State sets Health Connector rate increases assuming feds will keep paying mandated subsidies

The State House News Service reports on an announcement today by the Massachusetts Health Connector to limit increases for "silver" plans to 10.5% for next year, rather than the 26% that would be required should the president just halt subsidies called for in the health-care law he has failed repeatedly to get repealed in Congress. "Copper" subscribers will see an average increase of nearly 14%, the Health Connector says, adding it is continuing to try to figure out what to do if the subsidies are held up.

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Bad timing

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Since Trump announced 12 hours later that he's stopping the payments. Probably he didn't get a third scoop of ice cream at dinner so he's having another tantrum.

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More litigation coming?

I expect this will become the subject of yet another lawsuit by state attorneys general (including our Maura Healey) against the Trump administration.

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Trump, political genius

Trump has no ideology. He betrays the congress and pulls these big issues apart to position himself on the popular side. Republicans wanted to throw 20 million off health care. Democrats will now own higher premiums.

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Trump is an ego driven

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flim-flam man-child. He is the showman extraordinaire. He bloviates over and over, flinging outrageous and/or misleading and/or just plain "fake" statements like a shyster salesman peddling his crap wares to a mostly gullible and/or uniformed and/or angry and/or just plain mean audience. He is the Chaos-maker in Chief. He loves to get his base all excited and to make anyone else left screaming silently in the night. He does not care if his words hurt or harm not does he care if his actions do the same. He can't see beyond his own need for feeling like the king of the world.

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Nope

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He may be where Indiana and Alabama are, but he is distinctly ANTI American in every way.

He is a grifting royal wannabe - something that Jefferson and Washington might have personally tarred and feathered, with Revere heating the tar.

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Oh, Washington

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would of taken Mr. Trump! to task (the list would of been exhausting), most definitely, on so many, many, many issues.

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I should pay

Everybody should have everything, but I don't want to pay, YOU should pay, or those rich people should pay.

I am delighted to pay extra so that people who are less fortunate than I am, can have health care.

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Re: Then Trump is right where America is

That's very nice, until it's you, a friend, or a family member who gets hit with devastating medical expenses.

One could pay final expenses, then die. Might be cheaper. Might even bring more jobs to the funeral industry. Maybe we'll get rid of the surplus population that way.

/sarcasm

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Wrong

Republicans will own the increase in premiums entirely. We will call it the "Trump tax."

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We need universal health care in this country

We need politicians who will honestly explain to the people that we are paying 18 % of GDP on healthcare and no one else in the world spends more than 12% and we have worse overall health outcomes. The system is not efficient or healthy.

I had a meeting with the CEO of Boston Medical Center this summer. She makes roughly 1.5 million dollars a year, to run our "city" hospital. A family member of hers has an aging disease and she advocated for that family member to go to Norway to receive better care. When the CEO of a hospital in Boston who can clearly afford nearly any care necessary advocates for family members to go to Europe for health care, you know our system is broken.

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Why are US citizens eligible

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Why are US citizens eligible for 'free' healthcare paid for by European citizens?

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Who said

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"free"?

However, you can get free ER care if you need it while travelling in Europe.

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So you have a right to the

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So you have a right to the labor of a nurse, doctor, or technician without paying?

What about a lawyer? representation
Farmer? food
Carpenter? shelter

Where does it end? Does everyone have to work for everyone else for free because of basic human needs? Or is everyone responsible for doing their part to provide for themselves?

Why should US citizens be paying for non-citizens to have professional services provided to them? Why should EU citizens be paying for free-loading Americans? Where is the line? Can anyone travel to any country at will and demand 'free' services?

People expect to be paid for their knowledge and labor. Insisting you are owed that knowledge and labor because it is your 'right' is something I'd expect from some medieval noble demanding peasants do their bidding.

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That one's easy.

"What about a lawyer? representation"

That one's easy. You don't have an inherent right to a lawyer provided at government expense. But, on the other hand, the government doesn't have the right to put you on trial for crimes, except under the condition that they offer you a lawyer.

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You already paid the bill

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You realize the way universal healthcare works [or public defenders or food or housing assistance or transportation etc. etc.] is a portion of your taxed income and/or assets goes towards paying for those doctors and nurses and lawyers and farmers and carpenters. Nobody is getting a single "free" service at all from governments.

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Sure

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But its not my responsibility to pay for it.

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Actually, it is

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Or do you not understand how insurance works?

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Did you wear your clown costume in the meeting?

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You have some good ideas PP. Stop the stupid clown crap if you want to be taken seriously. And yeah I know you say you tried being normal and you couldnt get elected. But you fail to realize that wearing a clown costume make things worse not better.

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What you fail to realize

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The clown costume is about how people like you see only "clown costume" and talk about "clown costume", because you are superficial and not interested in depth anyway.

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Gee!

Think Stan and Bobby will have to resort to stealing more money in the middle of the night to pay those higher premiums?

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Probably not

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Stan doesn't like Nohores "subsidizing Boston".

Even though NoHores are being subsidized BY Boston. Shhh.

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So the best-case scenario...

...IF the subsidies miraculously survive, rates will STILL go up over 10%? How many people got a 10%-plus salary increase since last year? How are working people supposed to keep up with this? Why do Americans continue to PUT up with this?

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Stock market

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Up about 15% this year thanks to Fed (and other central bank intervention)

Everything goes up 10% plus when the government restricts supply.

See also:

Rents
Liquor licenses
Cab medallions (oops, private sector fixed that, nevermind)

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Oooh. More koolaid?

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You need to take off those Galt-colored glasses dear.

Our healthcare costs are high because the government doesn't restrict PROFIT.

By your "logic" and weak grasp of facts, we should have the cheapest health care around.

Then again, what can we expect from some dimwit who thinks that "preventative medicine" shouldn't be covered despite a century or more of data indicating substantial cost reductions?

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Never said that

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Preventive medicine can be covered all day long. But by an insurance system, not a pseudo payment system like we have now which actually artificially stimulates demand more than restricts supply. Huge difference.

If you don't see the myriad ways supply of health care is restricted (and demand is artificially inflated) by the government, you are not intelligent enough to have this discussion with.

And for the record, this is a nasty move by the president. Obamacare (including universal coverage, no preexisting and more) is fixable. But this ain't it. Deductible based on income/ wealth that is 100% payable by the insured, very basic universal coverage like say a canada model, and supplemental insurance for those that want, need can afford it like Britain ie even similar to our own medicare. Lots of details in between, but that's an insurance model that works with individual incentives to keep costs down.

As for profit, few people in the system really make much money. Some administrators and doctors individually perhaps. Then drug and device makers, but there is a reason most of the medical advances come out of the US. If you have a way to do it cheaper, I'm all ears and you'll be wealthier than mark Zuckerberg

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few people in the system really make much money??????

https://www.cnbc.com/2017/08/05/top-health-insurers-profit-surge-29-perc...

Combined, the nation's top six health insurers reported $6 billion in adjusted profits for the second quarter. That's up more about 29 percent from the same quarter a year ago — far outpacing the overall S&P 500 health care sector's growth of 8.5 percent for the quarter

https://www.nytimes.com/2017/03/18/business/health-insurers-profit.html?...

Since March 2010, when the Affordable Care Act was signed into law, the managed care companies within the Standard & Poor’s 500-stock index — UnitedHealth, Aetna, Anthem, Cigna, Humana and Centene — have risen far more than the overall stock index. This is no small matter: The stock market soared during that period.

The numbers are astonishing. The Standard & Poor’s stock index returned 135.6 percent in those seven years through Thursday, a performance that we may not see again in our lifetimes. But the managed care stocks, as a whole, have gained nearly 300 percent including dividends

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thank you for making my point

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Yes - $6 billion is a lot of money in a quarter - or roughly $25 billion a year - but put that in perspective:

It's about 1% of what we spend in total on health care. It's maybe 2% of the private insurance market which I think is about half (the other side being Medicaid, Medicare and VA-a perfect example of what happens when the government runs health care - read the Globe and let me know if you want that). In the scheme of things, it's a pittance. Hand it to the government and if they are just slightly less efficient - it wipes out the savings.

Of course their stocks have skyrocketed - they have tens of millions of new customers thanks to Obamacare. They probably make less per customer - but they make more sales, more profit and their stock goes up disproportionately to the market. Trump's move is beating them up today.

And again - for the record - I think Obamacare as a whole re. the coverage is pretty good. However, I'm just saying we as customers have too little incentive to reduce costs. My main argument (Medicaid excepted) is that we should have more liability upfront - perhaps some mandatory liability like physicals and flu shots.

I do have an issue with health insurance incentives too - but not sure how to fix that - they make about 10 cents on the dollar - with about a penny or two in profits. they have an incentive for higher costs as it's better to make 10% on $200 instead of $100 - which may be a cost driver. If you have a fix for that - happy to hear your ideas. I also think you could take a fraction of a penny out if you could offer health insurance across state lines - but that's a whole political kettle of fish too with each state regulating their insurance industry - lots and lots of jobs at risk.

But again - a 10% after tax profit for a private company is pretty reasonable for providing a complex service.

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No profit?

Gee, so all those times I waited for private jets owned by HMO's those jets were paid for by the guys flying in them?

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a pittance????

Come on - that $ is just for a half-dozen insurance companies.

Your statement that "few people in the system really make much money" is a total joke. If you think only a few people in the insurance, pharma, hospital, etc industries are making money...

Here are a "few" for you
https://www.usatoday.com/story/money/markets/2016/08/26/drug-money-pharm...

  • Heather Bresch, who has been CEO of Mylan since early 2012, was paid $18.9 million last year
  • Leonard Schleifer, CEO of biotech Regeneron Pharmaceuticals (REGN), wins there. He was awarded a compensation packaged valued at $47.5 million last year
  • Jeffrey Leiden, CEO of Vertex Pharmaceuticals (VRTX), is the drugmaker CEO with the next largest compensation package. Leiden, 60, has been CEO of the company since 2012 and pulled down $28 million last year.
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Right?

I mean it's small compared to the millions spent yearly on swag for doctors with Victoza on it. Or the money the pharma companies pay to have a doctor driven by limo to a restaurant in East Bumfuck, NH to explain the benefits of Xarelto or maybe you've never had a doctor talk about how he's being paid from the time he leaves his house in Atlanta til he gets back to travel to Boston to play golf under the banner that reads "Effexor welcomes you to the Ocean's Edge in Brewster"?

Small numbers, I'm sure.

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Not saying all that is good

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And we live in Mass where much of it is now illegal.

The point is, you're pussing in the ocean with that.

Bigger fish to fry if you want healthcare savings.

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LOL!

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You do understand that private insurance companies also restrict they ways people access health care? 'Cause if you do not, then you are not intelligent enough to even speak on this matter, my friend.

Just one example: https://www.usnews.com/opinion/articles/2016-05-05/how-the-health-insura...

And since you are a bit lop-sided on your thinking, here you go: https://en.wikipedia.org/wiki/Healthcare_rationing_in_the_United_States

Oh, by the way, I think the government does a good job in administering Medicaid and Medicare which covers around 100 million of our citizens: https://blog.medicare.gov/2015/07/27/medicare-and-medicaid-50-year-anniv... It has helped my family and continues to help my family. Thank goodness for both of the programs.

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Don't disagree

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Sure there's "rationing" - there has to be to keep things somewhat reasonable (my big beef is with turning healthcare over to the government entirely - the VA being a case in point - although we may end up there for "basic" coverage eventually as there may not be a choice. It'll be crappy care - but it'll be what half the population or more has access to.

And you'll note - I specifically say Medicaid needs to stay in another post.

And as a financial planner - Medicare is vitally important - I don't know how we continue to pay for it 10-15 years out - but we'll have to find a way.

None of that was my point.

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Ok, I get it.

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The VA situation is complex as well as appalling. It appears a general lack of accountability and worse has been going on for a very long time. There is enough blame to go around.

I do not agree with your rationing statement. None of us are appointed to play God with a person's health and well being. There has to be a re shifting of our budget priorities as well as examining ways, at a governmental level, to get more money into our coffers (higher tax brackets for the very wealthy, close corporate loopholes (no overseas shell companies) so corporations, like Apple, pay there fair share of taxes) to offer good health coverage to our citizens. I am not saying it has to be a single payer system, but if our government can do Medicare/Medicaid well, than it can do the other well. We are pretty creative people and am sure, if we tried to fix things, we could. Let us start with examining the military budget:

https://www.google.com/imgres?imgurl=https://media.nationalpriorities.or...

The is a role for good government in creating a good society.

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Not the Galtian conservative everyone likes to say I am

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I just think you need better systems in place - and the government rarely is that system (room for improvement - but they are great at running an army, and Medicare/Medicaid/social security are actually pretty efficient).

I don't disagree with your revenue statements either - I may go about collecting it a little differently.

Here's the thing:

We pay $3 trillion for health care annually - it has to come from somewhere. We're not arguing over the cost - we're just trying to figure out a) how to pay for it and who pays for it (because let's face it - we've effectively had universal coverage for decades - people aren't getting kicked out of hospitals) and b) how to make it cheaper and c) keep the incentive for innovation that we have all benefited from.

My "radical" idea is that the first $x gets paid out of pocket (or perhaps a tax free shelter like an HSA). The more you make, the bigger x is. Then you use an existing system - like Medicaid/medicare for basic coverage and private on top of that - just to keep proper consumer incentives in place.

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I understand.

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And no, you are not just one thing. Most people are combo plates. One must be careful (including myself) to make assumptions about folks. You know what they say....

I think you and I have the same basic concerns but just different approaches. I would counter that people do get kicked out from emergency rooms, per example. I just don't think our private health insurance system number one priority is the people they insure. It is definitely more profits over people. That being said, the insurance I receive from my employer is very good (thank you!) and they try to keep the yearly premium increases at a low rate (only 1.9% this year. I am very lucky).

I am not a fan of tax free shelters as a long term solution to the bigger health care coverage problem. My employer is offering a high deductible plan this open enrollment season with a HSA and basically the plan is a bit cheaper but with far less coverage. If you are single, young and healthy, it might be a better deal. But for most, not.

Good chatting with you.

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The VA average outcomes, when

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The VA average outcomes, when data is taken at a wide scale, are on par or better than a lot of private healthcare in this country, especially when you account for the higher percentage of homeless, elderly, and mentally ill populations the VA sees that do not have access to private care.

The one off horror stories that we see in the media happen everywhere. Private hospitals aren't subject to FOIA and have more discretion to pay people off. Or refuse to see medically hopeless , comorbid patients in the first place.

That said, you go to one VA and you've seen one VA. Some of them are run much better than others.

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The government does restrict supply

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Of course government restriction is part of the problem. Everything in American medicine has a professional gatekeeper. You can't get a a $2 round of antibiotics without first paying for a $100 office visit (or $500 emergency room visit) to get a piece of paper allowing you to buy the antibiotics.

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I think this is misleading

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I was under impression that subsidies for premiums will continue but not for deductibles, thus effecting poor people more. Am I wrong?

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You aren't wrong, but the

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You aren't wrong, but the confusion lies in who directly receives the subsidies (insurance companies) vs. who benefits (patients). The ACA accomplishes cost-sharing reduction in two parts. In the first part, insurance companies are required to offer plans with reduced cost-sharing to lower income families. Normally, the trade-off for low cost-sharing is higher monthly premiums. However, in the second part of this equation, the federal government reimburses insurance companies for the lost revenue incurred by lowering deductibles and copays; this means that insurance companies no longer need to raise premiums to make up the difference.

Because the offering of reduced cost-sharing plans (part 1) is not contingent upon the federal government reimbursements (part 2), insurers participating in the individual marketplaces can't just increase cost-sharing in these specialized plans. Instead, they'll need to increase premiums more broadly (say, on all silver tier plans or all individual plans) to compensate.

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Petition Canada?

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Province of New England?

I'm sure they would welcome a Province that pays more into the federal coffers than it receives by a 1.5 to 2x ratio.

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The red states are poor hell

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The red states are poor hell holes even after stealing from blue states. Imagine what a mess they would be if they had to pay their own bills? I smile at the thought.

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Where does you food,

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Where does you food, manufactured goods, building materials, and petrol come from?

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Duh

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China.

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This might amaze you

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Petrol???

We get a fair bit from Canada, actually. Refined in NJ and PA.

Food? California isn't a red state. Neither is Mexico.

Building materials? A lot of that is fairly local.

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