WaPo: "Suddenly, Obamacare Is More Unpopular Than Ever"

[7,052,770]

I don't pretend to know everything about the law, but your understanding of ACA and the economics of insurance is not substantial enough for us to have meaningful conversation.

Whatever man. Anyone who doesn't have the same opinion as you just doesn't know what he's talking about. Even if said person is a health actuary.

[memphis]

The premiums on my parents' insurance went up this year, like they do ever year. They blame it squarely on ObamaCare. My father's getting a procedure done in a week, and has no idea what it will cost him yet. But, of course, he is already complaining about how ObamaCare has made it "too expensive."

U.S. insurance plans are too complex for the average American to understand.

That's why I think one of the biggest blunders in implementation was to ignore successful online insurance models. Imagine if they set up the federal site like Geico designed to get you through the questionnaire in 15 minutes. How about running a state exchange like Progressive that gets you to enter your insurance needs then shows you a list of competing providers without a lot of extraneous noise? My experience was that the federal contractors wanted to reinvent the wheel when private insurers in other sectors had a good handle on how to make a clear online presentation to the public.

That's exactly what the website did. The federal one at least. I can't speak to any of the state websites, but the federal one asked a few simple questions and then gave a list of competing products, each with a bronze, silver, or gold rating and a premium price. Not sure what your quibble is.

[muon2]

The premiums on my parents' insurance went up this year, like they do ever year. They blame it squarely on ObamaCare. My father's getting a procedure done in a week, and has no idea what it will cost him yet. But, of course, he is already complaining about how ObamaCare has made it "too expensive."

U.S. insurance plans are too complex for the average American to understand.

That's why I think one of the biggest blunders in implementation was to ignore successful online insurance models. Imagine if they set up the federal site like Geico designed to get you through the questionnaire in 15 minutes. How about running a state exchange like Progressive that gets you to enter your insurance needs then shows you a list of competing providers without a lot of extraneous noise? My experience was that the federal contractors wanted to reinvent the wheel when private insurers in other sectors had a good handle on how to make a clear online presentation to the public.

That's exactly what the website did. The federal one at least. I can't speak to any of the state websites, but the federal one asked a few simple questions and then gave a list of competing products, each with a bronze, silver, or gold rating and a premium price. Not sure what your quibble is.

The problem was that at the rollout the competing products were often not accurately portrayed. A great many people found that the initial process was anything but short, which contributed to the initial dissatisfaction with the website. Then, to get to an actual policy required a great deal more info and even then the offered price could turn out to be wrong for the policy in question.

I any case my quibble is more fundamental. Where is the flexibility of commercial insurance websites? On those I can easily add options on to a required base policy to meet my individual needs, trading cost for benefit. The healthcare runs more like a cable company where I'm stuck with bundled services that either leave me short or overcharge me for a bunch of channels I don't want. But cable has to deal with independent content providers, and those contracts often drive the bundling. Health insurance typically comes from a single provider, so like other commercial insurance products there's no reason to bundle beyond the required base level services that appear in the bronze plan.

[Brittain33]

I any case my quibble is more fundamental. Where is the flexibility of commercial insurance websites? On those I can easily add options on to a required base policy to meet my individual needs, trading cost for benefit. The healthcare runs more like a cable company where I'm stuck with bundled services that either leave me short or overcharge me for a bunch of channels I don't want. But cable has to deal with independent content providers, and those contracts often drive the bundling. Health insurance typically comes from a single provider, so like other commercial insurance products there's no reason to bundle beyond the required base level services that appear in the bronze plan.

On the contrary, insurance companies often provide different levels of service at different prices. I've had 3 options from Cigna offered by my company recently similar to the distinctions the federal government offered. Usually the distinction is not services that are bundled with, but the breadth of network and how co-pays and deductibles are handled to have the user assume more or less risk. This is what the federal guidelines do for PPACA healthcare.

I can not begin to imagine how Fox News and the WSJ would have tackled it if the Obamacare sites offered only a single option to customers at one price. We would have seen footage of people lining up for potatoes in Communist-era streets in the USSR.

[muon2]

I any case my quibble is more fundamental. Where is the flexibility of commercial insurance websites? On those I can easily add options on to a required base policy to meet my individual needs, trading cost for benefit. The healthcare runs more like a cable company where I'm stuck with bundled services that either leave me short or overcharge me for a bunch of channels I don't want. But cable has to deal with independent content providers, and those contracts often drive the bundling. Health insurance typically comes from a single provider, so like other commercial insurance products there's no reason to bundle beyond the required base level services that appear in the bronze plan.

On the contrary, insurance companies often provide different levels of service at different prices. I've had 3 options from Cigna offered by my company recently similar to the distinctions the federal government offered. Usually the distinction is not services that are bundled with, but the breadth of network and how co-pays and deductibles are handled to have the user assume more or less risk. This is what the federal guidelines do for PPACA healthcare.

I can not begin to imagine how Fox News and the WSJ would have tackled it if the Obamacare sites offered only a single option to customers at one price. We would have seen footage of people lining up for potatoes in Communist-era streets in the USSR.

I was thinking more like car insurance. There's a mandated minimum policy that is set by the state. You can then add on additional liability and collision coverage, as well as separate items like loaner cars or vehicle replacement. PPACA has a mandated minimum plan, but I should be able to separately price co-pays, deductibles and service coverage beyond that minimum. Most of the complaints I heard during the initial rollout were from women with adult children but too young for Medicare. They had existing insurance that was cancelled and they found that bronze was below what they were used to, but silver had service networks below their expectation but priced up other pieces which didn't matter as much to them. Gold simply was way above their previous price point and had lots of features they wouldn't normally request of a policy that clearly drove up the cost.

[Brittain33]

What are some of the features that a Gold plan has that a Silver doesn't, or a Silver vs. a Bronze? I really thought it was just about access to a broader network of doctors and lower copays and deductibles. Do you know of any examples?

I recall your mentioning some months ago how women in that age group were not pleased to be paying for contraceptive coverage because they didn't need it, but that I believe is common to all levels.

[muon2]

What are some of the features that a Gold plan has that a Silver doesn't, or a Silver vs. a Bronze? I really thought it was just about access to a broader network of doctors and lower copays and deductibles. Do you know of any examples?

I recall your mentioning some months ago how women in that age group were not pleased to be paying for contraceptive coverage because they didn't need it, but that I believe is common to all levels.

Unfortunately I didn't take enough notes last year to answer that. I do recall that a frequent complaint was from people who wanted to keep their network of doctors, and were willing to pay more for co pays or deductibles. However, they complained that as one went up the ladder all aspects improved and of course got more expensive. There wasn't the kind of trade off one might find for other types of insurance where only one aspect was improved.

[Person Man]

What are some of the features that a Gold plan has that a Silver doesn't, or a Silver vs. a Bronze? I really thought it was just about access to a broader network of doctors and lower copays and deductibles. Do you know of any examples?

I recall your mentioning some months ago how women in that age group were not pleased to be paying for contraceptive coverage because they didn't need it, but that I believe is common to all levels.

It's the copay level that determines the plans rank from platinum to bronze. It goes from 10% to 40% respectively.  It's amazing how little we all know about the ACA or ever knew about health insurance to begin with. It is heartening that this poll shows that a record amount of people want to simply reform it than canceling it.

[7,052,770]

What are some of the features that a Gold plan has that a Silver doesn't, or a Silver vs. a Bronze? I really thought it was just about access to a broader network of doctors and lower copays and deductibles. Do you know of any examples?

I recall your mentioning some months ago how women in that age group were not pleased to be paying for contraceptive coverage because they didn't need it, but that I believe is common to all levels.

The only definite difference in the metal levels is the Actuarial Value, which is the expected % of claim dollars the insurance will pay for a member. In actuality this will vary wildly, but the average Gold member will have to pay 20% out of pocket (copays + deductible + coinsurance), while the average Silver member will pay to pay 30% out of pocket.

Depending on the company, Gold plans might also have better networks, more drugs covered or other extras, but they don't necessarily have to.

[memphis]

I don't know why anybody would expect to buy health insurance a la carte like that. Has anybody heard of purchasing a plan like that? My pre-exchange individual plan certainly didn't work like that. It was actually a much bigger pain because I had to document a couple of pre-existing conditions and sign privacy waivers at doc's offices to get them to fax info. And then follow up on it because medical people are always drowning in paperwork, and that sort of non-urgent stuff always gets lost in the shuffle. And, with the exchange, I also got to compare plans from multiple insurers in one spot. Before, I would have had to play the fax game with every insurer I wanted a quote from, which would have been ridiculous. Except for waiting for the website to get fixed, which it was, with plenty of time to spare, buying from the exchange was a piece of cake in comparison to the old style.

[7,052,770]

What are some of the features that a Gold plan has that a Silver doesn't, or a Silver vs. a Bronze? I really thought it was just about access to a broader network of doctors and lower copays and deductibles. Do you know of any examples?

I recall your mentioning some months ago how women in that age group were not pleased to be paying for contraceptive coverage because they didn't need it, but that I believe is common to all levels.

Unfortunately I didn't take enough notes last year to answer that. I do recall that a frequent complaint was from people who wanted to keep their network of doctors, and were willing to pay more for co pays or deductibles. However, they complained that as one went up the ladder all aspects improved and of course got more expensive. There wasn't the kind of trade off one might find for other types of insurance where only one aspect was improved.

That's the fault of the insurance company for not offering the exact plan the member wants, rather than the fault of the ACA. There's nothing preventing insurance companies from offering dozens of combinations of networks and copay/deductible combos, as long as they have enough actuaries and time to calculate the rates.

[7,052,770]

I was thinking more like car insurance. There's a mandated minimum policy that is set by the state. You can then add on additional liability and collision coverage, as well as separate items like loaner cars or vehicle replacement. PPACA has a mandated minimum plan, but I should be able to separately price co-pays, deductibles and service coverage beyond that minimum. Most of the complaints I heard during the initial rollout were from women with adult children but too young for Medicare. They had existing insurance that was cancelled and they found that bronze was below what they were used to, but silver had service networks below their expectation but priced up other pieces which didn't matter as much to them. Gold simply was way above their previous price point and had lots of features they wouldn't normally request of a policy that clearly drove up the cost.

That would be a whole lot of work for the actuaries, thus raising the administrative costs of the plan. How much specialization do you advocate?

[AggregateDemand]

I don't pretend to know everything about the law, but your understanding of ACA and the economics of insurance is not substantial enough for us to have meaningful conversation.

Whatever man. Anyone who doesn't have the same opinion as you just doesn't know what he's talking about. Even if said person is a health actuary.

It's the construction worker vs architect problem.

The insurance industry does not teach you about insurance per se. A policy with flat-rate copay is not insurance. Policies that cover regular, foreseeable expenses (birth control, annual checkup) are not insurance. All kinds of perverse economic programs have fallen under the banner of insurance because health insurance is exempt from federal taxation. Rather than fixing the exemption problem, and returning to proper health insurance systems, ACA makes the income exemption problem much worse.

You cannot insure yourself against birth control. The expense is regular, known, and predictable. Therefore, insurance policies that cover benefits like birth control are nothing more than thinly veiled entitlements, in which some demographic of people is forced to pay for the services of other demographics via ACA "insurance" policies.

[memphis]

Oh goody. Now we get to play semantics games.

[AggregateDemand]

Oh goody. Now we get to play semantics games.

The semantics games have been going on since the tax exemptions were introduced. If you're just now noticing the level of intellectual debauchery in the insurance system, you haven't been paying attention. All sorts of perverse economic programs have been classified as insurance to achieve tax exempt status.

ACA is not a health insurance bill. It's a series of new entitlements. At first, Dems thought these programs would be administered through government agencies, but, in the end, they decided to grease the palms of private insurers to get them to administrate the system. Instead of fixing the problem, Obamacare expands the problem, an absurd political stance that Democrats justify by the new entitlements they've buried in ACA.

[muon2]

I was thinking more like car insurance. There's a mandated minimum policy that is set by the state. You can then add on additional liability and collision coverage, as well as separate items like loaner cars or vehicle replacement. PPACA has a mandated minimum plan, but I should be able to separately price co-pays, deductibles and service coverage beyond that minimum. Most of the complaints I heard during the initial rollout were from women with adult children but too young for Medicare. They had existing insurance that was cancelled and they found that bronze was below what they were used to, but silver had service networks below their expectation but priced up other pieces which didn't matter as much to them. Gold simply was way above their previous price point and had lots of features they wouldn't normally request of a policy that clearly drove up the cost.

That would be a whole lot of work for the actuaries, thus raising the administrative costs of the plan. How much specialization do you advocate?

The same level that I can find for car insurance. That level of flexibility involves a simple table for each feature and has not driven up car insurance costs.

It's the construction worker vs architect problem.

The insurance industry does not teach you about insurance per se. A policy with flat-rate copay is not insurance. Policies that cover regular, foreseeable expenses (birth control, annual checkup) are not insurance. All kinds of perverse economic programs have fallen under the banner of insurance because health insurance is exempt from federal taxation. Rather than fixing the exemption problem, and returning to proper health insurance systems, ACA makes the income exemption problem much worse.

You cannot insure yourself against birth control. The expense is regular, known, and predictable. Therefore, insurance policies that cover benefits like birth control are nothing more than thinly veiled entitlements, in which some demographic of people is forced to pay for the services of other demographics via ACA "insurance" policies.

This raises a real cost hidden in health coverage; a legacy from the beginnings of the HMO movement of the 70's. It's the equivalent of putting maintenance expenses like oil changes and new tires on an auto insurance policy. These are normal budgetary expenses and don't require an insurer to assume risk on behalf of the policy holder. Instead one is charging the consumer for the convenience of having the insurance company manage that part of the budget for the consumer.

[AggregateDemand]

This raises a real cost hidden in health coverage; a legacy from the beginnings of the HMO movement of the 70's. It's the equivalent of putting maintenance expenses like oil changes and new tires on an auto insurance policy. These are normal budgetary expenses and don't require an insurer to assume risk on behalf of the policy holder. Instead one is charging the consumer for the convenience of having the insurance company manage that part of the budget for the consumer.

Exactly. Drivers would pay extraordinary agency costs to a private company that essentially bills them and then returns their money, less the insurance company fee. People with expensive cars and high maintenance bills make out like bandits, while frugal spenders are gouged. Normally, private insurance would used discriminatory pricing to avoid gouging the smart-spenders, but ACA tends to view all healthcare services as exogenous consumption, forcing the healthy to pay for the routine, predictable services demanded by other citizens.

[angus]

What are some of the features that a Gold plan has that a Silver doesn't, or a Silver vs. a Bronze?

I never understood this either.  Are we talking about the olympics or medical insurance.  I get the two confused when folks start with this gibberish.  This is yet another annoying feature of the PPACA.

I assume that "gold" plans cover more stuff and "silver" plans have higher premiums or out-of-pocket expenses, whereas "bronze" plans must be the sort of insurance that paranoid but healthy young adults would have bought even without a mandate, and are just in case of seriously catastrophic events. 

[7,052,770]

I assume that "gold" plans cover more stuff and "silver" plans have higher premiums or out-of-pocket expenses, whereas "bronze" plans must be the sort of insurance that paranoid but healthy young adults would have bought even without a mandate, and are just in case of seriously catastrophic events. 

It's ... really not that hard. The higher on the list, the more benefits a plan has (lower deductibles and copays, and potentially but not necessarily a better network), but it also costs more in premiums:

Platinum
Gold
Silver
Bronze

Anyone confused by this is trying to be confused.

[7,052,770]

I was thinking more like car insurance. There's a mandated minimum policy that is set by the state. You can then add on additional liability and collision coverage, as well as separate items like loaner cars or vehicle replacement. PPACA has a mandated minimum plan, but I should be able to separately price co-pays, deductibles and service coverage beyond that minimum. Most of the complaints I heard during the initial rollout were from women with adult children but too young for Medicare. They had existing insurance that was cancelled and they found that bronze was below what they were used to, but silver had service networks below their expectation but priced up other pieces which didn't matter as much to them. Gold simply was way above their previous price point and had lots of features they wouldn't normally request of a policy that clearly drove up the cost.

That would be a whole lot of work for the actuaries, thus raising the administrative costs of the plan. How much specialization do you advocate?

The same level that I can find for car insurance. That level of flexibility involves a simple table for each feature and has not driven up car insurance costs.

Health insurance is a whole lot more complicated than car insurance. A car insurance policy is going to max out in the low 5 digits, and in the 4 digits for most people. There are all kinds of complicated induced demand factors for every feature, making the mix-and-match options not really viable. If you make everything ala carte, you have to factor in that only people who need the features are going to buy it and adjust the numbers accordingly (but avoiding the "death spiral").

ACA or no ACA, health insurance companies just aren't going to be able do that.

Having said all that, if you find the Illinois Exchange website not user-friendly enough, aren't you in the perfect position to actually do something about it for 2015? You don't seem like the "We'll never do a single thing to help Obamacare in the slightest type, even that means hurting our constituents!!!!1" type of Republican that are so widespread in DC.

[muon2]

I was thinking more like car insurance. There's a mandated minimum policy that is set by the state. You can then add on additional liability and collision coverage, as well as separate items like loaner cars or vehicle replacement. PPACA has a mandated minimum plan, but I should be able to separately price co-pays, deductibles and service coverage beyond that minimum. Most of the complaints I heard during the initial rollout were from women with adult children but too young for Medicare. They had existing insurance that was cancelled and they found that bronze was below what they were used to, but silver had service networks below their expectation but priced up other pieces which didn't matter as much to them. Gold simply was way above their previous price point and had lots of features they wouldn't normally request of a policy that clearly drove up the cost.

That would be a whole lot of work for the actuaries, thus raising the administrative costs of the plan. How much specialization do you advocate?

The same level that I can find for car insurance. That level of flexibility involves a simple table for each feature and has not driven up car insurance costs.

Health insurance is a whole lot more complicated than car insurance. A car insurance policy is going to max out in the low 5 digits, and in the 4 digits for most people. There are all kinds of complicated induced demand factors for every feature, making the mix-and-match options not really viable. If you make everything ala carte, you have to factor in that only people who need the features are going to buy it and adjust the numbers accordingly (but avoiding the "death spiral").

ACA or no ACA, health insurance companies just aren't going to be able do that.

Having said all that, if you find the Illinois Exchange website not user-friendly enough, aren't you in the perfect position to actually do something about it for 2015? You don't seem like the "We'll never do a single thing to help Obamacare in the slightest type, even that means hurting our constituents!!!!1" type of Republican that are so widespread in DC.

Perhaps IL will have an exchange in 2015 or beyond. The state was so slow in getting going that we have a federal partnership arrangement, and partisanship wasn't a factor since there were a number of Pub members who supported early ACA waivers for Cook ( ). Currently there's a state website, but it's only designed to screen candidates for expanded Medicaid coverage, but everyone else is shunted to the federal website.

[memphis]

So, the new disingenuous Republican talking point is that they're opposed to health insurance because they're not smart enough to understand it? I'm sure all of them prefer to go uninsured personally. And what exactly is the alternative? A comprehensive single payer government plan? I'm sure they'd line up for that one.

[AggregateDemand]

So, the new disingenuous Republican talking point is that they're opposed to health insurance because they're not smart enough to understand it?

Why bother bluffing, if everyone knows you're holding no cards?

If you believe the choices are limited to shoddy wealth redistribution disguised as insurance or comprehensive federal single-payer (Medicare), you've already resigned your electoral privileges.

[angus]

It's ... really not that hard. The higher on the list, the more benefits a plan has ...

That's really all healthcare.gov says as well.  

  Bronze: Your health plan pays 60% on average. You pay about 40%.
  Silver: Your health plan pays 70% on average. You pay about 30%.
  Gold: Your health plan pays 80% on average. You pay about 20%.
  Platinum: Your health plan pays 90% on average. You pay about 10%.

Pretty cheesy description.

Based on that description, my own insurance can be described as "platinum" so long as I stay in my "preferred provider" network, "gold" if I go outside the network.  Really, this gold/silver/bronze thing is very helpful when it comes to the olympics, but not so helpful here.  If I wanted to ditch my policy and pick another one, I'd have to read the fine print on both.  The color-coded designations are absolutely unhelpful in this regard.  The government is famous for this.  Remember Bush's security threat levels?  Red, orange, yellow, blue, and green.  (That one was especially irksome because of the weird order.)  Good God!  How unhelpful was that?  And it was over-complicated.  Five colors?!  They should have used two colors only.  One means everything is basically peaceful.  Expect to stand in line an hour or so at the airport.  The other means shit has hit the fan.  Arrive at the airport at least three hours early if you want to make your flight.  All the in-between stuff is just unnecessary.  And this gold/silver/bronze thing is even worse, since it has no analytical value whatsoever.  

[Brittain33]