OT: Predictions for 2016 Presidential Election

[livinincali]

[quote=SK in CV]
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.
[/quote]

While technically true no plan had to be canceled, the authors of the bill knew they would be. Insurance providers typically treat their plans as 12 month contracts and make changes every year. If the insurance companies keep a grandfathered plan they couldn’t make any changes to out of pocket costs, deductibles, what was covered, etc. Their new plans were required to insure people with pre-existing conditions and those people were obviously going to be net beneficiaries, so they needed to get as many healthy people into those plans that they could. It made financial sense to cancel those old plans. The government and CA insurance regulators wanted those plans canceled. It was obviously the goal of the law to get everybody on full coverage type plans. By definition they were going to cost more because they included coverage for more things, and they were required to include people with pre-existing conditions.

[SK in CV]

[quote=bearishgurl]
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[/quote]

Yes, exactly. Not a dirty little secret. That was the goal. Get people access to health care. You really have a problem with that?

[livinincali]

[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]

There’s been other defections. Blue Cross left New Mexico this year and they had half of the enrolled population. There’s no longer any PPO plans in the Houston area. There’s less offerings in the Platinum and Gold plans. I think it’s too early to say how things shake out but it wouldn’t surprise me if you end up with one provider/plan choices in some markets, and possibly no provider at all. Or options so limited than they are kinda worthless.

Right now you have the most experienced insurance companies operating in the space, if they leave because they can’t make enough money, then you might be left with no providers or inexperienced providers that fail anyways. It’s certainly the biggest risk for the the law. It’s more of a risk than the republicans winning the white house.

[SK in CV]

[quote=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.[/quote]

It is not simply a true statement. It is a bigoted made up fantasy from someone who is either terrified or hateful of brown people. I don’t need to know anything about you to judge your words. Your words are racist. Full stop.

And this is how absolutely stupid your words are. Native Americans are exempt from the coverage mandate under the ACA. There might be some that are covered under exchange plans. But none of them have to be. None of them are subject to a penalty for not having coverage. So the likelihood that genetic predisposition to diabetes in Native American populations is even a tiny piece of the reason that an insurance company backed out of participating in an exchange is zero. But you “believe” they’re responsible. Because it’s easier to blame a brown person. Idiot.

[carli]

I have many years experience in executive positions for large health insurance companies, including those mentioned in this post (try not to hate on me because of it). I can tell you from direct experience working with senior actuaries and their very detailed claims data, being involved in many board room discussions where management is analyzing this data and debating whether or not to pull out of markets, that basically everything SK in CV is stating is accurate and most everything bearishgurl is stating is completely inaccurate, false and made up in her own mind with no apparent basis in fact whatsoever.

Bearishgurl, I guess if you like spending your time posting your random opinions and made-up speculations, you’re free to do so, but please either clarify that these are your opinions, not facts, or stop posting about the health care/insurance/CC topic because your statements couldn’t be further from the truth. It’s a huge disservice to readers who see your posts on this important topic, especially if they’re unfamiliar with the details of the subject (as most are, since it’s such a complex one) and may mistakenly view your speculations as facts. Please stop. Thank you.

[bearishgurl]

[quote=carli]I have many years experience in executive positions for large health insurance companies, including those mentioned in this post (try not to hate on me because of it). I can tell you from direct experience working with senior actuaries and their very detailed claims data, being involved in many board room discussions where management is analyzing this data and debating whether or not to pull out of markets, that basically everything SK in CV is stating is accurate and most everything bearishgurl is stating is completely inaccurate, false and made up in her own mind with no apparent basis in fact whatsoever.

Bearishgurl, I guess if you like spending your time posting your random opinions and made-up speculations, you’re free to do so, but please either clarify that these are your opinions, not facts, or stop posting about the health care/insurance/CC topic because your statements couldn’t be further from the truth. It’s a huge disservice to readers who see your posts on this important topic, especially if they’re unfamiliar with the details of the subject (as most are, since it’s such a complex one) and may mistakenly view your speculations as facts. Please stop. Thank you.[/quote]My main beef has always been with the state exchange and how it operates, NOT with the carriers themselves. In CA, it treats its enrollees horribly. If you have no experience being a customer on Covered CA and live in CA, then you cannot possibly know what we go thru on a monthly (and even weekly) basis. If you have coverage through work, you cannot possibly know what it is like not have choice because your state individual marketplace has been decimated by the inception of the ACA.

[SK in CV]

I appreciate your words carli. There is a problem even labeling her rants as opinions. Picking a favorite drink at Starbucks calls for an opinion. Speculating whether a particular group of people caused an insurance company to withdraw from a market isn’t an opinion. It’s not a matter of opinion. There is an objective reason. No opinions are warranted. Everyone is not entitled to an opinion on every subject. With some subjects, there’s only facts. This is one of them.

[bearishgurl]

[quote=SK in CV][quote=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.[/quote]

It is not simply a true statement. It is a bigoted made up fantasy from someone who is either terrified or hateful of brown people. I don’t need to know anything about you to judge your words. Your words are racist. Full stop.

And this is how absolutely stupid your words are. Native Americans are exempt from the coverage mandate under the ACA. There might be some that are covered under exchange plans. But none of them have to be. None of them are subject to a penalty for not having coverage. So the likelihood that genetic predisposition to diabetes in Native American populations is even a tiny piece of the reason that an insurance company backed out of participating in an exchange is zero. But you “believe” they’re responsible. Because it’s easier to blame a brown person. Idiot.[/quote]I happen to know for a fact that Native American tribes are encouraging their members to enroll in a bronze plan through their state exchanges with a subsidy (if possible). They (and the IHS who partially funds them) desperately need to be reimbursed for the often comprehensive services they provide to NA’s at their own clinics and hospitals.

[bearishgurl]

[quote=SK in CV]I appreciate your words carli. There is a problem even labeling her rants as opinions. Picking a favorite drink at Starbucks calls for an opinion. Speculating whether a particular group of people caused an insurance company to withdraw from a market isn’t an opinion. It’s not a matter of opinion. There is an objective reason. No opinions are warranted. Everyone is not entitled to an opinion on every subject. With some subjects, there’s only facts. This is one of them.[/quote]The problem I have is not whether you’re spouting “facts” as you understand the way the ACA should run. It is with how it actually runs on the ground in CA. The two may not be comparable in many ways.

[bearishgurl]

[quote=livinincali][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]

There’s been other defections. Blue Cross left New Mexico this year and they had half of the enrolled population. There’s no longer any PPO plans in the Houston area. There’s less offerings in the Platinum and Gold plans. I think it’s too early to say how things shake out but it wouldn’t surprise me if you end up with one provider/plan choices in some markets, and possibly no provider at all. Or options so limited than they are kinda worthless.

Right now you have the most experienced insurance companies operating in the space, if they leave because they can’t make enough money, then you might be left with no providers or inexperienced providers that fail anyways. It’s certainly the biggest risk for the the law. It’s more of a risk than the republicans winning the white house.[/quote]Yes, livinincali, this happened in OK as well. BCBS (the largest PPO in the state) narrowed their network on the exchange plans to the extent that in many suburban, semi-rural and rural areas, there are no in-network primary care providers at all and the ones that are listed as “in-network” are overburdened. Of course, they don’t mind taking their planholders premiums every month but they have little to nothing to offer them in return in the way of non-emergency services.

Of course, the Healthecare.gov exchange initially offered a few “fly-by-night” carriers (again, with very narrow networks) which are no longer operating and smaller carriers to choose from but those plans weren’t PPOs.

[bearishgurl]

carli, perhaps with your “expertise” in the field, here, can you tell us when those six carriers who defected CA at the end of 2013 will again begin offering a full panopoly of health plans to the (off-exchange) individual market of “Region 19” (SD County, CA)? I’m all ears.

[SK in CV]

[quote=bearishgurl]The problem I have is not whether you’re spouting “facts” as you understand the way the ACA should run. It is with how it actually runs on the ground in CA. The two may not be comparable in many ways.[/quote]

The problem I have is you. You spout opinions on things that aren’t subject to opinions. Whether Hispanics and Native Americans caused UH to pull out of CA isn’t a matter of opinion. It’s a matter of fact. That wasn’t the reason.

What you think are facts, don’t support your conclusions. I said Native Americans are eligible for coverage on the insurance exchanges. You expanded that to be proof that they’re enrolling because tribes are encouraging it. That part is true. What isn’t true is that they are enrolling. They aren’t in any significant numbers. Not in Arizona where I do have direct knowledge. And not in California where there is no published evidence of significant enrollment.

The only opinion I’ve provided is that you’re a racist. I’ve based that opinion on what you’ve said here. There’s ample evidence to support that opinion. Previous example included.

[carli]

BG, you stated, “If you have no experience being a customer on Covered CA and live in CA, then you cannot possibly know what we go thru on a monthly (and even weekly) basis.”

Yes, I am a resident of CA and yes, I have experience being a Covered CA customer so I do know what “we” go through. I have had all types of coverage (employer-sponsored, COBRA, Covered CA, etc) and have been tasked with designing health plans, selling health plans, discontinuing health plans, rating health plans, etc, etc over my 20 plus years in the industry.

It’s a waste of time (and could be detrimental to others’ understanding of the ACA and Covered California) to encourage you to keep going with this discussion so I will not engage you further.

As SK in CV said, your statements don’t even qualify as opinions so I will just leave them as wild speculations and inaccuracies. Feel free to continue to make stuff up, but I’m not interested in taking part in that kind of charade, and more importantly, I hope other readers will disregard your statements as the complete inaccuracies that they are (never mind that they’re also obviously bigoted and biased).

[bearishgurl]

[quote=SK in CV][quote=bearishgurl]
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[/quote]

Yes, exactly. Not a dirty little secret. That was the goal. Get people access to health care. You really have a problem with that?[/quote]The ACA was “touted” by its supporters as “You can keep your healthplan” and, “you can keep your doctors.” Both of which were outright lies because those in-the-know excluded the fact that many carriers wouldn’t want to have anything to do with it, nor would all the best providers.

The ACA was presented to the masses as “healthplans you purchase,” NOT Medicaid! In CA, the expanded Medicaid program is nothing but a snare for the middle income, asset rich individual over the age of 55 who does NOT want to be on the (overburdened) Medicaid/Medi-Cal system … whether or not they have significant assets to lien. These people have been paying their own bills all of their lives and do NOT want to be on “forced public aid.” Especially a program shoved down their throats as “mandatory” to join but oh, we forgot to tell you that your $630 month “dues” will be deferred until after your death so no worries :=0

Many in this segment don’t need a high income and don’t wish to withdraw large sums from their retirement accounts as early as their late fifties and early sixties if their homes are paid off and they have monthly pension(s) coming in. Yet the Covered CA snare into Medi-Cal seems to be affecting those who have an AGI under about $33K (after writeoffs are taken). Many in this (now dicey) group are finding themselves duking it out with CC up to 4x year, continually “proving their incomes” to keep their coverage … until a few months down the road when they’ll be asked to prove it again.

This is my main beef with the “system” in CA. Add to that the general incompetence of CC staff and it is a recipe for disaster for those who paid their premiums on time and thought they were covered but actually are not and end up needing to access care during the times they were “bumped” from their plan.

[bearishgurl]

As usual, non-answers, deflection of the issues that “nobody wants to talk about” and more insults from people who do not know anything about me.

carli, I asked you, according to your “expertise,” which, based on your posts, I believe you have, when are the major carriers coming back to the CA individual market to offer plans in all of the metal levels on the open market? Inquiring minds want to know.

[Author]

Posts