danivon wrote:Nope. I'm trying to explain how insurance works in general, so you can get a basic picture of why it's not necessarily correct to look at a single category of coverage in a list of standard coverage terms and point to it to say 'if it was not mandatory, the insurance would cost less'.

in order to demonstrate that covering pregnancy is making a difference to increase premiums for people who cannot get pregnant, and larger than offsetting factors, I think you need to provide data.

Until then, I see no point trying to answer questions that are based on accepting the assumption that they do.

Well, while you are trying not to be condescending (and failing miserably), you might actually try to understand that paying for something you cannot use is rarely a savings. I need to prove nothing.

Go to your insurance agent. Tell him you'd like to add some coverages and then demand that you pay less.

I'll wait.

You did notice the list, right? You did notice that's from the Federal government, right? You do know that the more you "get" the more you pay, right? You do have some idea how insurance works, right?

I do know one thing: you've lost none of your capacity for being a jerk.

The article I cited to before indicated that most individual plans before the ACA did not cover pregnancy. Not a few, not some, most. And women of child-bearing age were buying those policies. In answer to that problem, the ACA mandated pregnancy coverage so that women would be covered for pregnancy. I think that is a pretty good thing. I get that a 60 year old does not need maternal coverage. what I don't know is how much that coverage is costing her. Why should it cost her more than a nominal fee when she is so unlikely to get pregnant? The laws says the coverage must be offered, even to women who don't need it. Why should insurance coverage premiums go up when insurance companies are exposed to little risk in offering that coverage.? Insurance coverage costs should only go up because insurance companies are incurring enhanced risks in offering the coverage.

Doctor Fate wrote:Well, while you are trying not to be condescending (and failing miserably), you might actually try to understand that paying for something you cannot use is rarely a savings. I need to prove nothing.

Except that insurance against a thing is not the same as the thing. And insurance costs are not simply the costs of providing the thing when people claim. They include the costs of collecting information to set up the policy, assessing risk, administering the policy, processing claims, etc etc etc.

Go to your insurance agent. Tell him you'd like to add some coverages and then demand that you pay less.

I'll wait.

Ahem. I already pointed out to you that adding my wife as a named driver on my car (and vice versa) reduced our premiums. I didn't 'demand', that, it showed up on the quotes when I was comparing rates last time we renewed, and when I saw it obviously I took up the cheaper but wider cover.

You did notice the list, right? You did notice that's from the Federal government, right? You do know that the more you "get" the more you pay, right? You do have some idea how insurance works, right?

Yes, I do know that list is from the Federal government. Did I claim otherwise?

I also know how insurance works - I have worked in the Insurance and Assurance industries, have you?

Insurance works by aggregating risk across groups. But it also recognises individual risks vary based on various criteria (such as age, gender, location), and premiums are set accordingly. The more you 'get' in terms of coverage may lead to a greater payment, but there are other factors:

1) One standard plan is easier to administer than a multiplicity of different plans - because there are a lot of different groups risks to cover across all of them. That can increase the costs. It is also easier when it comes to claims to work out if someone is covered or not if the plans are more universal - claim handling is a major on-cost for insurance.

2) Your focus has been on pregnancy. But it is only one part of the list, and people who are at very low or zero risk of falling pregnant may well be at greater risk of other items that are covered.

3) It is not universally true that not having a particular item of coverage will reduce premiums. I will repeat the example of removing contraceptive cover from policies as requested/demanded by Catholic Bishops and organisations - the removal would actually increase the costs of providing those policies, which will of course lead to higher premiums.

I do know one thing: you've lost none of your capacity for being a jerk.

And I am glad to see that you have avoided the use of insults.

freeman3 wrote:The article I cited to before indicated that most individual plans before the ACA did not cover pregnancy. Not a few, not some, most. And women of child-bearing age were buying those policies. In answer to that problem, the ACA mandated pregnancy coverage so that women would be covered for pregnancy. I think that is a pretty good thing. I get that a 60 year old does not need maternal coverage. what I don't know is how much that coverage is costing her. Why should it cost her more than a nominal fee when she is so unlikely to get pregnant? The laws says the coverage must be offered, even to women who don't need it. Why should insurance coverage premiums go up when insurance companies are exposed to little risk in offering that coverage.? Insurance coverage costs should only go up because insurance companies are incurring enhanced risks in offering the coverage.

Why force everyone to buy it, even those who CANNOT use it?

danivon wrote:

Doctor Fate wrote:Well, while you are trying not to be condescending (and failing miserably), you might actually try to understand that paying for something you cannot use is rarely a savings. I need to prove nothing.

Except that insurance against a thing is not the same as the thing. And insurance costs are not simply the costs of providing the thing when people claim. They include the costs of collecting information to set up the policy, assessing risk, administering the policy, processing claims, etc etc etc.

Balderdash.

There is no "cost" for something that can never be used. That's profit. If it's 5 cents or half a million dollars.

Go to your insurance agent. Tell him you'd like to add some coverages and then demand that you pay less.

I'll wait.

Ahem. I already pointed out to you that adding my wife as a named driver on my car (and vice versa) reduced our premiums. I didn't 'demand', that, it showed up on the quotes when I was comparing rates last time we renewed, and when I saw it obviously I took up the cheaper but wider cover.

Ah, but you've not given up the "why?" Why is it that the rate went down?

I also know how insurance works - I have worked in the Insurance and Assurance industries, have you?

Up to this point, there's been no reason to think you know anything about it. You've spouted and provided nothing.

Insurance works by aggregating risk across groups. But it also recognises individual risks vary based on various criteria (such as age, gender, location), and premiums are set accordingly. The more you 'get' in terms of coverage may lead to a greater payment, but there are other factors:

1) One standard plan is easier to administer than a multiplicity of different plans - because there are a lot of different groups risks to cover across all of them. That can increase the costs. It is also easier when it comes to claims to work out if someone is covered or not if the plans are more universal - claim handling is a major on-cost for insurance.

2) Your focus has been on pregnancy. But it is only one part of the list, and people who are at very low or zero risk of falling pregnant may well be at greater risk of other items that are covered.

There is also pediatric coverage, which may be problematic for people with no children and no ability to have them. The point is this law removes choice, then gouges people for what they don't want.

3) It is not universally true that not having a particular item of coverage will reduce premiums. I will repeat the example of removing contraceptive cover from policies as requested/demanded by Catholic Bishops and organisations - the removal would actually increase the costs of providing those policies, which will of course lead to higher premiums.

Okay, so when story after story pops up about rates going up and people having to pay much more than prior to the ACA, we should understand this is "efficiency?" Great.

She went on, “Blue Cross also tells me that if I don’t pick one of the options, they will just assume I want the one for $647. ... Someone please tell me why my premium in January will be $356 more than in December?”

http://www.suntimes.com/news/marin/2335 ... rance.html

And, she is a Democrat who worked for a Congressman. So, she's probably lying . . .

I do know one thing: you've lost none of your capacity for being a jerk.

And I am glad to see that you have avoided the use of insults.

I have no problem telling it like it is.

Doctor Fate wrote:There is no "cost" for something that can never be used. That's profit. If it's 5 cents or half a million dollars.

Again, you are not considering how insurance works. Risk is balanced out, the 'profit' from one risk is balanced by a 'loss' on another. Obviously insurance companies want to make an underwriting profit [total premiums minus total claims over policy life], although they do not have to in order to be profitable as they have other means (chiefly, investments).

So, a 63-year-old woman can't get pregnant? Maybe not, but she's got a higher risk of other health issues than a 25-year-old woman does.

Go to your insurance agent. Tell him you'd like to add some coverages and then demand that you pay less.

I'll wait.

Ahem. I already pointed out to you that adding my wife as a named driver on my car (and vice versa) reduced our premiums. I didn't 'demand', that, it showed up on the quotes when I was comparing rates last time we renewed, and when I saw it obviously I took up the cheaper but wider cover.

Ah, but you've not given up the "why?" Why is it that the rate went down?

I did in the earlier post. If you can't be bothered to read it, I can't be bothered to repeat it. It's about risk.

I also know how insurance works - I have worked in the Insurance and Assurance industries, have you?

Up to this point, there's been no reason to think you know anything about it. You've spouted and provided nothing.

Well, it's a shame you can't look up how insurance works on the internet and prove that I'm talking rubbish.

Insurers' business model - Wikipedia

How Insurance works - Association of British Insurers

How Insurance works - Insurance Institute of Michigan

There is also pediatric coverage, which may be problematic for people with no children and no ability to have them. The point is this law removes choice, then gouges people for what they don't want.

Hmmm. I went on to the US government's site, to see whether it actually does affect the cost. For Arkansas, Bradley county (picked at random) I looked for priced based on "you, and your spouse" and "you, your spouse, and your children".

The former had a premium about $440, the latter about $650. I'm going to go out on a limb and suggest that if you don't have kids, your premium won't be including very much to cover pediatric care because the risk is very low. So no 'gouging'.

This is how insurance works.

Okay, so when story after story pops up about rates going up and people having to pay much more than prior to the ACA, we should understand this is "efficiency?" Great.

Except you are trying to tie it to specific coverage not being needed, when that is not really the main issue - what is is the wider range of coverage overall and the extension to a lot more people.

She went on, “Blue Cross also tells me that if I don’t pick one of the options, they will just assume I want the one for $647. ... Someone please tell me why my premium in January will be $356 more than in December?”

http://www.suntimes.com/news/marin/2335 ... rance.html

Well, her premium does not have to be $356 more. Blue Cross offered more than one option for a start. And she could look at alternative providers.

danivon wrote:

Doctor Fate wrote:There is no "cost" for something that can never be used. That's profit. If it's 5 cents or half a million dollars.

Again, you are not considering how insurance works.

Rubbish. You are just ignoring what you want to ignore.

Risk is balanced out, the 'profit' from one risk is balanced by a 'loss' on another. Obviously insurance companies want to make an underwriting profit [total premiums minus total claims over policy life], although they do not have to in order to be profitable as they have other means (chiefly, investments).

So, a 63-year-old woman can't get pregnant? Maybe not, but she's got a higher risk of other health issues than a 25-year-old woman does.

True, but her maternity insurance is a cost to her, whether you wish to acknowledge it or not. Now, let's see, should I believe you or . . . Aetna CEO Mark Bertolini?

Bertolini identifies three main factors: 1) Obamacare imposes a requirement that, on an actuarial basis, insurance cover at least 60% of health care costs. Currently, more than half of Americans who buy individual coverage are below 50%. 2) Obamacare imposes 4% to 5% additional cost in the form of new taxes and fees. Aetna alone will pass on $1 billion in Obamacare taxes and fees to its policyholders. 3) Obamacare mandates many coverages, whether customers want them or not, and requires insurers to provide subsidized coverage to those who are already sick.

I would draw your attention to #3.

Ah, but you've not given up the "why?" Why is it that the rate went down?

I did in the earlier post. If you can't be bothered to read it, I can't be bothered to repeat it. It's about risk.[/quote]

True, but this is also not an apt comparison. Better: going from zero collision coverage to having it. Why is that a better comparison? Because now those buying insurance go from not having maternity coverage they didn't need to having it. The "risk" has not changed. They have unneeded coverage. No matter how you slice it, it is not going to be free.

Well, it's a shame you can't look up how insurance works on the internet and prove that I'm talking rubbish.

Done.

There is also pediatric coverage, which may be problematic for people with no children and no ability to have them. The point is this law removes choice, then gouges people for what they don't want.

Hmmm. I went on to the US government's site, to see whether it actually does affect the cost. For Arkansas, Bradley county (picked at random) I looked for priced based on "you, and your spouse" and "you, your spouse, and your children".

The former had a premium about $440, the latter about $650. I'm going to go out on a limb and suggest that if you don't have kids, your premium won't be including very much to cover pediatric care because the risk is very low. So no 'gouging'

.

So, paying "not very much" (unspecified) that you don't need to pay is just fine, according to you. Many Americans may not agree.

Except you are trying to tie it to specific coverage not being needed, when that is not really the main issue - what is is the wider range of coverage overall and the extension to a lot more people.

But, to individuals who are watching their rates go up significantly, the unneeded coverage is a very big issue.

Well, her premium does not have to be $356 more. Blue Cross offered more than one option for a start. And she could look at alternative providers.

As I pointed out, the ACA has driven companies out of some markets. Some states have as few as one or two providers. This law is not about competition.

fate

Because the "efficient" Politburo has determined what he must have.

States have been requiring minimum standards for liability insurance for cars... for many years and that's not considered "socialist".

Since the US has socialized the provision of medical care, with the law requiring emergency wards to take and treat anyone regardless of ability to pay .... its reasonable to expect people to be able to meet their potential obligations. In the same way they are required to meet potential obligations if they drive.
Mandating minimal standards for medical insurance is not just protecting the individual consumer, its protecting the tax payer - who have been picking up the tab for the use of emergency wards by indigents and dead beats for 35 years...

rickyp wrote:fate

Because the "efficient" Politburo has determined what he must have.

States have been requiring minimum standards for liability insurance for cars... for many years and that's not considered "socialist".

1. It is a "State" and not the Federal government.

2. The requirements are generally minimal--to protect others against you.

3. There's a wide variety of choices.

4. You get to pick what car to drive, which has a huge impact on your insurance costs.

Since the US has socialized the provision of medical care, with the law requiring emergency wards to take and treat anyone regardless of ability to pay .... its reasonable to expect people to be able to meet their potential obligations.

But, is it reasonable to expect them to meet obligations they will NEVER have? Again, why should people without kids pay for pediatric coverage?

In the same way they are required to meet potential obligations if they drive.
Mandating minimal standards for medical insurance is not just protecting the individual consumer, its protecting the tax payer - who have been picking up the tab for the use of emergency wards by indigents and dead beats for 35 years...

To put it in perspective, imagine there were 4 levels of auto insurance: Lamborghini, Mercedes, Acura, and Lincoln. Now, if you drive a 20 year-old Hyundai, you might not be too thrilled. You might think, "Why do I have to carry comprehensive? It only covers theft and there's nothing in the car worth stealing."

In the case of the ACA, it mandates some things that some people do not want and cannot use.

We're about to watch the implosion of it anyway. When Glenn Kessler gives Obama 4 Pinocchios for his "if you like it, you can keep it" speeches, you know the wheels are coming off.

Just got out of my company healthcare meeting. My employer pays for most of my plan but I have to pick up coverage for the family. My plan has gotten worse. The cheapest plan I have to pick from will cost me $106.13 per week, ($5,518/year my cost plus what my employer contributes) and what does this get me?
I pay 100% of all costs up to $5200, after that insurance kicks in and pays 80%, I pay nothing once I hit $11,000.
(there ARE several preventative procedures that are covered 100% but even those have hidden costs associated with them, for example I had a colonoscopy several months ago, the procedure was covered but anesthesia, consultation and facility expenses were not covered at all, this "free" procedure cost me several hundred dollars but yes, some (few) expenses are covered "free")

This is "affordable" coverage?
You want to defend this crappy plan as either good coverage or affordable?

Doctor Fate wrote:Rubbish. You are just ignoring what you want to ignore.

Yes, because that is what looking at insurance holilstically and not simply focusing on one provision is all about....

So, a 63-year-old woman can't get pregnant? Maybe not, but she's got a higher risk of other health issues than a 25-year-old woman does.

True, but her maternity insurance is a cost to her, whether you wish to acknowledge it or not. Now, let's see, should I believe you or . . . Aetna CEO Mark Bertolini?

Bertolini identifies three main factors: 1) Obamacare imposes a requirement that, on an actuarial basis, insurance cover at least 60% of health care costs. Currently, more than half of Americans who buy individual coverage are below 50%. 2) Obamacare imposes 4% to 5% additional cost in the form of new taxes and fees. Aetna alone will pass on $1 billion in Obamacare taxes and fees to its policyholders. 3) Obamacare mandates many coverages, whether customers want them or not, and requires insurers to provide subsidized coverage to those who are already sick.

I would draw your attention to #3.

Ok, a few things here. It's one part of #3. But if these are listed in order of significance, then #1 and #2 are more likely to be the source of rises in individual premiums. And the other part of #3 is also not insignificant.

But without quantifying, it doesn't actually say what the impact of having pregnancy cover is on premiums for those who can't become pregnant. or what the impact is of having a larger pool cover the other things that those people are more at risk of than pregnancy.

Your quote does not answer that in any way, although helpfully it shows that there are more factors in the increased cost than the one you are hanging on to like a dog with a bone.

True, but this is also not an apt comparison. Better: going from zero collision coverage to having it. Why is that a better comparison? Because now those buying insurance go from not having maternity coverage they didn't need to having it. The "risk" has not changed. They have unneeded coverage. No matter how you slice it, it is not going to be free.

Except that if the actuarial risk is minimal, it won't feature in the premium. Or, of there are other greater risks from other items of coverage the inverse happens - they pay less for that outweighing any 'extra' that maternity cover 'costs'.

Hmmm. I went on to the US government's site, to see whether it actually does affect the cost. For Arkansas, Bradley county (picked at random) I looked for priced based on "you, and your spouse" and "you, your spouse, and your children".

The former had a premium about $440, the latter about $650. I'm going to go out on a limb and suggest that if you don't have kids, your premium won't be including very much to cover pediatric care because the risk is very low. So no 'gouging'

.

So, paying "not very much" (unspecified) that you don't need to pay is just fine, according to you. Many Americans may not agree.

I think I found that the 'not very much' is actually about -$210 in the example I looked at. If a premium that is about 30% lower is 'gouging', then I wonder if you know what the word actually means...

Except you are trying to tie it to specific coverage not being needed, when that is not really the main issue - what is is the wider range of coverage overall and the extension to a lot more people.

But, to individuals who are watching their rates go up significantly, the unneeded coverage is a very big issue.

Only if they believe that is the cause, when the Aetna quote suggests quite a few alternatives that seem more likely to add to pool risk.

And given that the impact has not been quantified, we can't tell whether it is more or less than other factors that would work the other way (such as that the people who are at very low risk of pregnancy are likely to be at higher risk for other things that they do want covered, but would be 'subsidised' by the premiums of others)

Well, her premium does not have to be $356 more. Blue Cross offered more than one option for a start. And she could look at alternative providers.

As I pointed out, the ACA has driven companies out of some markets. Some states have as few as one or two providers. This law is not about competition.

How many companies are there in the California exchange? That's where she is. If you are going to use a real example, carry it to the full conclusion.

I would not put it in those same words but yes, you are way more correct than wrong. What was promised?

*up to $2500 in savings for the average family
...lie, it's costing me more

*we could keep the same plan
...lie, my employer doesn't even offer the same plan!

*and the promised cost to taxpayers is what already 3 times that original "promise"?

we were sold a bunch of lies yet instead of liberals complaining about the deception, they continue to embrace it, Ricky titled this thread how it's going to help the economy for crying out loud!? Liberals should be asking why the promises made are not being kept, demand what they voted for should be what we see, not this mess they ended up with. I am more and more shocked every day how liberals simply can't find fault with Obama or the Democratic party. Yet they still complain about Bush and blame things on him!

Further...

I was wondering if maybe I can cover myself by my employer plan and go to the ACA plans for the wife and kids? Maybe these "savings" are better there? So I go to the New York State website and find several problems. first the following message:

The Federal Data Services Hub is down. As a result, the New York State of Health Marketplace (NYSOH) is unable to process new applications at this time...

But I need an answer to my HR department in a week or so!

second, I can't simply check my rate, I need to create an account first. That was not part of the promise either, we were supposed to be able to shop prices and policies without registering. To get a plan, yes, you must register but to simply shop????

so I set up an account, started to fill everything out. I need to enter social security numbers? I'm supposed to SHOP, why do they need all this information for me to simply shop for the best rate?

This is worse than the right wing whacko radio guys are complaining about!

danivon wrote:Ok, a few things here. It's one part of #3. But if these are listed in order of significance, then #1 and #2 are more likely to be the source of rises in individual premiums. And the other part of #3 is also not insignificant.

But without quantifying, it doesn't actually say what the impact of having pregnancy cover is on premiums for those who can't become pregnant. or what the impact is of having a larger pool cover the other things that those people are more at risk of than pregnancy.

Here's the problem: is it right to force people to pay for coverage they can't use so that others pay less?

I think most Americans would say "No!"

Your quote does not answer that in any way, although helpfully it shows that there are more factors in the increased cost than the one you are hanging on to like a dog with a bone.

Sure, like the reduction in competition--engineered by the ACA.

Except that if the actuarial risk is minimal, it won't feature in the premium. Or, of there are other greater risks from other items of coverage the inverse happens - they pay less for that outweighing any 'extra' that maternity cover 'costs'.

No matter how you frame it, telling people they SHOULD pay for coverage they know they cannot use is not going to pass muster politically. That goes for maternity, pediatric, and other required coverages.

think I found that the 'not very much' is actually about -$210 in the example I looked at. If a premium that is about 30% lower is 'gouging', then I wonder if you know what the word actually means...

Um, so, you're claiming that carrying pediatric coverage and having no kids is cheaper than not carrying the coverage? Really? Insurance companies punish people who don't have kids by charging them more? Is that what you're suggesting?

How many companies are there in the California exchange? That's where she is. If you are going to use a real example, carry it to the full conclusion

No. I'm not playing your game. You want to believe that the ACA is driving down costs. Fine. Let's see.

I'm predicting the longer this train wreck continues, the less popular the President will be. When it hits critical mass, we will see him move in a major way.

Tom, every year,for a couple of decades in companies across the US - the experience you've just had occurs constantly. It was caused, not by the ACA, but because health care inflation greatly out stripped normal inflation.For decades.
Companies, forced by law to provide health insurance, keep trying to limit their investment. So plans keep getting worse. And health insuracne companies keep trying to ratchet up profits so the value in every plan goes down. (despite all the choice)
With or without the ACA, you would have experienced the same thing.

tom

But I need an answer to my HR department in a week or so

So you've got time.... Or are you going to give up because the web was down the first time you tried?


ruff

While those situations suck, it's yet to be demonstrated why the entire system has to be overhauled to protect them. We could have simple expanded the existing safety net to help these folks

.
Well, its not just those folks. The benefits in insuring everyone accrue to every tax payer, who no longer has to help foot the bill for the uninsured who take advantage of emergency departments.
Plus, the numbers of uninsured, or poorly insured (like Tom) have been increasing year after year...
Your right that simply expanding the safety net would have been the best bet. That would be medicair for everyone. It would free companies like Toms from having to patch together shitty insurance plans together that the company can afford .... It would eliminate the need to administrate hundreds of different insurance plans (reducing overhead for hospitals and doctors from 12% of costs to less than 3%) and it would have provided a better negotiating lever with suppliers of health care.
But that wasn't politically possible was it Ruff? So you get a half assed solution essentially to protect the health insurance industry.
And you continue putting 17.7% of the GDP into health care when it should be around 11%. Imagine what that other 6% could be in whats, except for health care, a very efficient economy?