Newest Policyholders Under Health Law Are Sicker and Costlier to Insurers


#1

NY Times:

Newest Policyholders Under Health Law Are Sicker and Costlier to Insurers

WASHINGTON — People newly insured under the Affordable Care Act were sicker, used more medical care and had higher medical costs than those who already had coverage, the Blue Cross and Blue Shield Association said Tuesday in a new study of its policyholders.Because insurers’ premiums have to cover their medical expenses, the new report helps explain why Blue Cross plans have sought, and insurance commissioners have approved, substantial rate increases in many states. Another round of rate review is about to begin, with insurers generally required to file rate requests for 2017 in the next two months.

The findings are noteworthy because Blue Cross and Blue Shield plans operate across the country and have the largest share of the individual market in many states, giving them an unrivaled source of claims data.
In its report, the Blue Cross and Blue Shield Association examined the use of medical services by people who enrolled in its plans before and after major provisions of the Affordable Care Act took effect in 2014.

One of those provisions essentially required insurers to offer coverage to people who had previously been denied coverage because of their medical problems.
People newly enrolled in individual Blue Cross health plans in 2014 and 2015 were found to have higher rates of certain diseases and conditions, including high blood pressure, diabetes, depression, coronary artery disease, H.I.V. and hepatitis C, than people who already had coverage.

Can you say “death spiral”?


#2

If only there had been some group of people who had warned of this very thing happening before the law was passed…


#3

Another article I read said that thanks to the healthcare law there’s now fewer insured people than before.

I know plenty that lost their plans and can’t afford any of the new ones. Hooray.


#4

Yep, more people are opting to pay the IRS penalty instead of paying for worthless, expensive insurance.


#5

This is what comes of a for-profit healthcare system, which is what “Obamacare” is. If Obamacare fails, it will be due to 2 factors:

1 - the refusal of certain governors to open Medicaid subsidized healthcare exchanges in their states

2 - misguided priorities of greedy insurance, pharmaceutical, and medical device companies, which put profit above all else.

Affordable healthcare is a basic human right, according to Catholic doctrine.


#6

It will be interesting to see what twists and turns our healthcare system takes in the future. The current direction is often mentioned as being unsustainable. There is a good amount of problems with our health care system, including how we define health and treatments that are provided.

I’ve seen articles recently about the over pricing of drugs. Hepatitis C high costs have been mentioned. Some AIDs medicines overpricing of course have been in the news.

The latest I read concerned politicians highlighting the high costs of a prostate drug used in America. With this, I can imagine at some point a larger push will be made to create a system that helps lower the cost of drugs sold in America.

“Americans pay 300% more for this prostate cancer drug than much of the rest of the world”

marketwatch.com/story/are-americans-being-ripped-off-by-medivations-129000-cancer-drug-2016-03-29

Equally, our medical system tends to push the use of newer expensive drugs. Helpful, less expensive generic drugs can be overlooked. One generic drug that looks promising and has been written about some of late is Low Dose Naltrexone (LDN) While not a cure for autoimmune diseases, imagine if it was prescribed more liberally would be beneficial for many.

“The Promise Of Low Dose Naltrexone Therapy: Potential Benefits in Cancer, Autoimmune, Neurological and Infectious Disorders”

amazon.com/The-Promise-Dose-Naltrexone-Therapy-ebook/dp/B002MUAEOS/ref=pd_sim_351_1?ie=UTF8&dpID=41DBoGif%2BBL&dpSrc=sims&preST=OU01_AC_UL160_SR104%2C160&refRID=1PF0E88B1X55DW38CTH4

Naltrexone is an opiate antagonist drug developed in the 1970s and approved by the FDA in 1984 for opiate and drug abuse treatment. When used at much lower doses in an off-label protocol referred to as low dose naltrexone (LDN), the drug has been shown to halt disease progression in Crohn’s disease and certain cancers, to reduce symptoms in multiple sclerosis and autism, and to improve numerous autoimmune and neurodegenerative conditions, including Parkinson’s disease and amyotrophic lateral sclerosis (ALS).
Grounded in clinical and scientific research, this book describes the history of naltrexone, its potential therapeutic uses, its effects on the immune system, its pharmacological properties, and how the drug is administered. It also lists fillers and compounding pharmacies, doctors who prescribe LDN, and patient resources, and includes interviews with LDN patients and researchers.


#7

Yup, the very law itself and the federal folks that run it are utterly blameless. We always are. Legally speaking.


#8

No matter how spectacularly government fails, the reason why it failed according to the left is because there wasn’t ENOUGH government…:rolleyes::rolleyes:


#9

If the ACA ultimately fails, it will be because it almost entirely lacks a Catholic influence. Any proposed reform, I fear, will also fail because the government which proposes it lacks a Catholic influence.

Conservatives talk of “limited government”, and “small government” as solutions to healthcare problems. The universal practical result of this is government taken over by powerful private interests which turn government into an instrument for their benefit, when according to Catholic teaching, government’s only legitimate function is to promote and protect the common good.

If one looks around the world, one can see: absence of government or government with little influence (“small government”) correlates highly with failed states. I look to Flint Michigan as an example of what happens when those in authority think in terms of the “small government” mentality.

On the other hand, the socialist reaction to “small government” policies has a punitive aspect that will inevitably lead to more social discord. Socialism fails because of its belief that government power derives from the will of the people.

The Catholic teaching is that the civil powers get their authority from Christ. The civil powers must cite their reliance on Christ for their authority.

In the US, that does not and will not happen.

Also, you are very much mistaken in ascribing my comments as coming from “the left”. “Left” and “right” are outmoded paradigms when one wants to discuss what’s truly needed to fix what ails America.


#10

Of course, everyone has heard about “risk corridors” and the “judgment fund.” You haven’t?

ibamag.com/news/are-obamacare-insurers-in-for-a-5-billion-windfall-29519.aspx

Ed


#11

The Catholic faith doesn’t demand the government run the healthcare sector of the economy. In fact it teaches the government should NOT do something a lower level of government or the people can handle themselves. Subsidiarity teaches that any such government involvement be temporary and should ended quickly.

Conservatives talk of “limited government”, and “small government” as solutions to healthcare problems. The universal practical result of this is government taken over by powerful private interests which turn government into an instrument for their benefit, when according to Catholic teaching, government’s only legitimate function is to promote and protect the common good.

If the government is smaller, then “powerful private interests” have less concern about the levers of power and the money flowing from government. If there is no pork to fight over, private interests move on and look elsewhere to earn a buck.

If one looks around the world, one can see: absence of government or government with little influence (“small government”) correlates highly with failed states. I look to Flint Michigan as an example of what happens when those in authority think in terms of the “small government” mentality.

Flint, Michigan has been run by Democrats and socialists for decades. There’s NOTHING “small government” about Flint. In fact, the problem of Flint’s drinking water was caused because the big government had so squandered money and bankrupted the city, that they switched water sources to reduce costs. Big government is what caused the problems in Flint.

On the other hand, the socialist reaction to “small government” policies has a punitive aspect that will inevitably lead to more social discord. Socialism fails because of its belief that government power derives from the will of the people.

That’s not why socialism fails, and not why the Church condemns it.

Also, you are very much mistaken in ascribing my comments as coming from “the left”. “Left” and “right” are outmoded paradigms when one wants to discuss what’s truly needed to fix what ails America.

Lay out for us your solution for America that somehow is neither left nor right.


#12

Well, I’m personally all for a Catholic theocratic monarchy.


#13

Obamacare is fundamentally a system by which one segment of the middle class subsidizes another segment of the middle class.

If you’re poor enough, you’re shunted off to already overcrowded Medicaid. If you’re better off than that, but (depending on whether you have a family or not) not by a lot, you get a really big subsidy. If you earn over $80,000 for a family of four, you pay an inflated amount, to some degree for coverage you don’t need and for a policy you would not have chosen but have to.

Now, a lot of people are covered by employment-based insurance, that won’t change much until 2017. Their insurers benefit from the “well worker effect”. In other words, if you’re sick enough, you can’t work, so most people who work are relatively healthy. If you aren’t working, subsidized Obamacare is all there is, other than Medicaid. Yes, the deductibles are impossibly high for many, but if your income is low enough, the deductibles go away.

So naturally, the sickest individuals tend to be those who go to the exchanges.

And, of course, since Medicaid is grotesquely overutilized and is subsidized by providers by charging more for non-discount patients, the cost gets increasingly squeezed to those in the middle middle and upper middle classes. The truly wealthy, of course, can afford “Cadillac plans” or simply self-fund.


#14

This is no surprise, nor is it a bad thing. One goal of ACA was to help those who could not get insurance get medical treatment. Of course this meant healthy insured people would pay more. My only complaint about the whole mess is the “affordable” part. Not once did the lawyers we elect to office address the actual affordability of health care. They just shifted who was to pay into a system designed to keep a thriving industry of legal malpractice strong.


#15

Which is utterly ridiculous.


#16

Not too mention those greedy doctors and nurses who somehow expect a middle to upper middle class income for their years of training and sacrifice.


#17

Yeah, that user never mentioned nurses or doctors. So, I’m not sure why you brought it up.

The issue is with Pharma and health insurance companies.


#18

You’d get used to it.

People got used to Communism, and that never worked nearly as well as the centuries of Catholic monarchies.


#19

Doctors and nurses make up a big part of pharmaceutical and health insurance industries. How do you separate their greed from the greed of managers and administrators?


#20

Oh, come on, anyone paying attention knew this wasn’t a workable system. It was designed to fail to garner support for single payer with the government taking over the entire healthcare system. Providing our politicians with tremendous opportunities for cronyism and graft…

Stand by for single payer, make sure you don’t get sick or injured at the end of a fiscal year.


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