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Subject: AHCA and large employer health plans rss

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Has anyone posted a thread yet about the effect that the House or Senate healthcare bills may have even on large employer based health plans? I feel like people think this bill won't effect them since they are not on a ACA plan but they are overlooking the fact that lifetime limits will come back among other things.

https://www.brookings.edu/2017/05/02/allowing-states-to-defi...
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Jorge Montero
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It'll definitely depend on the company you work for. During most of the GWB years, I worked for Home Depot writing payment systems. Back in those days, the best available insurance that they'd offer would have a lifetime maximum of about a million dollars: I am sure companies like that will go back to lifetime maximums real quick.

I don't think my current employer will go back to lifetime maximums though, but that's mainly because it's a richer employer with younger, better paid staff.

I am pretty sure that the insurance situation will get worse for a majority of Americans, and spectacularly worse for a minority of them. Leaving the ACA the way it was wasn't going to be a good idea, but I don't see how anything in the AHCA will really help.
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My husband works for the state and we used to have one. I am sure they will go back to them. Could possibly insure through my employer but my plan has high deductible and OOP. Oh well. With my son arrived this year, I worry more than I used to. Hope for good health, I guess.
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Sue_G wrote:
My husband works for the state and we used to have one. I am sure they will go back to them. Could possibly insure through my employer but my plan has high deductible and OOP. Oh well. With my son arrived this year, I worry more than I used to. Hope for good health, I guess.

I feel for you Americans. How you have politicians who claim to be Christians and allow people to have treatable ailments is a mystery to me.
The foundation myths of the US have certainly made it a strange place through European eyes.
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Sue_G wrote:
My husband works for the state and we used to have one. I am sure they will go back to them. Could possibly insure through my employer but my plan has high deductible and OOP. Oh well. With my son arrived this year, I worry more than I used to. Hope for good health, I guess.
You had/got a kid? Does Jarred know?
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Sue_G wrote:
Hope for good health, I guess.
That's usually when Murphy knees you in the groin.
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hibikir wrote:
I don't think my current employer will go back to lifetime maximums though, but that's mainly because it's a richer employer with younger, better paid staff.


It may be that they don't have an option - insurance companies like lifetime maximums because of the way they limit exposure. I don't know if there are statistics on the number of plans available without maximums before the ACA, but I'll bet it was vanishingly small.
 
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Sue_G wrote:
My husband works for the state and we used to have one. I am sure they will go back to them. Could possibly insure through my employer but my plan has high deductible and OOP. Oh well. With my son arrived this year, I worry more than I used to. Hope for good health, I guess.


I hope your baby has health, happiness, and long life.
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hibikir wrote:
It'll definitely depend on the company you work for. During most of the GWB years, I worked for Home Depot writing payment systems. Back in those days, the best available insurance that they'd offer would have a lifetime maximum of about a million dollars: I am sure companies like that will go back to lifetime maximums real quick.

I don't think my current employer will go back to lifetime maximums though, but that's mainly because it's a richer employer with younger, better paid staff.

I am pretty sure that the insurance situation will get worse for a majority of Americans, and spectacularly worse for a minority of them. Leaving the ACA the way it was wasn't going to be a good idea, but I don't see how anything in the AHCA will really help.


Assuming lifetime maximums come back, it would be spectacularly worse for a very small minority of Americans (as you noted). This is mainly those that have catastrophic illnesses which incur costs above $1m (or whatever max the health plan uses).

Insurers increased premiums to account for the removal of the lifetime max. This increased premiums for ALL enrollees, but the extra premiums only exceeded cost for those with >$1m in claims, which is a small number.

As a result, the majority of members will be better off without lifetime maximums. Anyone who doesn't, or never would, incur more than $1m in expenses now has lower premiums. I don't know how you figure the majority of American's would be hurt by this?

I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.
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We need to be realistic about lifetime maximums and the corresponding increased livespan.

Otherwise we boomers will bankrupt the system for an extra month of life.

At some level the same logic applies to people of any age. We cant spend a billion dollars per citizen on healthcare (or on any citizen).

This is the problem with declaring health care a right.

Rather, we need to decide what our budget for health care is and give the best care to the most people while considering likely remaining lifespan. And it would probably be some form of single payer.

Icu is over $21000 per day. 90 days of icu level treatment would be $200,000 dollars.

If at the start, the only prognosis is death at the end of icu then we should probably spend the money saving the life of a premie instead of extending the life of four seniors like myself for 90 days (probably of misery too).

The republicans are being murderously harsh but there is a balance point and we don't have unlimited resources. And we could do a ton for only t0 billion a year.

(edit- fixed various phone typing anomalies like 'tbe' for 'the'.
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Keele047 wrote:

I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.


That calculation pretends that if someone goes over lifetime maximums, they are the only person that is affected by it. When someone's mother, or sister, or adult son happens to go over lifetime maximums, it's not as if we take them behind a shed and shoot them, and everyone else just keeps living normally.

So in practice, a far more significant number of people are a lot worse off, unless we want to pretend we all live by ourselves. We are also all affected anyway, because the risk of getting hit there isn't all that low: Remember the blue lives matter thing? Compare fatality rates by handgun for policemen with that 0.028%
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maxo-texas wrote:
We need to be realistic about lifetime maximums and the corresponding increased licespan.

Otherwise we boomers will bankrupt the system for an extra month of life.

At some level the same logic applies to people of any age. We cant spend a billion dollars per citizen on healthcare (or on any citizen).

This is the problem with declaring health care a right.

Rather, we need to decide what our budget for health care is and give the best care to tbe most people while considering likely remaining lifespan. And it would probably be some form of single payer.

Icu is over $21000 per day. 90 days of icu level treatment would be $200,000 dollars.

AIfs a start, the only prognosis is death at the end of icu then we should probably spend tbe money saving the life of a premie instead of extending the life of four seniors like myself for 90 days (probably of misery too).

The republicans are being murderously harsh but there is a balance point and we dont have unlimited resources. And we could do a ton for only t0 hillion a year.


But in that case, first you should look at maximums for medicare first, instead of creating a hole between 55 and 65. And then you should come up with plans that really lower costs of care, instead of just removal of care. The US is good at either not delivering care, or delivering very expensive care compared to other nations. Cheap alternatives are completely out of the market, and the places where they'd be the most useful are in medicare, not in the private market or the parts of medicaid that cover children and poor people.

Here, a crazy ideological libertarian wonders why in the world we are OK with the way we handle drug patents in the US: http://www.econtalk.org/archives/2017/06/robin_feldman_o.htm...

When we are expecting a major increase in demand for medical care, what we should see is more competition and a major increase in supply that lowers prices. Where are all the articles talking about major expansion in medical schools?

This is unfortunately not just a US problem though: European countries also face more doctors and nurses retiring than graduating from college.
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Keele047 wrote:
I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.


I guess I look at this another way. If it's that small a percentage, it would seem like the marginal cost to the remainder of the population to extend coverage to the very few that need it would be quite low. For every person that needs that much coverage, there are around 3500 people that don't. If the policy runs 30 years, those 3500 people would need to pay an additional $11 annually to cover the entire cost.

Of course, this sort of illustrates why it'd be better not to use private insurance for primary healthcare, if you ask me. Pooling the risk over the entire population is the most effective way to manage the cost, but a market-based solution for coverage simply won't do that.
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perfalbion wrote:
Keele047 wrote:
I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.


I guess I look at this another way. If it's that small a percentage, it would seem like the marginal cost to the remainder of the population to extend coverage to the very few that need it would be quite low. For every person that needs that much coverage, there are around 3500 people that don't. If the policy runs 30 years, those 3500 people would need to pay an additional $11 annually to cover the entire cost.

Of course, this sort of illustrates why it'd be better not to use private insurance for primary healthcare, if you ask me. Pooling the risk over the entire population is the most effective way to manage the cost, but a market-based solution for coverage simply won't do that.


I completely agree with your first point. The number of people affected by lifetime maximums is very small so the burden on the rest of society to remove the maximum is small. However, that wasn't hibikir's claim. He claims the majority (>50%) would be hurt, which I think is wrong.

Obamacare was a program designed to help a small amount of people who would be otherwise catastrophically harmed by lack of affordable health care. It was designed to do this at the expense of the majority of the population. In Obamacare the young pay more so the old can pay less. The healthy pay more so the sick can pay less. Those with private insurance pay more so the poor can pay less (Note that the rich are never singled out as paying especially more, the middle class pays just as much more as a percent as the upper class).

All of that may be morally justified. However nobody should pretend that the majority of American's benefited from this. Less than 30m benefited, at the expense of the other 280m. The health insurer fee was charged to MA organizations and Medicaid MCO's so it really did hurt commercial, Medicare, and Medicaid enrollees. Not just the 'rich'.

AHCA will hurt those <30m and benefit the majority. Due to the proportions of individuals in each bucket, each individual in the <30m will hurt far more than the other >280m will benefit. That may be morally reprehensible to some, and I wouldn't even necessarily disagree. But let's be very clear that most people are benefiting from the AHCA.
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hibikir wrote:
Keele047 wrote:

I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.


That calculation pretends that if someone goes over lifetime maximums, they are the only person that is affected by it. When someone's mother, or sister, or adult son happens to go over lifetime maximums, it's not as if we take them behind a shed and shoot them, and everyone else just keeps living normally.

So in practice, a far more significant number of people are a lot worse off, unless we want to pretend we all live by ourselves. We are also all affected anyway, because the risk of getting hit there isn't all that low: Remember the blue lives matter thing? Compare fatality rates by handgun for policemen with that 0.028%


That is a good point, but even if each person who is directly affected knows 100 people who will be significantly indirectly affected (and there is 0 overlap in these people) that still only reaches 2.8% of the population. That is still a tiny minority who are hurt.

It is also not like a person dies if they exceed this amount. There are many alternatives. They can switch insurers between years to reset their amount. They can pay for some portion of it out of pocket or take out loans and then declare bankruptcy. If their financial situation deteriorates enough they can get Medicaid coverage. I can think of 100 people who would be affected materially by my death, but I couldn't even think of 2 people (aside from myself) who would be affected by my financial hardships. I think my estimate of 100 people is generous.
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Keele047 wrote:


That is a good point, but even if each person who is directly affected knows 100 people who will be significantly indirectly affected (and there is 0 overlap in these people) that still only reaches 2.8% of the population. That is still a tiny minority who are hurt.



Because insurers will be oh so willing to take on a new patient who has exceeded his/her lifetime caps...
 
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Keele047 wrote:
I completely agree with your first point. The number of people affected by lifetime maximums is very small so the burden on the rest of society to remove the maximum is small. However, that wasn't hibikir's claim. He claims the majority (>50%) would be hurt, which I think is wrong.


Hmmm. I think you're perhaps reading more than he wrote there, but it might be better to let him clarify that. I read his post to say "the AHCA will make things worse and one of the reasons is..."

Quote:
Obamacare was a program designed to help a small amount of people who would be otherwise catastrophically harmed by lack of affordable health care.


I similarly think this isn't quite right. Obamacare's stated goal was to make healthcare more accessible and affordable for everyone. Whether or not they would be "catastrophically harmed" was not really front and center, though it would certainly help out those that might have been. It really failed to do this for a variety of reasons, but let's not get the goal wrong out of the gate.

I could debate other points you raise, but I don't have the impression that you're really treating the law, the reasons for the law, or its outcomes particularly fairly. And that's coming from someone that thinks the ACA was a pretty horrible solution for the stated problems that has achieved just about none of its goals and certainly hasn't reduced costs for anyone. The tone of your post is such that I'm not sure I'm interested in investing the time in the discussion.
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wifwendell wrote:
Keele047 wrote:


That is a good point, but even if each person who is directly affected knows 100 people who will be significantly indirectly affected (and there is 0 overlap in these people) that still only reaches 2.8% of the population. That is still a tiny minority who are hurt.



Because insurers will be oh so willing to take on a new patient who has exceeded his/her lifetime caps...


How would they know? Do you think insurers have some giant, collaborative, database of health records for all insured individuals everywhere? That is nonsense.

Plus, the title of this thread suggests we are talking about large groups. Large groups often have multiple health plan options through multiple insurers which are offered on a GI basis. In those cases the insurer doesn't have a choice.
 
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Keele047 wrote:
It is also not like a person dies if they exceed this amount. There are many alternatives. They can switch insurers between years to reset their amount.


That assumes that they can't be denied coverage due to preexisting conditions. Which certainly wasn't the case before the ACA and may not be after the AHCA.

Quote:
...or take out loans and then declare bankruptcy.


This is commonly referred to as fraud and is a felony. Applying for a loan you know you will not repay can (and really should) land you in jail.
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Keele047 wrote:
perfalbion wrote:
Keele047 wrote:
I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.


I guess I look at this another way. If it's that small a percentage, it would seem like the marginal cost to the remainder of the population to extend coverage to the very few that need it would be quite low. For every person that needs that much coverage, there are around 3500 people that don't. If the policy runs 30 years, those 3500 people would need to pay an additional $11 annually to cover the entire cost.

Of course, this sort of illustrates why it'd be better not to use private insurance for primary healthcare, if you ask me. Pooling the risk over the entire population is the most effective way to manage the cost, but a market-based solution for coverage simply won't do that.


I completely agree with your first point. The number of people affected by lifetime maximums is very small so the burden on the rest of society to remove the maximum is small. However, that wasn't hibikir's claim. He claims the majority (>50%) would be hurt, which I think is wrong.

Obamacare was a program designed to help a small amount of people who would be otherwise catastrophically harmed by lack of affordable health care. It was designed to do this at the expense of the majority of the population. In Obamacare the young pay more so the old can pay less. The healthy pay more so the sick can pay less. Those with private insurance pay more so the poor can pay less (Note that the rich are never singled out as paying especially more, the middle class pays just as much more as a percent as the upper class).

All of that may be morally justified. However nobody should pretend that the majority of American's benefited from this. Less than 30m benefited, at the expense of the other 280m. The health insurer fee was charged to MA organizations and Medicaid MCO's so it really did hurt commercial, Medicare, and Medicaid enrollees. Not just the 'rich'.

AHCA will hurt those <30m and benefit the majority. Due to the proportions of individuals in each bucket, each individual in the <30m will hurt far more than the other >280m will benefit. That may be morally reprehensible to some, and I wouldn't even necessarily disagree. But let's be very clear that most people are benefiting from the AHCA.


It's not nearly as simple as "the young pay more so the old can pay less".

I agree that's a factor.

However, young people develop serious illnesses and have work, auto, and personal accidents with enormous costs all the time.

And because they lack insurance- their costs are dumped on the rest of society and in many cases, lacking therapy and treatment, they also become burdens on society for the rest of their lives when they do not have to be.
 
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perfalbion wrote:
Keele047 wrote:
It is also not like a person dies if they exceed this amount. There are many alternatives. They can switch insurers between years to reset their amount.


That assumes that they can't be denied coverage due to preexisting conditions. Which certainly wasn't the case before the ACA and may not be after the AHCA.

Quote:
...or take out loans and then declare bankruptcy.


This is commonly referred to as fraud and is a felony. Applying for a loan you know you will not repay can (and really should) land you in jail.


Dark little movie on that with Mickey Rooney no less.

https://en.wikipedia.org/wiki/Quicksand_(1950_film)

In that case, it was just buying something on credit and then selling it for cash before the loan was paid off. the movie is artful for the slow slide into .. well.. quicksand... that he descends from his first tiny mistake.
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Keele047 wrote:
hibikir wrote:
It'll definitely depend on the company you work for. During most of the GWB years, I worked for Home Depot writing payment systems. Back in those days, the best available insurance that they'd offer would have a lifetime maximum of about a million dollars: I am sure companies like that will go back to lifetime maximums real quick.

I don't think my current employer will go back to lifetime maximums though, but that's mainly because it's a richer employer with younger, better paid staff.

I am pretty sure that the insurance situation will get worse for a majority of Americans, and spectacularly worse for a minority of them. Leaving the ACA the way it was wasn't going to be a good idea, but I don't see how anything in the AHCA will really help.


Assuming lifetime maximums come back, it would be spectacularly worse for a very small minority of Americans (as you noted). This is mainly those that have catastrophic illnesses which incur costs above $1m (or whatever max the health plan uses).

Insurers increased premiums to account for the removal of the lifetime max. This increased premiums for ALL enrollees, but the extra premiums only exceeded cost for those with >$1m in claims, which is a small number.

As a result, the majority of members will be better off without lifetime maximums. Anyone who doesn't, or never would, incur more than $1m in expenses now has lower premiums. I don't know how you figure the majority of American's would be hurt by this?

I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.


That's at least encouraging (the low number affected, although I'm sure it's no consolation to them). I think that the original article also suggested that there would now annual limits that could come into play. Not sure how that affects the numbers.
 
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perfalbion wrote:
Keele047 wrote:
I'm looking at a 2017 commercial (under 65) lifetime claims probability distribution table right now. It suggests about 0.02832% of American's will incur more than $1.15m (That was the first bucket above $1m) in costs in their lifetime prior to turning 65 and being eligible for Medicare. That means 99.97168% of American's are better off.


I guess I look at this another way. If it's that small a percentage, it would seem like the marginal cost to the remainder of the population to extend coverage to the very few that need it would be quite low. For every person that needs that much coverage, there are around 3500 people that don't. If the policy runs 30 years, those 3500 people would need to pay an additional $11 annually to cover the entire cost.

Of course, this sort of illustrates why it'd be better not to use private insurance for primary healthcare, if you ask me. Pooling the risk over the entire population is the most effective way to manage the cost, but a market-based solution for coverage simply won't do that.


With employer plans, one person can actually really blow up the budget very quickly. I know I've read of it happening. When they are outside of a government pool, it's problematic for employers because they aren't spreading that cost over as big of a pool as would, say, a single payer system. It's also a huge risk for insurers. (I pretty much agree with what you're saying in principle though)

Which again makes me sad that we don't have a single payer system which avoids the pitfalls of things like individual mandates that are pretty much necessary for any workable system, but which are much harder to justify to the public.
 
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TheChin! wrote:
Sue_G wrote:
My husband works for the state and we used to have one. I am sure they will go back to them. Could possibly insure through my employer but my plan has high deductible and OOP. Oh well. With my son arrived this year, I worry more than I used to. Hope for good health, I guess.
You had/got a kid? Does Jarred know?


Lol, actually yes, Jarred does know. My son is now 3 months old and is pretty much the center of my life right now.
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maxo-texas wrote:
We need to be realistic about lifetime maximums and the corresponding increased livespan.

Otherwise we boomers will bankrupt the system for an extra month of life.

At some level the same logic applies to people of any age. We cant spend a billion dollars per citizen on healthcare (or on any citizen).

This is the problem with declaring health care a right.

Rather, we need to decide what our budget for health care is and give the best care to the most people while considering likely remaining lifespan. And it would probably be some form of single payer.

Icu is over $21000 per day. 90 days of icu level treatment would be $200,000 dollars.

If at the start, the only prognosis is death at the end of icu then we should probably spend the money saving the life of a premie instead of extending the life of four seniors like myself for 90 days (probably of misery too).

The republicans are being murderously harsh but there is a balance point and we don't have unlimited resources. And we could do a ton for only t0 billion a year.

(edit- fixed various phone typing anomalies like 'tbe' for 'the'.

I'm replying to both Max and AMK.
I have 2 points to make. And a question.

1] A "lifetime cap" under either ACA or AHCA seems to me to only be a limit until age 65 when everyone switches to Medicare, right?

2] A real lifetime cap [not the until 65 one now] would it seems to me to be a way to decide who is going to be allowed to die because the society can't afford to save everyone from everything. It acts like a death panel. It is not the best way to do this because not spending the 2nd $500,000 would have been better, but it eliminates the need for a panel to use their crystal ball to peer into the future. Who can prove that the panel got any one decision right? Answer, no one can.

The question -- Does Medicare have a lifetime cap? If so, what is it?

 
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