88,000 lose Blue Cross coverage plans in Texas

[Eli]

Wife lost her BXBS Medicare PPO, managed to switch her to a Humana PPO.
Daughter, self employed, lost her PPO and is having a difficult time finding an individual plan that comes anywhere near the coverage she had last year, at twice the cost.

There's always the exchanges

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There's nothing available that isn't ridiculously expensive, and nowhere near as good as pre-0bamacare.

Eli

 

[cbigclarke]

Oh I'm sure of that

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[Mreed911]

There's nothing available that isn't ridiculously expensive, and nowhere near as good as pre-0bamacare.

Which helps show the problems in the market before ACA - the subsidies were on the other side of the line, hidden from the consumers, and risk wasn't spread across the entire pool at the same rate.

Now that we've turned the model upside down and spread risk evenly regardless of responsibility/condition, people are seeing the true cost of health care in this country.

If more paid attention to their benefits/payment notices, they'd see how HUGE the negotiated discount is. That, my friends, is the "actual" cost of healthcare - not billings, but bookings.

My example: broken leg + surgery + rehab. Billed? Almost $150K. Paid by me + insurance? Somewhere around $50K. That's 200% markup in billings, and that's the number used by the media. The actual cost is significantly lower and STILL affords both insurance and provider a margin of profit. Figure actual cost was somewhere around $30K, all in, all the providers, supplies, etc. (including five nights in a Level I trauma center, non-ICU, and six months of rehab).

 

[vmax]

....
Now that we've turned the model upside down and spread risk evenly regardless of responsibility/condition, people are seeing the true cost of health care in this country....

that statement shows your complete inability to understand even the simplest concepts.
What kind of a "true cost" model do you have when the government passes a law saying that a citizen has to buy a product? Thats a F**Ked up market. Its artificial and cannot be sustained.

If I had a business and it was a law that people had to buy my product or service, the price goes to the roof, every time.

Artificial demand, just like student loans and the price of higher education.

The true cost of health care won't ever be realized until all insurance companies are gone and it is just the consumer and the provider, with no middle men.

When I take my kid to the Doc in the box for a exam and a script and I pay $75 cash and walk out the door, no insurance claimed, just me and the business, thats the true cost of that visit.
Same thing with my dentist. How much is a crown? $950
What if I am paying cash, no insurance? $600

some of you are so used to Socialism you cannot separate yourself from thinking that way.

 

[Tejano Scott]

Ah, that makes sense, I guess.

This change is only applying to the BCBS health exchange plans (aka "the obamacare plans"), the article does a poor job of making that clear. I just read United Healthcare is doing the same thing, they lost a fortune. Here is what I am seeing, and the article mentions this- people sign up for a quality health exchange plan, knowing they have a pre-existing condition that can no longer be denied, they go and get the expensive treatment they need, then don't bother to pay their premiums next month. It used to be that my side (Hospitals) had to take these risks and absorb them or refuse to treat them, barring care that EMTALA applies to. Now insurance is the one who has to make these gambles since they can't deny for pre-x. I predicted this would happen 3 years ago.

 

[scap99]

This change is only applying to the BCBS health exchange plans (aka "the obamacare plans"), the article does a poor job of making that clear. I just read United Healthcare is doing the same thing, they lost a fortune. Here is what I am seeing, and the article mentions this- people sign up for a quality health exchange plan, knowing they have a pre-existing condition that can no longer be denied, they go and get the expensive treatment they need, then don't bother to pay their premiums next month. It used to be that my side (Hospitals) had to take these risks and absorb them or refuse to treat them, barring care that EMTALA applies to. Now insurance is the one who has to make these gambles since they can't deny for pre-x. I predicted this would happen 3 years ago.

Wow, destined for failure it seems.

 

[Mreed911]

that statement shows your complete inability to understand even the simplest concepts.
What kind of a "true cost" model do you have when the government passes a law saying that a citizen has to buy a product? Thats a F**Ked up market. Its artificial and cannot be sustained.

It was artificial before - just abstracted from the consumer. ACA brought that abstraction to the other side of the purchasing process, and I think we agree that was a stupid decision.

The true cost of health care won't ever be realized until all insurance companies are gone and it is just the consumer and the provider, with no middle men.

Except that most people can't save up enough to sustain a catastrophic event. I think what you'll actually see are more high deductible health plans, more reasonable costs from provider to consumer, and true "insurance" for catastrophic events (like car wrecks are primarily covering catastrophic events, e.g. collisions).

When I take my kid to the Doc in the box for a exam and a script and I pay $75 cash and walk out the door, no insurance claimed, just me and the business, thats the true cost of that visit.
Same thing with my dentist. How much is a crown? $950
What if I am paying cash, no insurance? $600

That was my point. $150K billed, $50K paid. True cost = $50K. The media (and government) report on true costs being $150K, which is hogwash.

 

[Tejano Scott]

The sleeper issue on Obamacare was the first Supreme Court case. There were 2 issues, though only 1 got any attention (the individual mandate, aka the tax you pay if you do provide yourself insurance). The other issue was whether the Federal Government could force states to expand Medicaid or terminate their funding altogether. While the Court upheld the individual mandate, it said no the the Feds can't force states to expand Medicaid. So Obama scrambled and tried to get private insurance companies to cover the states that refused to expand Medicaid. Those plans are what everyone refers to as the "health insurance exchange" plans. All of those plans, and I seriously can't think on one exception, lost a boatload of money this year. They are pulling out in almost every state/market. It's about to put a huge kink in Obamacare unless the Feds are willing to insure the insurance carriers against these losses. The house of cards is slowly starting to fall.

 

[vmax]

...

That was my point. $150K billed, $50K paid. True cost = $50K. The media (and government) report on true costs being $150K, which is hogwash.

true and the cost would be lower if there were not government mandated insurance

If a homeless person gets cancer from smoking and needed $400,000 in treatment and surgery is everyone else supposed to be forced to pay for it?
SCOTUS said yes... twice. which does not make it right anymore than slavery being "legal" the first 100 years in this nation

I am not trying to sound mean, just be real about it.

I've read the Bill of Rights and healthcare is not in there.

 

[Mreed911]

true and the cost would be lower if there were not government mandated insurance

Maybe, but probably not by much. Given the number of people that had to be employed and trained to provide me those services, that's probably within a reasonable margin of cost.

If a homeless person gets cancer from smoking and needed $400,000 in treatment and surgery is everyone else supposed to be forced to pay for it? I am not trying to sound mean, just be real about it.

Agreed. Same homeless person has a heart attack or gets hit by a car. What changes?

Beyond that, there's a place that charities can and should step up. We actually disincentivize that now.

I've read the Bill of Rights and healthcare is not in there.

One could argue that a right to life includes healthcare to save/preserve it.

 

[zincwarrior]

Humana has doubled in price both years since signing up for it. And they say they're losing money.....

They just need to expand Medicare to all Americans and be done with it.

14th Amendment:

Equal Protection under the law.

Medicare is ok but they can do better. A review of the German and Swiss systems is in order.
Fortunately I have an awesome plan, not like you peasants with your Blue Cross coverage. I think I'll go smoke some Cuban cigars and laugh at you bunch of lazy Democrats.

 

[TheDan]

It's about to put a huge kink in Obamacare unless the Feds are willing to insure the insurance carriers against these losses.

They do to a certain extent through "risk corridors."

 

[Tejano Scott]

Yeah but 400+ million in loses per major payor still leaves a slight deficit.


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[Mexican_Hippie]

Another example of government intervention ruining a market. ACA was just the nail in the coffin.

Catastrophic-only insurance would be a popular option if it was available.

 

[Mexican_Hippie]

Medicare is ok but they can do better. A review of the German and Swiss systems is in order.
:

I think a spreadsheet of commies to shoot if they do that is in order.

 

[scap99]

Another example of government intervention ruining a market. ACA was just the nail in the coffin.

Catastrophic-only insurance would be a popular option if it was available.

I'd sign up in a heartbeat.

 

[breakingcontact]

I'd sign up in a heartbeat.

I had some short term insurance for a few months this year. I'd say it is catastrophic!

 

[scap99]

I had some short term insurance for a few months this year. I'd say it is catastrophic!

Short term disability?

Or do you mean something else?

 

[breakingcontact]

Short term disability?

Or do you mean something else?

Short term insurance. Pretty cheap...very basic. BUT due to this Obamacare mess...many providers stopped offering it. I was with BCBS...called them up all "Hi I tried to renew my plan online and couldnt" That's because they stopped offering the plans.

Also Obamacare rules won't let you be on short term insurance (outside the "exchange") for more than 3 consecutive months I believe.

I also hate that they use the free market term, exchange.

 

[scap99]

Short term insurance. Pretty cheap...very basic. BUT due to this Obamacare mess...many providers stopped offering it. I was with BCBS...called them up all "Hi I tried to renew my plan online and couldnt" That's because they stopped offering the plans.

Also Obamacare rules won't let you be on short term insurance (outside the "exchange") for more than 3 consecutive months I believe.

I also hate that they use the free market term, exchange.

Damn, this whole subject is like listening to a lawyer speaking in Latin.

I freely admit I know very little about insurance.