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Friday, January 24, 2014

Yes, yes, yes

I got rather sick. I survived. 

I have been watching the ACA meltdown with some fascination. It's hard to top stuff like this, but it is not funny for those who have paid their insurance bill, or had their accounts double-debited, and are still having to pay out of pocket for medicines and treatment. How long will it be before someone goes postal? 

From the provider side it's not much better - if you signed up to deal with this it is administrative chaos that has the potential to destroy a practice. 

It is not going to get better as the year wears on. The backend mechanisms aren't there, and several of the state sites are so bad they will probably be canned. The fixed expense/medical payout ratio in the law means that companies can't hire enough staff to straighten this out. Moody's is quite right.

I don't think that the government premium subsidies are being paid to the insurance companies, which is a big problem. From the insurance companies' perspectives, they are not getting paid the premiums, yet they have the problem of trying to straighten out the mess, and they have to pay claims without having received the premiums. It leaves little incentive. 

And then consider that a very small minority of their total insured counts have the capacity to overwhelm their entire customer service system - they must be scrambling to set up different numbers and try to segregate ACA customers from their paying customers. That's reality, folks, and it's why CA ACA "customers" can't get through to a human being.The government pretends to pay for your insurance, and then your insurance company pretends to provide insurance, and then your provider has to figure out what to do with patients who may or may not be insured.

From the provider perspective, all these people in healthcare limbo pose a distinct threat to your finances. If you provide care without getting payment, you are going to be in a hole, and if you don't provide care, you may get sued. In any case, straightening out the fuss for these patients is likely to chew up your customer service staff's time and cause problems for your entire patient base.

Again, this is not going to get better as the year wears on. It's going to get worse, and access to care for ACA insured people is going to degenerate as providers start to tumble to the fact that insurers are mandated to carry the policy for 90 days if the premium was paid once, but not mandated to pay claims after the first thirty days. It's going to convert to a cash-up-front deal, reimbursement later in a lot of circumstances.

Your pie-in-the-sky liberal thought of the day: It takes a village to dig a small child out of the global warming drift, although it goes somewhat faster if you use solar panels as improvised global warming shovels!!

Glad to hear you're better. We worry, you know, when we don't see your posts. And some of us are on tenterhooks regarding your new research. Nag, nag nag. Just what you need during recovery, eh?

Glad you're doing alright, M_O_M.

I've been watching ACA like the slow, inexorable approach of a Gojira.

We didn't lose our insurance this year, but since it's a grandfathered plan, it's only a matter of time. As far as I can tell, the entire individual insurance market is now composed of Obamacare plans, whether you buy them on or off the exchange. Which leaves me attempting to guess which way the monster is going to turn so that I can change our circumstances so as to avoid getting stepped on if possible.

One thing that seems inexorable is that no family making less than $90K should be considered "middle class" anymore. That's the absolute minimum required to pay the bills, taxes, and have some savings (that aren't just going to end up going to pay the hospital eventually).

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I think there is a sucker punch coming in all of this. The penalty for not signing up will probably first flood ACA with much needed capital, and then the system will be flooded with sign-ups who might as well sign-up if they are going to pay a penalty.

Unless the penalty is nowhere near the premium charge.
Glad to hear you're recovering. Wish I could say the same about other things.
For a family of four, the penalty will rise in 2017 to $2780, or 2.5% of your income, whichever is larger. The premiums are running $12000 to $15000 per year for that same family. If the plans were any good, the penalty would get people signed up. But they're not.

Alessandro - but not if the premium would be more than 8% of your income, which, due to high premiums, takes out most of the individual mandate.

ACA is usually only "affordable" for those who get the subsidized premiums.

But it's not the individual structure that worries me, it's the underlying fiscal disaster. So far this bill, according to the administration, has literally been impossible to implement. There is no employer mandate, and it's doubtful that there will be next year.
WSJ - "survived" was literally accurate - it will take me some time to fully recuperate.
Teri - if you are out there, how is Danielle? Due to being very, very ill indeed I did not see your request.


I didn't know about the 8% rule. That does take a chunk out of the penalty. Actually, the way the plans are priced, it's almost as if the middle middle class was not intended to have insurance at all.

Which is not all bad--if Medicaid doesn't put all the providers out of business, we're headed for an all-cash health care industry. We can rebuild from there. If Medicaid wrecks things then we're headed for medical speakeasies, and that'll be a nightmare.

MOM - best wishes that your recovery speeds up then. Very sorry to hear you were so ill.
Speedy recovery on the rest of the way back to normal.

While the ACA spectacle is truly something to behold, the green meltdown in Europe is almost as spectacular. Sounds like the retro chic of energy poverty has worn off and they are ready to give fossil fuels a chance to save the day:

Neil - that's exactly it, but how long do you think that can last?

Will the middle class really continue to sign on to a system that gives poor/welfare people good health care while they get very little?

You are right - for the time being, it has turned into a three-tier system, with the moderately successful natural independents (the swing voters) being out in the cold and having the least access. Do the electoral math.
Brian - I spent a lot of time reading the German newspapers yesterday. It is a wonder to behold.

But not really surprising, is it? The Germans are slowly but surely regressing to a coal/windmill economy of say the 1600s, and no I don't think even they will want to stay there.

CO2 emissions in Germany rose again last year.


I think it depends on two things; How fast the provider network collapses, and how corrupt elections get. On the 2nd point, I've come to think that it's 50/50 odds whether we continue to have meaningful elections after this November.

The speed of the collapse of services matters a great deal--the Administration can nullify the employer mandates by fiat, which divides the middle class. If the provider network collapses slowly, employees of large corporations are likely to just want protection for their relatively better-off position as things get worse and worse. They'll defend the status quo as long as they benefit relatively.

If the provider network collapses suddenly, then we're all in the same boat. If that happens we might see a wave election. That is, if elections still matter--which is why my second point is important.

Relieved to see your new post, MOM. Praying for your continued recovery.

Our daughter avoided the exchange and went direct to the insurance companies. Since she is a health care provider she is familiar with the insurance companies in Washington State. Her new policy is comparable to her old one (except for all the "extras")but has doubled her premiums and deductibles. She can afford it, but barely. She would much prefer to put the money in her 401k or save for the coming collapse.
if Medicaid doesn't put all the providers out of business, we're headed for an all-cash health care industry.

When you realize that 75% of Americans have NO cash or liquid assets - except what is in their retirement accounts, which will probably be used to deny them benefits if not flat-out confiscated in part - you're going to see changes in health care that we can't even dream of yet. I expect a rise in medical quackery to go hand in hand with the legislative quackery.
I'm out here, but can't post comments on my iPhone. Danielle has been moved out of the ICU at OHSU. She is able to sit in a chair for a few hours and is receiving physical therapy. She can't talk but Monica says she is somewhat aware of her surroundings. They want to start work on stimulating her brain, to help with the healing process. I don't know how well she will recover. At one point, the doctors were not hopeful. It is a very difficult thing for a parent to go through and she can still use the prayers.

I have Lifewise insurance through work, so I already have that $5000 deductible. And just to let you know, clinics are now dumping customers into collections, even if they have been paying their bills. It will be interesting to see what the reaction is when folks learn that. The clinic here expects payment within a year or that's it.
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