OT: Predictions for 2016 Presidential Election

[FlyerInHi]

[quote=livinincali]
Aren’t you contradicting yourself in these 2 paragraphs.
First you say Obamacare is here to stay then you say we’re going to have universal health coverage. Wouldn’t that mean Obamacare is getting replaced. As I see it Obamacare will likely cease to function if they can’t get costs under control. [/quote]

I see obamacare as a compromise. The concept that all American residents should have health coverage is becoming embedded in American society. Medicare for all would have been viewed as too “extreme” back in 2009.
The compromise is that we now have obamacare and the chances of ending up with Medicare for all are now greater. We’ve made progress, and we can always improve on what we have.

[joec]

In CA, I think United Healthcare has the smallest share of customers out of all the exchange insurance companies…

If they left, maybe they lose 1% of customers? It could also be a cost cutting move since they aren’t really playing in the state anyways…

That said, I think Blue Shield made the most in 2014 from a latimes article I read…so some companies were able to make money, of course, Blue Shield and Blue Cross/Anthem are bad IMO.

[bearishgurl]

[quote=joec]In CA, I think United Healthcare has the smallest share of customers out of all the exchange insurance companies…

If they left, maybe they lose 1% of customers? It could also be a cost cutting move since they aren’t really playing in the state anyways…

That said, I think Blue Shield made the most in 2014 from a latimes article I read…so some companies were able to make money, of course, Blue Shield and Blue Cross/Anthem are bad IMO.[/quote]Yes, joec, Blue Shield has the most planholders out of all carriers who offer plans on Covered CA. That is likely because they offer the only PPO on the California exchange and people (like me) who lost coverage due to the ACA wanted to keep their doctors and most of the good ones only take PPOs. Blue Shield of CA has between 20% and 30% market share of the exchange customers who selected a plan (those not on Medi-Cal), depending on region. (SD County is the last region of 19 or “Region 19”). BSoC’s PPO also has nationwide coverage through the nationwide BCBS provider roster.

IIRC, United Health just reappeared back in the CA individual (exchange) market in October 2015 stating that they were going to offer coverage (not sure what type – HMO, EPO or PPO) starting 1/1/16 on Covered CA in about 3-4 NorCal regions or “test-markets.” However, in November 2015, they backed out, citing “unprofitability in the CA market.”

see: http://hotair.com/archives/2015/11/20/covered-california-hey-united-healthcare-will-expand-in-our-markets/

I feel that the probable reason for United Health backing out of offering plans on CC for 2016 was that Hispanics have a high rate of diabetes and high blood pressure as do members of Native American tribes and CA has the biggest population of any state in the nation of both of these races/Nationalities.

However, United Health won a 5-year contract to administer the Federal government’s Tricare Standard and Prime programs for the Triwest Region (incl CA) beginning 10/1/12. Millions of CA residents are eligible for and currently using Tricare in CA.

On 12/31/13, CA lost six major healthplan carriers from its individual market. Those were Aetna, Wellpoint, Humana, Pacificare, United Health and Cigna. All of the people with individual healthplans from these carriers were dumped onto Covered CA because by the end of 2013, the only individual plans offered in SD County were through Covered CA except possibly a few Bronze Plans (2-3) and “Cadillac” plans still offered through the open market. Those particular (non-ACA compliant) Bronze plans were all canceled at the end of 2014, dumping the planholders back on the exchange. In November of 2015, Cigna came back to SD County, offering two Bronze plans on the open market (one an HSA plan). I’m waiting to see what new carriers (if any) will offer plans on the CA individual market this fall.

I understand that SK resides in AZ and he was able to buy a suitable off-exchange plan for 2016 there. But CA is a completely different animal. Covered CA (and their partner in crime, Medi-Cal) run the exchange and all the planholders on it (as well as all the Medi-Cal recipients) as if we’re in the wild west. They have their OWN interpretation of the ACA. The bottom line is, you sign up on Covered CA for a non-MediCal plan and accept a subsidy to help pay the premiums (no matter how small), there are a whole lotta of strings attached to that. In short, CC owns your a$$. Not only MUST you file your tax returns on time and NOT file any extensions (as with ALL healthplan exchanges across the country) but your plan’s carrier has absolutely NO SAY whatsoever in whether they get to keep you as a customer the entire 12 months … or not. Paying your premium on time has nothing to do with it. If CC orders your carrier to drop your coverage on the 5th of the month (AFTER they rec’d your portion of their monthly premium thru automatic payment as well as received your subsidy from the Federal Govm’t to pay the rest of your monthly premium), they most certainly can and will drop your coverage. Neither they, nor CC have to tell you first that they are doing this, and usually do not. This could happen multiple times per year without your knowledge, folks. CC also follows orders from Medi-Cal, who wants as many people on Medi-Cal as possible as soon as possible. County Medi-Cal offices are under the gun to get the HUGE group of CC enrollees over the age of 55 enrolled in Medi-Cal (due to a large percentage of them now out of the workforce and thus no longer have access to employer-provided coverage) for the express purpose of placing of a “placeholder lien” on any real property they own for ALL Medi-Cal managed care premiums paid on their behalf for each month they are placed on Medi-Cal between the ages of 55 and 65. Since the inception of the ACA, there is no longer any “asset test” to qualify for Medi-Cal so many, many “asset rich” boomers are now prime targets for forced placement into Medi-Cal!

SB 1124 was introduced in 2014 to eliminate the incentive for CC/Medi-Cal to “target” their over-55 enrollees for forced-placement into Medi-Cal for estate recovery purposes. The CA Legislature DID pass the bill last year but Gov Brown refused to sign it, stating that he wanted to see significant improvement in CA’s general fund before agreeing to it.

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1124

http://www.scpr.org/news/2015/09/11/54356/calif-lawmaker-pulls-medi-cal-asset-recovery-bill/

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB33

http://canhr.org/publications/newsletters/NetNews/Feature_Article/NN_2015Q2.SB33.htm

▪ Health policy debate will continue in budget hearings and on bills to cover California’s remaining uninsured regardless of immigration status (SB 10 by Sen. Lara), and to limit Medi-Cal estate recovery (SB 33 by Sen. Hernandez), which discourages patients from enrollment and potentially risking losing family home.

http://www.sacbee.com/news/politics-government/capitol-alert/article53523005.html

The whole CC/Medi-Cal debacle (practical interpretation of the ACA by CA’s PTB) is greatly exacerbated by the dearth of plans now offered on CA’s open market. In essence, what has happened in CA is that we HAD a lot of choice as to healthplans and carriers on the open market, prior to when the ACA became law but now there really isn’t any choice at all. If one can’t obtain an employer based plan, has Tricare or VA eligibility or is offered an “affordable” plan through their union or retirement association, then they are essentially “stuck” with the plans CC offers.

In reality, CC does not exist to place individuals and families in plans they like (or can live with) who are willing to pay the monthly premium for. CC does not care if it signed up 1M enrollees into “marketplace plans” or just 200K. CC exists solely to gather financial information from its unsuspecting enrollees to be culled and re-culled from month to month and year to year for possible forced Medi-Cal placement. It traps a “captive audience” into the “CALHEERS/Medi-Cal system with the lure of “subsidies” to assist with monthly premiums (which are 2-3 times higher than the vast majority of the monthly premiums of pre-ACA plans and rise 6-20% per year). The “subsidies” are to “cushion the shock” of the massive increase from the enrollee’s old (pre-ACA) healthplan premium to CC’s current premiums so they “don’t feel it as much.” Once trapped into the “system,” CC enrollees’ financial info is manipulated and used against them for possible Medi-Cal forced placement, knowing that the vast majority of them have no other choice in healthplans.

The only reason that “obamacare” is called a “success” by its “supporters” is because far more people were placed on Medicaid/Medi-Cal than in actual “marketplace healthplans.” Obamacare’s proponents are using those Medicaid/Medi-Cal enrollee numbers to state that so many more millions are people are now “covered.” That doesn’t mean there are actually any providers willing to care for all these extra Medicaid/Medi-Cal enrollees in their respective regions. All it means is that these millions of new (willing and unwilling) Medicaid/Medi-Cal enrollees are now used by “obamacare proponents” for “statistical purposes” to tout how successful the ACA has been in getting the “uninsured” covered. The dirty little secrets of how the ACA really works on the ground are never mentioned, including the fact that a large portion of those signing up on exchange plans WERE previously covered prior to the ACA but their plans dropped them (even if they were “grandfathered”) in the wake of “obamacare.”

[SK in CV]

[quote=bearishgurl]
I feel that the probable reason for United Health backing out of offering plans on CC for 2016 was that Hispanics have a high rate of diabetes and high blood pressure as do members of Native American tribes and CA has the biggest population of any state in the nation of both of these races/Nationalities.

[/quote]

I get that you hate brown people. But that doesn’t give you the right to make shit up. Your feelings don’t allow you to makes shit up without being called on it. If you have actual facts, share them. This isn’t an opinion thing. There may be a factual basis. Or it could be your racism. It’s one or the other.

[SK in CV]

[quote=bearishgurl]They have their OWN interpretation of the ACA. The bottom line is, you sign up on Covered CA for a non-MediCal plan and accept a subsidy to help pay the premiums (no matter how small), there are a whole lotta of strings attached to that. In short, CC owns your a$$. Not only MUST you file your tax returns on time and NOT file any extensions (as with ALL healthplan exchanges across the country) but your plan’s carrier has absolutely NO SAY whatsoever in whether they get to keep you as a customer the entire 12 months … or not. [/quote]

You can’t continue too make shit up without being called on it. Nobody is bound to accept subsidies. Anyone can pay full price for their insurance and never share any tax info. Furthermore, even if subscribers do accept subsidies, their tax returns must be timely filed. That means including extensions. You’re just wrong on this. You have no idea what you’re talking about. I have no idea what that last part of the last sentence means about carriers having no say in whether they keep you. They do. Insureds contracts are with the carrier. And only with the carrier.

Additionally, if someone wants to get a premium tax credit and doesn’t want to share tax information with the exchange, whether it’s California or any other state, they don’t have to. Ever. They do have to pay 100% of their premiums up front, and then take the tax credit on their tax return.

[SK in CV]

[quote=bearishgurl]In reality, CC does not exist to place individuals and families in plans they like (or can live with) who are willing to pay the monthly premium for. CC does not care if it signed up 1M enrollees into “marketplace plans” or just 200K. CC exists solely to gather financial information from its unsuspecting enrollees to be culled and re-culled from month to month and year to year for possible forced Medi-Cal placement. [/quote]

1.7 million Californians purchased qualified healthcare plans on the exchange.

[SK in CV]

[quote=bearishgurl] The dirty little secrets of how the ACA really works on the ground are never mentioned, including the fact that a large portion of those signing up on exchange plans WERE previously covered prior to the ACA but their plans dropped them (even if they were “grandfathered”) in the wake of “obamacare.”[/quote]

Every plan was grandfathered. No plan had to be cancelled because of Obamacare. Not a single one. Fact is, almost no insurance plans ever survived more than 2 years. Insurance companies constantly change them. And that goes for both the individual market and the employer market.

Your experience with the ACA is not representative of most people. Fortunately, actual facts aren’t affected by what you think. Most people like their exchange plans. But then, most people aren’t as bitter and racist as you either.

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]They have their OWN interpretation of the ACA. The bottom line is, you sign up on Covered CA for a non-MediCal plan and accept a subsidy to help pay the premiums (no matter how small), there are a whole lotta of strings attached to that. In short, CC owns your a$$. Not only MUST you file your tax returns on time and NOT file any extensions (as with ALL healthplan exchanges across the country) but your plan’s carrier has absolutely NO SAY whatsoever in whether they get to keep you as a customer the entire 12 months … or not. [/quote]

You can’t continue too make shit up without being called on it. Nobody is bound to accept subsidies. Anyone can pay full price for their insurance and never share any tax info. Furthermore, even if subscribers do accept subsidies, their tax returns must be timely filed. That means including extensions. You’re just wrong on this. You have no idea what you’re talking about. I have no idea what that last part of the last sentence means about carriers having no say in whether they keep you. They do. Insureds contracts are with the carrier. And only with the carrier.

Additionally, if someone wants to get a premium tax credit and doesn’t want to share tax information with the exchange, whether it’s California or any other state, they don’t have to. Ever. They do have to pay 100% of their premiums up front, and then take the tax credit on their tax return.[/quote]SK, I’m not going to beleaguer this point any longer with you but healthplans don’t have any say on whether they can keep exchange enrollees, or not. They have absolutely no control on whether they will be allowed to accept exchange enrollees future premiums within the same plan year … or not. In CA, the carriers have no control whether their planholders are dropped by CC or Medi-Cal and no control as to the start and end date of a customer’s plans. This is because the planholder is actually a customer of CC and not the plan itself. When a CC enrollee is dropped from their plan by CC or Medi-Cal, it takes 4-9 months for them to receive a refund from their carrier of their premiums paid for all the time they paid a premium but weren’t covered, IF they receive any refund at all. Most of these cases have to go through the appeals process because the carrier argues that the planholder was dropped through no fault of their own. And a lot of “gypped former CC planholders” don’t have the time, energy or expertise to appeal.

I truly believe that you may have studied the (voluminous) ACA during the time it was passed into law. But my last post described how CC does business in a very rudimentary fashion. There is much, much more.

You live in AZ, right? Perhaps you may be unfamiliar with how CC operates because you have never enrolled with CC yourself, have never assisted anyone enrolling with CC and with their various problems with CC subsequent to that enrollment because you don’t live in CA.

I can see here that you cannot possibly put yourself into another person’s shoes who has been repeatedly dumped from their (health exchange) plan after making timely, automatic premium payments every month and can’t fathom that this is actually happening. But it does happen very frequently in CA. The traditional “grace period” of yore means absolutely nothing to CC, Medi-Cal or the exchange carriers.

Thank you for posting your last paragraph. I am going to independently verify it with CA experts in the field. If it is true and there are no other plans to choose from in SD County this fall, I will renew my exchange plan for 2017 and drop my request to receive an APTC up front every month and pay my premiums upfront in 2017. I wouldn’t mind at all to just let the IRS refund me any excess premium paid out of my pocket using whatever formula they use and will encourage others to do the same. That’s what I thought WAS going to happen when I first signed up on the exchange in late 2013. I had no idea at that time that CC and the county would constantly be in my business and repeatedly canceling my plan and neither did anyone I assisted with enrolling and renewing on CC. None of us want to continue with the uncertainly of being repeatedly dropped from our healthplans behind our backs and/or force-placed into Medi-Cal. We all want SB33 to get signed into law by the governor this year but we have no control over whether this happens or not.

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]In reality, CC does not exist to place individuals and families in plans they like (or can live with) who are willing to pay the monthly premium for. CC does not care if it signed up 1M enrollees into “marketplace plans” or just 200K. CC exists solely to gather financial information from its unsuspecting enrollees to be culled and re-culled from month to month and year to year for possible forced Medi-Cal placement. [/quote]

1.7 million Californians purchased qualified healthcare plans on the exchange.[/quote]Yeah, I think it’s time to take a little “data dive” to find out how many CC signed up into Medi-Cal. Add in the new Medi-Cal signups which occurred “in the field” since the the last quarter of 2013 via “Medi-Cal outreach efforts” plus all the new signups done by county social workers who combed their SNAP and other aid databases for potential signups and you will likely have 2-4 times as many Californians who have been enrolled in Medi-Cal since 1/1/14.

Ditto for the rest of the states.

So this makes the ACA “successful” because it managed to get so many more people “covered” into “expanded” Medicaid/Medi-Cal :=0

[utcsox]

[quote=SK in CV][quote=bearishgurl]In reality, CC does not exist to place individuals and families in plans they like (or can live with) who are willing to pay the monthly premium for. CC does not care if it signed up 1M enrollees into “marketplace plans” or just 200K. CC exists solely to gather financial information from its unsuspecting enrollees to be culled and re-culled from month to month and year to year for possible forced Medi-Cal placement. [/quote]

1.7 million Californians purchased qualified healthcare plans on the exchange.[/quote]

I think 1.7 million is the goal. Total registration is at 1.575 million according to this article below:

http://www.sandiegouniontribune.com/news/2016/feb/04/covered-california-2016-enrollment/

[bearishgurl]

[quote=SK in CV][quote=bearishgurl] The dirty little secrets of how the ACA really works on the ground are never mentioned, including the fact that a large portion of those signing up on exchange plans WERE previously covered prior to the ACA but their plans dropped them (even if they were “grandfathered”) in the wake of “obamacare.”[/quote]

Every plan was grandfathered. No plan had to be cancelled because of Obamacare. Not a single one. Fact is, almost no insurance plans ever survived more than 2 years. Insurance companies constantly change them. And that goes for both the individual market and the employer market.

Your experience with the ACA is not representative of most people. Fortunately, actual facts aren’t affected by what you think. Most people like their exchange plans. But then, most people aren’t as bitter and racist as you either.[/quote]

I had the exact same plan for NINE years until it disappeared when my carrier left the state and I am NOT ALONE. Not by a long shot. Those six carriers I mentioned LEFT CA at the end of 2013 PRECISELY BECAUSE they didn’t want to sell ACA-compliant plans in the state! In other words, the inception of “obamacare” was the catalyst for these carriers leaving the state! This happened in other states as well, leaving their planholders in limbo to scare up another open market plan or sign up for a plan on their respective exchanges.

I never stated I “didn’t like” my plan. I said it was 3x the cost of my old (pre-ACA) and that 3 of my longtime providers left the CA exchange plans. I’m not happy with the way CC treats their enrollees. I think they are grossly incompetent and their way of “doing biz” is utterly disrespectful to their enrollees.

I would MUCH RATHER deal directly with my carrier and NOT with the incompetent exchange middleman but I don’t currently have any CHOICE of PPO plans out on the open market to even consider purchasing! Do you not understand that?

The rest of your wildly inaccurate assumptions about me don’t even warrant a response.

[bearishgurl]

[quote=bearishgurl] …. Ditto for the rest of the states….[/quote]

Changed to read, “Ditto for the rest of the states which elected to expand Medicaid.”

[bearishgurl]

To get us started on Medi-Cal statistic data diving, here’s a Feb 2015 article from the SJ Mercury News:

….At least 1.2 million Californians have signed up for a private insurance plan since enrollment began in October 2013 under the Affordable Care Act, better known as Obamacare. But it’s Medi-Cal that has witnessed the largest growth — 2.7 million since the controversial law opened the program up to many more recipients in January 2014.

By mid-2016, more than 12.2 million people — nearly a third of all Californians — will be on Medi-Cal, state health officials say….

(emphasis mine)

http://www.mercurynews.com/health/ci_27481258/obamacare-medi-cal-waiting-game-many-low-income

Gosh …. it seems as if there may actually be 8x the amount of people on Medi-Cal by this summer as there are enrolled in an exchange healthplan! And growing? Who woulda thunk it??

If this article is anywhere near accurate, I wonder how many of those new Medi-Cal enrollees as of mid-2016 were former CC exchange plan enrollees, most of whom were “force-placed” into Medi-Cal? And will the exchange plan enrollee population shrink in tandem with the growth of Medi-Cal enrollees (which almost zero providers want to participate in)? That’s such great policy? Who dreamt it up?? Guess we’ll have to wait and see what happens here! I’m on pins and needles!

Well, I sure hope the AG’s office is winding down its “hiring blitz.” It seems as if they have had more than enough time by now to be properly “lawyered up” for the all the new “lien placing” and “estate recovery” duties they’ll be getting on account of CA’s new and expanding Medi-Cal enrollee group, mostly consisting of asset-rich boomers with low(ish) incomes, LOL.

I see a HUGE windfall for the Golden State! Get busy mining it!! Thar’s GOLD in them thar hills!!

Not so much, though, for those unfortunate folks who have been newly placed on “expanded Medi-Cal” since there seems to be a dearth of providers and a long waiting list to see one :=0

I’ll see if I can find some more “official” stats later. Any assistance in this regard is welcomed :=0

[bearishgurl]

[quote=utcsox][quote=SK in CV][quote=bearishgurl]In reality, CC does not exist to place individuals and families in plans they like (or can live with) who are willing to pay the monthly premium for. CC does not care if it signed up 1M enrollees into “marketplace plans” or just 200K. CC exists solely to gather financial information from its unsuspecting enrollees to be culled and re-culled from month to month and year to year for possible forced Medi-Cal placement. [/quote]

1.7 million Californians purchased qualified healthcare plans on the exchange.[/quote]

I think 1.7 million is the goal. Total registration is at 1.575 million according to this article below:

http://www.sandiegouniontribune.com/news/2016/feb/04/covered-california-2016-enrollment/
[/quote]

Preliminary Obamacare enrollment data released Thursday shows that California may have lost its top spot to Florida, which reported about 1.7 million sign-ups through Monday compared with about 1.5 million in the Golden State.

According to an estimate released on June 30 of last year, Covered California, the state’s health insurance exchange, had about 78,000 more enrollees than Florida before Obamacare’s third open enrollment period started on Nov. 1. Both states entered the latest sign-up season with more than 1.3 million enrolled residents.

A Covered California spokesman said one possible reason for Florida’s enrollment surge since Nov. 1 was its decision not to expand Medicaid. That means some people who enrolled in Florida’s health exchange would have qualified for the already-expanded Medicaid program in California, which is called Medi-Cal.

(emphasis mine)

DUH!

Last year, I HAD considered “retiring” to a state which did NOT adopt Medicaid expansion after I found myself constantly hassled by CC and Medi-Cal to “prove and re-prove my income.” But I was worried that the state I moved to could adopt expanded Medicaid in the future and I would be right back in the same place that I started (back when I lived in Cali).

Choosing a state for “retirement purposes” simply because they don’t currently have “expanded Medicaid” is one sorry azz reason to feel like you have to move in order to keep a healthplan and not have to worry if it will be taken away from you behind your back after you already paid your premiums!

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]
I feel that the probable reason for United Health backing out of offering plans on CC for 2016 was that Hispanics have a high rate of diabetes and high blood pressure as do members of Native American tribes and CA has the biggest population of any state in the nation of both of these races/Nationalities.

[/quote]

I get that you hate brown people. But that doesn’t give you the right to make shit up. Your feelings don’t allow you to makes shit up without being called on it. If you have actual facts, share them. This isn’t an opinion thing. There may be a factual basis. Or it could be your racism. It’s one or the other.[/quote]I just saw this and it doesn’t even deserve a response except to say that (1) that it is NOT meant to be derogatory but it is simply a true statement, and (2) you don’t know a damn thing about me … not my race, my nationality or that of any of my close relatives …. nothing. So you can stop making insults directed at me now.

[Author]

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