Health Reform Will Impact Existing Plans More Than Promised

[OhioChick]

"If you like your health care plan, you will be able to keep your health care plan."

Throughout the long health care reform debate, that promise from President Obama was one of the few constants, made to reassure the bulk of Americans who already have insurance that the sweeping legislation would not have a downside. Just Tuesday, Obama tried to counter critics who say the new law contains a slew of unintended consequences. Announcing a round of fresh set of new insurance rules, he called the regulations "a true Patient's Bill of Rights" and insisted that they are "not punitive."

But now that regulations about existing employer-sponsored plans have been issued, it's becoming clear that many of those with 160 million Americans with job-based coverage will not, in fact, be able to keep what they currently have.

Republican critics of the Affordable Care Act point to the Obama Administration's own estimates that by 2013, 39% to 69% of employer plans will be subject to new regulations and not "grandfathered" in, or exempted from new rules. Once they lose their grandfathered status, plans must be altered to adhere to new insurance rules as outlined in the new legislation. House Minority Leader John Boehner issued a press release about the grandfathering provisions headlined, "New ObamaCare Tagline Should Be 'If You Like Your Health Care Plan, Too Bad.'"

That partisan rhetoric may be heated, but it's not entirely off base. The truth is that employer-based plans, which many assumed would easily be categorized as "grandfathered," will be subject to the full regulatory thrust of the new law if they are altered in ways that are standard practice in the industry. Plans that increase the percentage of costs patients must pay out of pocket — known as co-insurance — lose their grandfather status. The same is true for plans that significantly decrease the percentage that employers contribute to premiums or those that significantly increase deductibles or co-payments. An employer who switches health insurance providers also loses its grandfather status. These kinds of changes are common year to year in the current marketplace, since employers are constantly looking for ways to limit their own expenses in the face of rising costs.


More: http://www.time.com/time/nation/article/0,8599,1999208,00.html

[Beetwasher]

1. Umm, Sounds Like This Is GOOD News As The Plans Will Be Under New, Better Regulations

"Plans that increase the percentage of costs patients must pay out of pocket — known as co-insurance — lose their grandfather status. The same is true for plans that significantly decrease the percentage that employers contribute to premiums or those that significantly increase deductibles or co-payments."

So if they want to increase your out of pocket (which means YOU will pay more), they are not grandfathered in and will be subject to NEW BETTER regulations and review. If they want to decrease the percentage your employer pays (meaning YOU will pay MORE). This is good because these sorts of things will new be subject to federal review and approval, whereas before, there was none.

This is good news, though you wouldn't know from the spin.

[dflprincess]

3. Though those of us who are already stuck with "Consumer Driven Plans"

which is the way the insurance companies like to sell these high deductitble and coinsurance plans that make access to care difficult will still be stuck with them. Though at least the out of pockets my current "coverage" allow are lower than what this bill says will be permitted. And note that what the bill says the out of pocket limits are only apply to "covered" expeneses. You will still be on the hook for anything, including adult vision & dental, that is not "covered" by your policy. And what you pay for a premium also does not count toward your deductible.

These plans are becoming more common despite growing evidence that, in the long run, these plans cost more as those with them put off seeking care and often do not take their medications the way they should because they can't afford them as prescrption drug costs are also subject to the deductible. The goal of these plans is to get people to use care less & they work - except that the "insured" are often sicker when they finally seek treatement.

Employers are going to pick the plan that's cheapest for them, the insurance companies will continue to make obscene profits and the ranks as the undersinsured will continue to grow as we find oursevles paying more and more for a shoddy product that delivers less and less.

[Beetwasher]

5. And How Would You Be Better Off With NO Reform?

And I think that even in the plans you discuss, MLR's and minimum converage requirements and state exchanges will ultimately benefit you, whether you want to believe it or not.

[dflprincess]

11. Actually, like many, I could be worse off.

As I said the plan I have now has max out of pockets that are less per year than what the insurance bill allows so I could see an increase in those. On the other hand, maybe I won't be any worse off. I can't afford care now & I won't be able to afford it if the deductible goes up so I guess I will still be in the same boat.

Minnesota already has strict MLR's and the nonprofits that operate here have been caught violating them - and that's with an attorney general's office that is monitoring them. Don't think for a minute that the crooks who broke the system won't find away around MLRs. And don't think for a minute that any regulations in this bill will be enforced any better than work safety regs have been.

Minimum coverage requirements do not mean that the items allegedly covered aren't subject to deductibles and out of pockets. Just as with most current coverage, screening (aka "preventative") tests will be covered but how much good will that screening test do you if can't afford any follow up it says you need? Minimum coverage requirements also don't mean that the insurance companies can't continue to play the same old games where they deny a claim even though it's for a covered service because they know most people won't put up more than a token fight.

You may think this is reform but calling it that doesn't make it so. It is nothing but a scam that digs the insurance companies in deeper and protects their profits as well as the campaign donations they make. We may see a short term drop in the number of uninsured but even in the CBO says that number will start to climb again. In a few years we'll be right back where we are now - only the premiums will be higher and even more Americans will not have access to care - including more of those with "coverage".

[Beetwasher]

12. And You Claiming You Might Be Worse Off Doesn't Make It So, Or Even Likely

In fact, it's quite unlikely, despite your hypothetical nonsense.

Just because YOU say regulations won't be enforced means squat. I say they will be enforced AND there will now be an extra layer of federal regulations that weren't there before.

[dflprincess]

16. Dream on

The fact is actual reform would have mandated access to care not require that we buy "coverage" from the crooks who have been cheating us for years.

And yes, if my out of pocket costs go up I will be worse off along with millions of others who will be in the same boat.

[Beetwasher]

17. According To YOUR Irrelevant Opinion, There's Not A Single Fact In Anything You've Posted

[dflprincess]

19. It is a fact that the insurance bill allows out of pocket costs that are larger than what many

people, even those with "consumer driven" plans have now. And that makes it a fact that many, perhaps most, of us will see no improvement in our ability to access care as we see both our premiums and out of pockets expenses continue to rise.

Unless you're a corporate officer or major shareholder in an insurance comapny it is not reform when all that happens is that an existing, parasitic, non-productive, failed system is propped up by requiring the transfer of billions of public & private funds into it while doing nothing to require the industry hold up its side of the contract.

It is a fact the U.S. is the only developed country that continues to ration health care by putting financial obstacles in the way of accessing care.

[Beetwasher]

20. No It's Not, Now You're Making Things Up

The actual facts are that the bill accomplishes a lot to curb the excesses of cost increases and out of pocket expenses and all you have is your opinion that you think your out of pocket expenses are going to go up.

[dflprincess]

21. The bill allows out of pocket expenses of just over $5,000 for a single person

and $10,000 for a family and that's just for "covered" expenses. Those are certainly high enough to discourage someone from seeking care and higher than what many of us have now. As premiums continue to rise employers will be looking for ways to cut that cost and one way will be to pick policies with bigger out of pockets - just like they've been doing. As long as they don't exceed what the law allows they can get by with it.

It's not those of us who understand what a scam this bill is who have to make things up - only those who are trying to sell it need to do that or just continue to deny what's it it.

[Beetwasher]

22. "Allows"? And What Was "Allowed" Before The Reform? What Part Of NEW Federal Regulations Do You Not

Grasp? What you call "allowing", I call a cap that didn't exist before. Your argument is based on your opinion that regulations won't be enforced.

[dflprincess]

23. Because the feds have such a great track record on enforcing regulations

look at how safe mines have become :sarcsam: or at that army of OSHA workers that are in gulf making sure the people working on the clean up have the proper protective gear.

I can't imagine why anyone would think regulations won't be enforced - and that if there is even token enforcement the insurance companies won't write the fines off as the cost of doing business.

Just what the hell good does a "cap" do if it's still unaffordable? BTW - the bill does have provisions that allow the cap to go up every year and that it can be rounded up to the nearest $100. There is no provision that says income has to go up to match the increases.

We are the only developed nation that continues to ration health care by making it unaffordable. Apparently we are also the only country where the populace can be conviniced that being required to bail out a for profit middle man that created the mess we're in and contributes nothing to our health care is "reform".

[Beetwasher]

24. Again, YOUR OPINION Is Irrelevant

But you're free to keep regurgitating it.

[inna]

15. +. And those who currently have decent employer-sponsored plans,

will NOT be able to keep them in most cases - Despite all claims to the contrary.

(I posted more on that downthread.)


"Employers are going to pick the plan that's cheapest for them, the insurance companies will continue to make obscene profits and the ranks as the undersinsured will continue to grow" - true. And the costs/financial burden will be shifted from employers/businesses to individuals/families.


The whole idea behind this HCD (Health Care Deform :P ) is to maximize profits (and reduce costs) for corporations and businesses and extract as much as possible from individual workers. In addition, one trillion dollars gets transfered from public sector (via taxpayer-funded subsidies and $500 billion taken away from Medicare) to the private, for profit insurance industry. It's a bit like Wall Street bailout - the parasitic insurance industry (the one that caused the problem in the first place) gets rewarded, enriched, empowered and placed in charge, instead of being eliminated or at least strongly regulated. Struggling working/middle class gets hit with massive financial burden. And on top of everything else, the insurance industry (the culprit) gets a trillion dollars of public funds from the government - at the expense of Medicare, a popular and working public program, which gets defunded (while it should've been expanded to let in more people). :banghead: If this is not a Health Care Deform, I don't know what it is. (The only thing that mitigates its overall obscenity is the fact that subsidies may actually provide a relief to some families. That is a good thing, but the overall approach was completely wrong.)

[Alcibiades]

2. Was this an editorial, or reporting?

"Still, while many employer-based plans will be snared in the regulatory net of the Affordable Care Act, many of those with this coverage could actually stand to benefit."

Ya think? Oh, but there is a regulatory net. But why? Because insurance companies suck, and people have demanded it.

"It will be years before it's clear exactly how much the employer-based health insurance system will be upended, and only then will consumers know precisely how costs will be affected."

Oh, it's not a question if it will be upended, but just a question of the degree.

:puke: :puke: :puke: :puke:

[Jumping John]

4. So this is good for people with jobs and health insurance. And those without JOBS and INS???? n/t

[Beetwasher]

6. Many Of Those People Will Have Access To Affordable Ins. Through State Exchanges

Many will have access through expansion of Medicaid, and others through the community health center system that is being set up.

Does this help every single person? Maybe not, but it's significant improvement.

[Jumping John]

7. Yes it is great for people W/O pre-existing and those who do not need Ins. I apologise for my

Attitude beforehand. Sorry for being a realist I guess.

[Beetwasher]

10. You're Not A Realist

Since you obviously haven't read the bill. The people who benefit the most are the one's with pre-existing conditions who cannot get insurance now.

[pscot]

8. There will have to be a lot of government spending

to enable this stuff. The states are dead broke. Is All that spending going to be subject to the appropriations process? In other words, is every dime going to need a 60 vote majority?

[Beetwasher]

9. It's All Paid For

Without the government going into debt or additional spending. Did you read the bill?

[pscot]

14. Nobody has read the bill

but that's beside the point. The bill is enabling legislation, but every dollar for every program (state pools for example) is going to have to be appropriated. For the last 8 weeks the Senate has been trying to appropriate money for the doc fix without being able to muster the 60 votes. Displace a few of the current senators with teabaggin' libertarians and then tell me it's all paid for. Just sayin'.

[Beetwasher]

18. Of Course People Have Read The Bill

I've read it.

[inna]

13. Not a great article, but what's absolutely certain is that

the general trend for employer-sponsored coverage will be shifting costs to the employee, decreasing the scope and quality of coverage, and in many cases dropping coverage altogether.


"The new regulations, after all, are designed to protect consumers."

Misleading. What these regulations do is simply setting MINIMUM standards (which are set much, much lower than what most employers currently provide).


Currently, employer-provided plans have an actuarial value of 80-85% on average. However, the Bill sets a "new standard" at 60-70% actuarial value:

Benefit Design

Essential benefits package
• Create an essential health benefits package
that provides a comprehensive set of services,
covers at least 60% of the actuarial value
of the covered benefits

Most employer-sponsored plans actually provide decent coverage and are vastly superior to individual plans and to what "new regulations" set as a minimum standard.

That might no longer be the case in the future, because the general trend will be downgrading the standard of coverage from 80-85% (current average actuarial values for employer-provided plans) to the "new standard" of 60-70%.

Some "protection of consumers". :shrug:


Anyway, it is simply a fact that many - if not most - people who currently have a decent employer-sponsored coverage that they like, will NOT be able to keep their current standard/quality of coverage. Employer-sponsored coverage WILL get worse (as a net trend, not in ALL cases of course), and the costs will be shifted to individuals.