<p>
Pretty sure this bill will be unconstitutional on the basis of that mandate and questions regarding dual federalism. Just my guess.</p>
<p>Wow… if it passes im having my parents negotiate a higher salary in lieu of medical benefits. </p>
<p>So i dont understand, if the maximum fee for not buying insurance is $2000 while the average plan for families cost $20000, who in their right mind would buy insurance? Sounds like the Clinton Hope Scholarship all over again…</p>
<p>It’s passed. As of President Obama’s signing today, this bill is now law.</p>
<p>BDM, I remember that the issue of the fine being less than the average insurance policy was raised when Massachusetts passed a similar insurance mandate a few years ago. Yet the Massachusetts bill has been touted as a success (mainly, I suspect, in an effort to gain Republican support, since the governor of MA at the time was Romney). What has ended up happening that prevents people from being better able to afford the fine than insurance in MA? Or is this a continuing problem in Massachusetts?</p>
<p>Doing a quick search on my own, it looks like there’s a subsidized plan for people making beneath a certain amount, and also there’s something similar to the new insurance exchange that will be formed as a result of the federal bill for people who don’t qualify for the subsidized plan. Has this been effective at providing some affordable private options for people not covered under employer-sponsored plans?</p>
<p>Well, the big reason is that the MA regulations affect insurers much less – so there’s a lot less incentive to opt out of an insurance plan. Under the new federal law, you can actually wait until you become sick and then buy insurance; there is no penalty (other than the fine) for doing so.</p>
<p>Under the MA law, insurers were free to increase your premiums if you attempted to engage in this kind of strategic behavior. So you have an incentive to buy health insurance, even when you’re healthy – plus the premiums should be less expensive.</p>
<p>Will the federal law stop the one-year waiting period for pre-existing conditions? I haven’t heard that, though I know about no longer being allowed to deny coverage to people with pre-existing conditions, but I thought the year’s waiting period (assuming the patient is not portable from another policy) was still in existence. Isn’t this period meant to be a penalty for waiting until you get sick to get insurance?</p>
<p>Ginny, this is the first I’ve heard of it. It sounds awfully reasonable. Would you mind sending me a source on this?</p>
<p>It’s part of HIPAA, I think (or at least, HIPAA modified it). For one year after the beginning of coverage, insurance companies are allowed to exclude coverage of anything that has been diagnosed, treated, or discussed with a medical professional within the last six months.</p>
<p>Source: [url=<a href=“http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html]Frequently”>http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html]Frequently</a> Asked Questions about Portability of Health Coverage and HIPAA<a href=“the%20first%20section%20of%20the%20page”>/url</a></p>
<p>Of course it’s not mandatory that every policy have this exclusion period, but I’ve always assumed that it’s pretty common–I’m not sure that I’ve seen a policy that didn’t have it. The webpage also doesn’t mention the portability aspect, though I can try to find a link for that one if you’d like. Six months isn’t forever, of course, but if people are playing “get insurance when I get sick” roulette, it’s often too long to wait between diagnosis and getting coverage if you have to abstain from all doctors appointments and all treatments.</p>
<p>Note that the above resource also seems to deal mainly with group policies. I’m not totally sure if it doesn’t talk about individual policies because most of these companies would’ve turned down people with pre-existing conditions, or if it’s because the rules differ in some ways.</p>
<p>Here’s a link to information from the Kaiser Family Foundation about pre-existing condition exclusion periods in states’ high risk pools. Of the states that have high risk pools (which are, by definition, individual policies, aren’t they?), only Alabama and South Dakota don’t have an exclusion period. The duration of the exclusion period and the “look-back” period differ among the states. [High</a> Risk Pool Portability Rules - Kaiser State Health Facts](<a href=“http://www.statehealthfacts.org/comparetable.jsp?cat=7&ind=604]High”>http://www.statehealthfacts.org/comparetable.jsp?cat=7&ind=604)</p>
<p>You know, I’m going to have to look into this more. It’s a very good catch, ginny. This might make the law much more sensible than I’d thought. Thanks!</p>
<p>The problem, as I see it, is that there’s a not-insignificant number of people without insurance not because they don’t want it, but because they can’t get a policy. In this economy it’s just not possible for someone (especially someone who is chronically ill) to be able to count on getting a job with employer-sponsored insurance (and their condition wouldn’t be covered for the first year anyway due to the exclusion period). </p>
<p>I would hope that (if nothing else) the health care reform bill (or whatever adjustments are yet to come) includes at least a period of enrollment where someone can get coverage without the exclusion period once the rule that insurance companies can no longer deny private policies to someone with a pre-existing condition goes into effect (in 2014?). To make those people wait for coverage of their pre-existing conditions when they were denied coverage would be cruel.</p>
<p>Ok, so our best and brightest should all become plastic surgeons because their rates won’t be affected? </p>
<p>I’d suspect America would be a lot prettier once Medicare 2010 kicks in. :D</p>
<p>Ginny – haven’t gotten a chance to look into it yet. When I do, I’ll be using the following CRS report as a summary of the bill:
<a href=“http://www.hlc.org/CRS_insurance_report.pdf[/url]”>http://www.hlc.org/CRS_insurance_report.pdf</a></p>
<p>Obviously this is a delayed reaction. To the best of what I can tell, waiting periods are no more than 30 days. I’ll keep looking into exactly the provisions of the bill – I’m writing my thesis on it, so I’m sure I’ll run into it eventually.</p>
<p>But mostly, just tagging this thread.</p>
<p>I just had a lecture by a well respected emergency medicine professor. He said the bill was not a complete panacea, but it took the right steps. People like to call the bill “health care reform” but in reality, it’s insurance reform. The people calling Obama a socialist are nuts because the bill favors the private sector by forcing everyone who can afford private insurance to buy it. Yeah it’s true the government is mandating it, but I see it as no different from the government telling you that you have to buy car insurance before you drive, it’s definitely not a step towards socialism, UHC, “ObamaCare,” or whatever people are calling it.</p>
<p>He said that insurance works by pooling money, people who need care pay less, people who don’t need care pay more. A lot of young people don’t buy insurance, so they are out of the pool. They also don’t really get sick as much as old people, so they don’t pay for health that they don’t use. This law will add more money to the pool from these guys.</p>
<p>The law also stated that at least 80 percent of an insurance company’s margins must go towards care, so profits are limited to 20 percent (reasonable IMO).</p>
<p>Basically, it seems like the law really helps people with no insurance due to factors like cost, pre-existing conditions, etc., it encourages businesses to provide health benefits, but I’m not sure how it will affect people who already have insurance.</p>
<p>The bill is clearly not socialist. Those charges are clearly incorrect. In that sense, your professor was right.</p>
<p>(But see closing paragraph.)</p>
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<p>The mandate may not strike you as particularly intrusive, but there is a major difference. Auto insurance is insurance in (1) you are engaging in willingly, (2) you are paying a premium relative to your own risk, (3) you’re covering the risks which you inflict on another person.</p>
<p>The health insurance mandate is different in all three respects. (1) You are compelled no matter what you do, (2) your premiums are NOT relative to your own risk anymore, and (3) you are covering the risks of others that have nothing to do with you. (*Moderate variations are still permitted for age, geography, and smoking.)</p>
<p>(Errors have been corrected from my original post; community rating doesn’t kick in until later.)</p>
<p>The law “adds more money to the pool from these guys” precisely because it takes it away from them. That may be socially optimal – I won’t comment on that here – but you can imagine that it is frustrating for these folks, who are now being taxed for being healthy.</p>
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<p>80% of insurance revenue now has to go towards actual claims. However, that doesn’t leave 20% as profit – it leaves 20% as administration, overhead, and profit. Still, that’s not a horrible ratio (and in fact is about where the industry tends to be on average at the moment anyway).</p>
<p>This regulation is not that big a deal. The private sector might find it a little annoying in principle – does the government tell grocery stores how much they have to pay for their raw ingredients? – but it won’t change that much.</p>
<hr>
<p>The law REALLY helps people who have no insurance because they’re sick and can’t find insurers willing to cover them. It does so by forcing everybody else to pay for them. That is not necessarily a terrible tradeoff., from a social point of view.</p>
<p>Obama has a compelling point. Right now, we have a lot of Americans who simply have no access to health insurance – in fact, it is the very people who need it most. This bill is designed to extend it to them. Whatever its faults may be, that is a virtue and should be appreciated as a noble intention. And it will probably succeed, at least for a little while.</p>
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<p>I will say this. It is conceivable that the math simply doesn’t work in the new bill. It is conceivable that there is no possible way for insurers to remain profitable while still complying with the new regulations. In that situation, then the health care system as we know it will have to be replaced with something else – likely something that includes more government intervention. This is what people mean when they call it a first step towards socialism. The bill itself clearly does not push the health care system into “socialism” – but it might make those future steps necessary.</p>
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</p>
<p>Actually, it leaves 20% for profit and whatever the insurance companies can’t figure out how to group into what’s covered by the other 80%. See this press release from today: [Press</a> Releases - Press Room - U.S. Senate Committee on Commerce, Science, & Transportation](<a href=“http://commerce.senate.gov/public/index.cfm?p=PressReleases&ContentRecord_id=c9a3b9b4-175f-4b71-9086-a080e2b08480]Press”>http://commerce.senate.gov/public/index.cfm?p=PressReleases&ContentRecord_id=c9a3b9b4-175f-4b71-9086-a080e2b08480)</p>
<p>It’s information like this that makes me even more in favor of the bill. Clearly (as they’ve proven again and again) the insurance companies can’t be trusted to operate in an above-board manner. This means that we either have to make laws to regulate their actions (and enforce those laws) or the insurance companies need to be cut out of the equation all together.</p>
<p>And, of course, BDM is right that the main reason to like the bill is that people who are ill can no longer be told that they don’t qualify for insurance. Any system that only allows the healthy to have health insurance (which, in practical terms, means access to health care) is fundamentally flawed.</p>
<p>lolly:</p>
<p>you might ask the well respected ER doc if s/he ever took a macro econ course. :D</p>
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</p>
<p>Umm, not all people drive nor own a car, city-slickers for example, and they do not have to buy auto insurance.</p>
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<p>Actually, by prohibiting age-based ratings, the bill RAISES premiums for the young adults, i.e., this year’s college grads. </p>
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</p>
<p>The bill has absolutely zero in it about controlling costs…</p>
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</p>
<p>Actually, they are being taxed for being a US citizen, for breathing.</p>
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</p>
<p>You’re certainly right in the converse. But I’d be careful about being too sunny about what insurance means.</p>
<hr>
<p>Many Dentists Won’t Fix Poor Children’s Bad Teeth (1999)
[Many</a> Dentists Won’t Fix Poor Children’s Bad Teeth - NYTimes.com](<a href=“http://www.nytimes.com/1999/06/26/us/many-dentists-won-t-fix-poor-children-s-bad-teeth.html?pagewanted=all]Many”>http://www.nytimes.com/1999/06/26/us/many-dentists-won-t-fix-poor-children-s-bad-teeth.html?pagewanted=all)
</p>
<hr>
<p>Note to Medicaid Patients: The Doctor Won’t See You (2007).
[Note</a> to Medicaid Patients: The Doctor Won’t See You. SF Gray Panthers<a href=“I%20have%20no%20idea%20who%20the%20%22Gray%20Panthers%22%20are%20–%20but%20they%20have%20the%20WSJ%20article%20I’m%20looking%20for.”>/url</a>
</p>
<hr>
<p>Boom Times for Dentists, but Not for Teeth (2007)
<a href=“http://www.nytimes.com/2007/10/11/business/11decay.html?pagewanted=print[/url]”>http://www.nytimes.com/2007/10/11/business/11decay.html?pagewanted=print](<a href=“http://mlyon01.■■■■■■■■■■■■■/2007/07/19/note-to-medicaid-patients-the-doctor-wont-see-you/]Note”>http://mlyon01.■■■■■■■■■■■■■/2007/07/19/note-to-medicaid-patients-the-doctor-wont-see-you/)</a></p>
<hr>
<p>Ala. Dental Spat May Foreshadow Obama Plan Effects (2010)
<a href=“http://www.nytimes.com/aponline/2010/04/07/us/AP-US-Alabama-Dental-Fight.html[/url]”>http://www.nytimes.com/aponline/2010/04/07/us/AP-US-Alabama-Dental-Fight.html</a></p>
<hr>
<p>As Medicaid Payments Shrink, Patients Are Abandoned (2010)
[As</a> Medicaid Payments Shrink, Patients Are Abandoned - NYTimes.com](<a href=“http://www.nytimes.com/2010/03/16/health/policy/16medicaid.html]As”>As Medicaid Payments Shrink, Patients Are Abandoned - The New York Times)
</p>
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</p>
<p>Age based rating is permitted in a 3:1 ratio. The current ratio for a 64-year-old to a teenager is about 4.26:1 nationally, so you’re looking at a 42% relative increase for the teenager.</p>
<p>It will be higher than 42%, since you’ll be lumping some senior citizens in. But it won’t be flat, is the point.</p>
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</p>
<p>The bill has literally hundreds of provisions intended to control costs. The correct objection is that none of these are systemic, proven cost-containment strategies – and that there is no guarantee that Congress will ever implement them on a broad scale.</p>
<p>It also has hundreds of provisions that will drive costs up. CBO projects that the savings and revenue provisions will slightly outweigh the increased spending provisions; in my view this is naive.</p>
<p>But it is incorrect to assert that the bill has no cost-control mechanisms. It has hundreds or thousands of them. They’re just… minor.</p>