paying. They will be somewhere between the commercial rates and Medicare rates. This means that people with exchange acquired insurance will be less desirable to providers from a financial point of view than people in orthodox plans. As the Los Angeles Times explains: People who want UCLA Medical Center and its doctors in their health plan network next year, for instance, may have only one choice in California’s exchange: Anthem Blue Cross. Another major insurer in the state-run market, Blue Shield of California, said its exchange customers will be restricted to 36% of its regular physician network statewide. And Cedars-Sinai Medical Center, one of Southern California’s most prestigious and expensive hospitals, said it’s not included in any exchange plans at the moment. Krugman points to the experience of health reform in Massachusetts in predicting how wonderful health reform is going to be: Massachusetts has had essentially this system since 2006; as a result, nearly all residents have health insurance, and the program remains very popular. So we know that ObamaCare — or, as some of us call it, ObamaRomneyCare — can work. But what has really happened in the Bay state? Insurance sold in the Massachusetts exchange pays doctors and hospitals only about 10% more than what Medicaid pays. And for reasons that are not entirely clear, doctors are less willing to see the newly insured (with exchange subsidies) than Medicaid patients. The Massachusetts reformers believed that once everyone was insured, patients would go to the doctor’s office for primary care rather than to the hospital emergency room. But in expanding the demand for care, they (just like ObamaCare) did nothing about supply. The newly insured can’t go to doctors’ offices for their primary care if there aren’t any more doctors’ offices. Here is what is happening on the ground. Traffic to hospital emergency rooms in Massachusetts is higher today than before health reform. Traffic to community health centers is almost one-third higher than it was before reform. Yet, the time it takes to get care is growing. The wait to see a new doctor in Boston today is two months ― the longest wait in the entire country. On balance, the only thing that seems to have changed in Massachusetts is that patients are waiting longer. They are going to the same places to get care that they went to before. They are getting the same care from the same providers. In the process, more money is being moved around. A lot more money. Let’s return to the subject of California premiums. Krugman links to a Johnathan Cohn New Republic column claiming that premiums on the newly created healthy insurance exchange will actually be lower that they are today. Yet this assertion is based on comparing premiums in today’s small group market with expected individual premiums on the health insurance exchanges. That’s not the right comparison. Small group premiums are significantly higher than individual premiums in most states. The relevant comparison is today’s individual insurance premiums versus the individual premiums in the exchange. Exchange premiums are going to be higher. With health reform, California premiums will be higher than they are today, but the sticker shock will not be as severe as in other states. The reason: California already has unisex rate requirements. As a result the age differential for males (60-year-old versus 20-year-old) is already close to the 3 to 1 band required by ObamaCare. In states without unisex regulation, the age differential would be 6 to 1. Still, middle class families in California should brace themselves. The surprises in ObamaCare are going to be just as arbitrary and unfair on the west coast as they will be in the rest of the country.

As always, when devil meets details, excrement hits the fan.

[punjabi_khota]

The links in the above article use data from 2008/2009 era, touted as "Today". I call BS. Full on dishonesty. Romneycare was implemented in 2006, and data collected in 2008 doesn't do any justice. Emergency visit data is from 2006-2008 period. Doctor wait times document is from 2009. The article is inflammatory and honestly, crap.

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Granted the Mass. data are old and presented as new. Goodman is a bad boy. The real question is - aren't 2009 data are not good enough to judge a policy that started in 2006? 3 years? Are they any recent data? Are they any better? Am curious. Now, why not apply the same critical eye to Kliff's and Lee's sleight-of-hand comparisons? Not to mention the fact that many providers and some of the best medical care centers have not signed on to accept the exchange payments? Thanks to crappy government reimbursements? Are we moving toward a 2-tier system? One that caters to the "exchange patients" and another to the rich? The road to hell is paved with good intentions.

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Here's Ezra Klein's rejoinder to Avik Roy's Forbes article. Makes some good points - especially the one about the individual market being really small (although set to grow 3x in the next 10 years because many employers may drop coverage). http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/01/the-shocking-truth-about-obamacares-rate-shock/

print The shocking truth about Obamacare’s rate shock By Ezra Klein, Updated: June 1, 2013 Imagine you went to Best Buy and found a great deal on a plasma television set. I want to be clear here: You didn’t find a great television set. This television set is actually a bit crummy. The picture is fuzzy. Consumer Reports says it breaks down a lot and it’s expensive to fix. But it’s really cheap. The price tag reads $109. When you take it to the counter, the saleswoman tells you that the set will actually cost you $199. And count yourself lucky, she confides in a conspiratorial whisper. There are customers whom Best Buy won’t sell it to at any price. You ask her which customers those are. The ones who need the TV most, she replies. So here’s the question: Does that television really cost $109? Best Buy, of course, would never do this to you. If they say you can buy a television set for $109, you can buy it for $109. Plus, they’re handsome, and their customer service is great, and I hope they advertise in The Washington Post forevermore, amen. But this is actually how the individual health-insurance market works. And understanding why is crucial to understanding a lot of what you’re going to read about health reform in the next year. Last week, California released early information on the rates insurers intend to charge on the new insurance marketplaces — known as “exchanges” — that the state is setting up under Obamacare. They were far lower than anyone expected. Where analysts had anticipated average premiums of $400 to $500, insurers were actually charging $200 to $300. “This is a home run for consumers in every region of California,” crowed Peter Lee, director of the state’s exchanges. The Affordable Care Act’s critics saw it differently. Avik Roy, a conservative health writer at Forbes, said Lee was being “misleading” and that “Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.” Obamacare, he said, would trigger “rate shock,” the jolt people feel when they see higher rates. That doesn’t sound like a home run at all. Who’s right? In typical columnist fashion, I’m not going to tell you just yet. But stick with me, and you’ll be able to parse the next year of confused and confusing Obamacare arguments with ease. Here’s the first thing to know: We’re talking about a small fraction of the American health-care system. This isn’t about people on Medicare or Medicaid or employer-based insurance. It’s about people joining Obamacare’s insurance exchanges. That’s people who buy insurance on their own now, as well as some of the uninsured. In 2014, 7 million people, or 2.5 percent of the population, is expected to buy insurance through the exchanges. By 2023, that will rise to 24 million people, or 8 percent. So we’re talking about a small portion of the market. Worse, we’re talking about that small portion of the market all wrong. Roy got his 146 percent by heading to eHealthInsurance.com, running a search for insurance plans in California and comparing the cost of the cheapest plans to the cost of the plans being offered in the exchanges. That’s not just comparing apples to oranges. It’s comparing apples to oranges that the fruit guy may not even let you buy. I ran the same search Roy did. I looked for insurance in Irvine, Calif. — my home town. The average monthly premiums of the five cheapest plans is $114. So I took the middle plan, HealthNet’s IFP PPO Value 4500. It’s got a $4,500 deductible, a $2,500 deductible for brand-name medications, huge co-pays and a little “bestseller” icon next to it. And it’s only $109 a month — if they’ll sell it to you for that price. That’s the catch, and it’s a big one. Click to buy the plan and eventually you’ll have to answer pages and pages of questions about your health history. Ever had cancer? How about an ulcer? How about a headache? Do you feel sad when it rains? When it doesn’t rain? Is there a history of cardiovascular disease in your family? Have you ever known anyone who had the flu? The actual cost of the plan will depend on how you answer those questions. According to HealthCare.gov, 14 percent of people who try to buy that plan are turned away outright. Another 12 percent are told they’ll have to pay more than $109. So a quarter of the people who try to buy this insurance product for $109 a month are told they can’t. Those are the people who need insurance most — they are sick, or were sick, or are likely to get sick. So, again, is $109 really the price of this plan? Comparing the pre-underwriting price of this plan to those in Obamacare’s exchanges is ridiculous. The plans in Obamacare’s exchanges have to include those people. They can’t turn anyone away or jack up rates because of a history of arthritis or heart disease. They also have to offer insurance that meets a certain minimum standard. Under Obamacare, for instance, the out-of-pocket limit for someone making 100 to 200 percent of the poverty line is $1,983. Under the Value 4500, you could spend up to $9,500 before the out-of-pocket limit kicked in. Obamacare also has subsidies for people making up to four times the poverty line. The poor pay next to nothing. The rich pay full freight. “We as a society have never really said here’s what reasonable insurance is,” says Larry Levitt of the Kaiser Family Foundation. “It’s just been anything goes. For the first time they’re setting a minimum about what reasonable insurance should be.” They’re also setting a minimum about who should be able to get it, and at what cost. Now it really will work like Best Buy, where the price on the tag is the price everyone actually pays. Some people will find the new rules make insurance more expensive. That’s in part because their health insurance was made cheap by turning away sick people. The new rules also won’t allow for as much discrimination based on age or gender. The flip side of that, of course, is that many will suddenly find their health insurance is much cheaper, or they will find that, for the first time, they’re not turned away when they try to buy health insurance. That’s why the law is expected to insure almost 25 million people in the first decade: It makes health insurance affordable and accessible to millions who couldn’t get it before. To judge it from a baseline that leaves them out — a baseline that asks only what the wealthy and healthy will pay and ignores the benefits to the poor, the sick, the old, and women — well, that is a bit shocking. © The Washington Post Company

But, it looks like 2 original points still stand: (a) Premiums are going up, just not as much as predicted. (b) Many premier providers are not signed up to accept California Covered plans just yet. That will leave quality medical care out of the reach of those who have these plans.

[Clarke]

Questions, i've lost track of healthcare story since I left Umerica: a) Does Obamacare prevent anyone from buying the $109 plan/tv ? b) Is average care worse than no healthcare ?

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Stanford Professor of Law and Expert in healthcare Dr. Dan Kessler pokes huge holes in the "lower premiums in California" claim. Good stuff from someone who knows what he is talking about (a real expert in healthcare policy unlike Sarah Kliff, John Goodman and Ezra Klein).

ObamaCare Is Raising Insurance Costs Despite what you read, premiums in Oregon and California are going up, especially for the young. By DANIEL P. KESSLER California and Oregon have recently announced the premiums for the health plans that will be offered through their ObamaCare insurance exchanges in 2014. Supporters of the law are jubilant. KQED, northern California's largest public radio station, reported that "experts had warned of 'rate shock.' That has not happened." The New York Times editorial page chimed in, writing that "For the most part, the premiums will increase only slightly or even decrease for individuals and family coverage on the exchanges." A closer examination of these health plans reveals a less rosy picture. Although the premiums are lower than some anticipated, this has been achieved by designing the plans around much more limited provider networks and including greater cost-sharing than the typical commercial health-insurance plan. The premiums for the policies that will be offered on the states' exchanges are much higher than analogous plans being sold today. One of the most important feature of any health plan is its "network"—the group of doctors and hospitals that agree to serve the plan's enrollees. Although the California and Oregon networks are not final, there are indications they will be narrow. California HealthLine, a service of the California HealthCare Foundation, reports that "some premier provider networks" (such as Cedars-Sinai and UCLA Medical Center) are largely absent from the exchange plans. In Los Angeles County, most of the exchange plans are priced comparably to L.A. Care—the health plan for Medicaid beneficiaries. This suggests that the other exchange plans will have provider networks similar to those that serve Medicaid—networks that have been criticized for giving beneficiaries inferior access to care. Even after the networks are made public, it will still be difficult to precisely determine their breadth. That's because a physician who participates in a network does not have to accept an unlimited number of patients enrolled in the plan. Providers can't discriminate against patients on the basis of prohibited characteristics like race or ethnicity. They can limit the number of patients they take with exchange insurance if they can't handle any more patients. Exchange plans also involve much more cost-sharing than the typical plan. For example, the deductible of an individual "silver" plan—the benchmark for determining the subsidies for low- and moderate-income people—in the California exchange is $2,000, considerably higher than the $1,250 minimum deductible for a High-Deductible Health Plan that qualifies for a Health Savings Account under current federal law. (The deductible for a "bronze," or budget, plan is $5,000.) Determining whether premiums for exchange plans are higher or lower than premiums of currently available plans is therefore difficult, because the two types of plans are not always directly comparable. However, one firm's exchange plans can be evaluated against its current product line: Kaiser Permanente. Kaiser is the nation's largest Health Maintenance Organization that serves its enrollees through its own proprietary network. Its network will be roughly the same in 2014 as it is today, and the wide variety of plans it currently offers makes comparisons more feasible. This apples-to-apples assessment shows how much higher exchange-plan premiums will be. For example, a 25-year-old male who lives in San Francisco can purchase a "California 40/4000" policy from Kaiser today that has a $40 copayment for office visits after a $4,000 deductible, with a $5,600 out-of-pocket maximum, for $140 per month. Kaiser's most comparable exchange policy—a "bronze" plan with the minimum benefits and the highest out-of-pocket costs—has a $5,000 deductible with a $6,400 out-of-pocket maximum, although it allows three office visits per year that are exempt from the deductible. It costs $227, 62% higher than its current comparable plan, the California 40/4000. Oregon's exchange policies are about the same. Today, a 25-year-old male who lives in Portland can purchase an "Oregon KP 2000/20%/HSA/Rx" policy from Kaiser that has 20% copayments, a $2,000 deductible and a $5,000 out-of-pocket maximum. It costs $129 per month. The most comparable exchange plan, a "silver" plan, has 25% copayments, a $1,750 deductible, and a $5,000 out-of-pocket maximum. It costs $229 per month—78% higher. None of this means that the exchange plans will provide inferior care or inadequate protection against financial risk. But it does show that the Affordable Care Act's goal of expanded coverage is going to require much higher premiums, especially for young people, and significant changes in the access and low cost-sharing that Americans have come to expect.

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Dear Ohio, Buyer's remorse, yet? http://www.insurance.ohio.gov/Newsroom/Pages/06062013ACAProposedRates.aspx

Press Release STATE OF OHIO DEPARTMENT OF INSURANCE COMMUNICATIONS OFFICE 6/6/2013 Health Insurance Costs to Increase Significantly Under Affordable Care Act Plans Filed with Department of Insurance Show Higher Costs for Ohio Consumers COLUMBUS — The Ohio Department of Insurance today released details of health insurance plans that insurers have submitted for approval to sell on the coming federal insurance exchange for Ohio. The Department's preliminary analysis of the proposed plans for the individual market reveal that insurers expect the cost to cover health care expenses for consumers will significantly increase. Based on a report released by the Society of Actuaries earlier this year, the Department estimates this increase is an average of 88 percent. While those costs do not specifically track with the premiums insurers charge individual customers, it is expected that these increases in costs will also translate to significant premium increases for many Ohioans. A total of 14 companies filed proposed rates for 214 different plans to the Department. Projected costs from the companies for providing coverage for the required essential health benefits ranged from $282.51 to $577.40 for individual health insurance plans. “We have warned of these increases since a state-specific study in 2011 indicated Ohio would be significantly impacted by the ACA,†Lieutenant Governor Mary Taylor said. “The Department’s initial analysis of the proposed rates show consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.†Estimates from a Society of Actuaries study released in 2013 showed Ohio’s current average cost to cover medical expenses for an individual health insurance plan is $223. Based on the proposals submitted to the Department, the average to cover those costs in 2014 is $420 representing an increase of 88 percent when compared to the Society of Actuaries study. The proposed rates are not effective and are currently undergoing the Department’s review process. During this process, rates may change before becoming effective. The Department released the information today to help health insurance consumers continue to prepare for the expected price increases. Specific premium information varies widely and can be unique to each individual or employer, but it is hoped that the information on proposed costs and rates can help consumers and health insurance consultants determine how their particular situations will be impacted. In 2010, the federal Patient Protection and Affordable Care Act (ACA), which includes sweeping changes to America’s health insurance system, became law. It includes the creation of health care exchanges in which individuals and small business owners in every state can purchase qualified coverage. According to the federal government, initial open enrollment on the exchange is set to begin October 1, 2013. Coverage purchased through the exchange will have an effective date of January 1, 2014. To learn more about the health care exchange visit www.healthcare.gov. Ohioans with questions about insurance can call the Department at 1-800-686-1526. NOTE: Filings submitted to the Department can be found on the System for Electronic Rate and Form Filings on the Department’s site; http://insurance.ohio.gov/Company/Pages/RecordsRequest.aspx. To access the filings, click on the HFAI link. Click HERE for a Department fact sheet.