Yeah but they are getting paid! So obamacare is already creating jobs!

Even if consumers are not educated enough to do it, the insurance agents will.

The objection to "Take on the fact that you can not not cover pre existing conditions , even for coverage lapses, and the idea of groups being set up is not tenable." is moronic.

Create a work requirement (this already does happen and is not prohibited under ACA) that you need to have xxx hours of work and continue to work xxx hours to qualify for the group plan (after that you go COBRA) and voila, you have an insulated group.

This already does happen.

interesting exchange between marksman and grizy.

Thanks guys

Took mom to her Ear, Nose and Throat dr. btw, I am on the dr. tour and am running out of specialties for her, lol

The doctor is so mad at the ACA that I was sorry that I asked him what he thought of it. Terrible, doomed to fail, will result in worse care, etc.

But what really got him was this: He'd been trying for years to have a specialized ENT hospital built in Phoenix as he says exists in other cities and says that the ACA makes doing that illegal. Is that true?

Quite possibly, yes, but they sound a lot like another insurance racket for referrals and classic rent-seeking, so the fact that this guy is butthurt leads me to believe it's not such a bad thing, and seems to be a key part of the cost-controlling mechanism. More on that here.

On the other hand, existing specialized facilities seem to be doing just fine.

In other news, California is potentially blocking some of BC/BS's cancellations.

Thanks for that link. I don't think this particular dr is trying to make a buck, he's hugely successful. Mom luck boxed her way by randomly choosing this dr. and I say this bec I mentioned his name when I took her to the ER once while talking about her other problems and the ER dr. said he's the best. So I ask how come he knows this dr. so well and he tells me that he's the guy they call when somebody is dying like from a crushed throat or something and they need an expert.

Plus, he seemed sincere: 'I've had the dream of having a ENT hospital w/ the latest, greatest………' and he was really upset.

I also asked if he used a medical billing company bec I'm thinking that that's going to be a nightmare now but his office does it's own billing and that's going to be a huge pita as well.

Obama stated last week that people getting cancelled would get better insurance on the exchanges. So California is now letting people keep an inferior product (for a few months at least) if they so choose.

Was surprised to learn this, but yeah it's probably true.

A specialty hospital is rent seeking and insurance racket?



CON bull**** is rent-seeking behavior, from established hospitals. Not the person trying to compete.

Yeah it is a racket Ike. They slough off having to provide overall care to the community and just take highly priced procedures.

They get their cake and eat it too. If left to continue to grow it would undermine hospital care in an extreme way. If every hospital is a speciality hospital, you no longer have ERs and Trauma Centers. If enough speciality hospitals exist, full service hospitals would likely be forced to close if all they are providing are community service.

Those are already existing employer plans. So I do not get the point. They already breakout employment groups.

Are you saying the big work around to the ACA is to offer group plans to companies and employees? I assumed we all knew that already existed. You seemed to imply that they insurance companies were going to be able to create other groups of healthy people and isolate them out.

Employer group plans need to be a better value than exchange plans. Also previously most employer group plans did not cover pre existing conditions for six to twelve months if you came from having lapsed coverage.

Your example does not really do what you said the insurance companies would do. Which is create groups of healthy people that they can pull off the exchange.

Cobra is just you essentially paying for all your insurance when you leave a job with insurance coverage. Doesn't even seem the least bit necessary.

How are they isolating these healthy people by making them get an employer group plan?

Some people will just get butthurt over everything.
Uh, yeah--multiple referrals are a significant driver of higher premiums because they bounce people around to as many providers as possible. It's not to say referrals are never necessary, but the perverse incentives in this field are ridiculous.

Edit: I realize now that you were refering to trade groups having employment requirements. I doubt such a requirement is legally feasible for a number of reasons and it still has nothing to do with extracting healthy people

Oh horse****. They provide a better service than what's available in the hospital and therefore take patients away from hospitals, so the hospitals work to outlaw them. Also, that "referral racket" exists in hospitals too.

ERs and full service hospitals wouldn't close in large numbers. That's an absurd prediction.

Lol SharesFromYourAunt.com. Yes I have 30 or 40 good ones for them.

Keeping/buying an inferior product isn't always a bad thing. I drive a Honda, it is inferior to say a Lexus. I would be very angry if I was forced to buy a more expensive product because mine "wasn't good enough." This isn't a perfect example, but the principle is that sometimes people buy an inferior product because it saves them money. Health insurance is more complicated because people are generally able to get needed treatment even if they aren't covered for it.

http://www.youtube.com/watch?v=jIHhmLNjS8c since other way isn't working =\

Insurance companies don't have to create the groups. They just have to find groups that have lower risk than the exchange pool. Fraternal organizations tend to be younger, especially the professional ones with working/recertification requirements (CFA, CPA, and even AMA are all good candidates to have below exchange rate group policies. On a more local level, the local chambers of commerce with self employed individuals. The NAPA already had negotiated discounted premiums and will be a natural group for a group policy.

One of my recent conversations was about selling/pricing a group policy to Chinese business owners in Flushing (they got some kind of association), who are too small to be required to provide care for their employers but still need coverage for themselves. This is a natural group for a population that's traditionally under-served.

The PPA would be a terrible fit because the barriers to entry are so low. But some kind of association of professional poker players with a requirement that you're active (xxx hands per year or some such thing) would actually be an attractive group due to average age of professional poker players.

Lapsed coverage is key term here. They were still required to cover pre-existing conditions, especially ones that you haven't seen the doctor for 6 months.

Before Obamacare: "As long as you aren't trying to rip insurance companies off by signing up only after you get sick, you can get coverage."

Well, provided you aren't too sick to find a group or qualify for some other group insurance.

Yeah it just won't work. Those things are fungible. Insurance companies already went down this road when it was much more beneficial to them. It is not going to happen. The insurance company is not going to monitor hands of poker played and this still does not create a group of healthy people.

You think these organizations are going to micromanage these random criteria for healthcare access. Not to mention it is not even clear that having groups with arbitrary requirements is legal.

I am not going to pursue this part of the discussion just because I know it is not going to happen.

By the way where are people playing poker in the us to qualify for this mythical PPA plan? The reality is insurance companies give discounts to large groups not ones made up of a few people who play poker. They would not even bother.

The insurance companies don't have to do the monitoring. The associations will as part of their membership requirements.

Kind of like how NAPA, CFA, CPA, and the AMA all have recertification/continuing education requirements.

Your continued insistence that group policies won't happen when it is happening at this very moment is a bit strange. The companies are too busy renewing old plans (grandfathering what they can, though strictly against regulations to renew for the sole purpose of grandfathering) right now but they'll have to service group policy holders somehow after this mad OEP period ends. Shifting them to (there are provisions in the law that make it lower margin, not the least of which is limits on commissions) exchange programs is not going to be the first choice, for at least a big chunk (if not most) of the consumers or for the insurers.

After that, there are many untapped markets. The obvious targets are under-served groups who have lower risk profiles than the exchange policy pool as a whole. The groups have to be natural (legal requirement) with significant barriers to entry (so you can't just get a license to qualify for plans).

For now, most of the pricing models for exchange rate policies are assuming 45~55 average age for the enrollees. Creating/finding groups that average significantly less than that is really not all that difficult.

What you're describing doesn't seem like a racket in any sense of the word.

LOL wat? Obama koolaid ftw!

Actually I think your example is fine and I agree.

You are forced to buy a more expensive car, though. Honda has to meet all of the minimum regulations for safety, environmental, etc, and these things cost money. You just don't notice because Honda doesn't sell a $2,000 street-illegal sedan without a muffler or seatbelts.

The same thing will be true of insurance when companies get rid of all of their non-compliant plans - something that is happening really quickly as you can see from all of the cancellation notices.

Car analogies always seem to backfire.