I doubt this gets read but that's what happens when work interferes...

typically policies are still in effect outside the country. Catastrophic coverage still burdens the public with your risks. I understand that you expect to be able to cover your own costs at need without relying on public assistance. But we the people have a right to a little more in the way of surety, hence the requirement of insurance.

You are correct to a point, My previous policy was very good, had my injury happened outside of the country the insurance would have covered not only the surgery but my housing, and if required flight back to the US to finish receiving treatment. Post ACA policy coverage is limited to "emergency treatment" only. The definition for "emergency Treatment" is so narrow that my new post ACA policy, that I am forced to pay more for, would still have soaked me for about $12 to 13k in out of pocket expenses because the nature of the injury requires 2 procedures, 1 to stabilize and 1 to repair. The repair process must be performed within 48 hours to ensure a positive outcome so really under the new ACA standards I actually am paying more for less. I still have to purchase travelers insurance to cover what a "regular" policy doesn't and due to the ACA and the state in which I reside the choices have gotten smaller and more expensive yet really do nothing more. All to satisfy a talking point driven by the right of surety.

I'm simply saying that your situation, though atypical, is like most other stories of "harm" in that the harm done to you may very well be more perceived than real.

I consider the harm to be real in that I am paying more for less all in order to subsidize a larger pool of beneficiaries. While that is how this whole "game" works, the added monies I now have to pay into the system comes at the expense of monies spent elsewhere in the economy at the expense of my comfort and to an extent others comfort as well as now more of my dollars will go straight to the top vs taking a small detour through a couple of other pockets on the way to the top.

As long as we allow the right to frame the argument in such a manner that causes us to have to fall back on the "well it's a start", we will never get the system to move forward with meaningful reform that benefits the major plurality vs the way it is now of benefiting the rich or the very poor. Now is the time for us to be making the forceful arguments that it is not "good enough", it is here to stay and it is time for fixes. Mark my words if the right gains control of the senate and retains the house they will defund the ACA and retain the mandate, and they will use the "well it's a start" arguments to do it. Then we will see everyone who is not at the top get hurt for real, and it will all be due to us not arguing loudly for proper reform that benefits the middle.

I don't quite follow. First I think your missing quite a few points. In no particular order, participating in insurance pools one year have no effect on other years' pools. That's why policies expire annually, insurers earn "excess" profits, and one of the things PPACA takes baby-steps toward reforming. Ideally, insurance pools are supposed to spread risks and costs over the life of the pool, not fiscal years, but currently they don't.

Also, typically policies are still in effect outside the country. Catastrophic coverage still burdens the public with your risks. I understand that you expect to be able to cover your own costs at need without relying on public assistance. But we the people have a right to a little more in the way of surety, hence the requirement of insurance.

Sounds like your surgical costs are due to your indecision not ACA. Its my understanding your insurer would have offered you alternatives and any new policy from anyone would provide coverage since preconditions are no longer barred. A 10K max against a 14K surgery on a policy that costs 2500/year saves you just 1500. If, as was typical before ACA, your policy is cancelled with rates increased as soon as you actually make a major claim it may not only not have saved you money it might actually have cost you more.

I don't know your details and I'm not arguing with you. I'm simply saying that your situation, though atypical, is like most other stories of "harm" in that the harm done to you may very well be more perceived than real. One reason those cheap policies are unacceptable, and WERE so cheap, is that most offered no real value, or actual coverage, at all.

As to your actual point... Full disclosure time. IMHO concentrating on the data is a red-herring. The basic problems with our system is that third party insurers are inherently expensive and wasteful. We, as a nation, are fully capable of self-insuring, eliminating both the middleman and the middleman's cut for his profit.

Additionally, when it comes to insurance, the larger and more diverse the pool, the more likely it is to remain solvent and the cheaper it is to finance it. So anything short of single-payer is a band-aid. I'll grant that it isn't politically or economically feasible to just chuck the insurance industry and enroll everyone in Medicare, so PPACA is better than nothing and moving in the right direction.--But not a WHOLE lot better.

What I like about ACA is that it at least starts to move us back to the idea of insurance, and insurance pools, instead of short-term gambles over whether claims can or will be filed this quarter, or this year. And away from the idea that "insurance" is about taking in any funds in the pool not expended in a year, so that preventing payouts on claims increases profits.

Insurers are SUPPOSED to be about earning fees for managing insurance pools. And insurance pools are supposed to be solely for the purpose of covering the claims of the insured.

I just wanted to chime in that the perspective of patience on the numbers is worthwhile and great job on breaking down some of the arguments, however it also is somewhat disappointing that the ACA discussion has come down to just numbers and is in general ignoring some of the larger issues and problems that plague the legislation as it now stands. I would have preferred to see something getting us little more into the "weeds" as the longer we avoid the weeds and allow both parties and the HC industry to dictate that the big numbers are the only ones that matter the longer major issues will not be addressed. I prefer the stance of patience while the numbers are collected but continue to hold both parties feet to the fire to provide accurate information and pointing out often that both sides are doing a sucky job of protecting the interests of the many and how we can be making the ACA better.

To LEW - I have to disagree on your stance that there are no losers. I am most definitely a loser in this transition. As a person who makes his living predominantly outside of the US I really never carried a qualifying ACA "traditional" style insurance policy as it made no sense for me to do so. For me it is cheaper to purchase travel insurance and pay out of pocket for my traditional preventative care. What I did have however was a very, very, good catastrophic policy, as that is really what I needed to prevent "bankruptcy". The current legislation makes no allowance for someone like me who is in and out of the country frequently it only makes an allowance for people who spend large consolidated blocks of time out of the country, so as a result I now have to carry insurance that for the most part I cannot use. Being forced to have "more" insurance is not so bad per se', however the price tag is, I happen to be fortunate enough to be able to provide for myself but this has come at a price in that I make just enough to be disqualified from receiving any subsidies and I live in one of the more expensive area's of the US. My old policy which limited my out of pocket at $10k max and covered a host of the side expenses only cost me $2500, now for a bronze policy which has a $12k cap (once you factor deductibles and other exp.) is going to cost me $6300 per annum. Now if the threshold for subsidies had been indexed for the cost of living as set by the census for the region my insurance premiums would have been closer to a more palatable $3k per annum. Yes I realize that by paying premiums we are subsidizing the pool and that is how this whole thing works, but how exactly am I winning by just having all of the years I've already put into the pool just tossed? Perhaps some of my view might have something to do with the fact that I have had to receive a tendon repair surgery while trying to find a replacement policy that works for my unique circumstance costs 14k and running.... Perhaps if they had thought things out better I still would of had my old policy that would have covered this. While my story is certainly not the norm, it is also not Fox news bait.

I will agree with most that there are lot's of people benefiting from the ACA I have friends that now have insurance and will not have to worry about treatment for long term problems. I also know people who will now be forced to purchase insurance they don't really need, to subsidize a risk pool held by a private corporation because of the way the ACA was written to keep the monied corporate interests happy. So in my opinion yes there are winners and losers.

Which, as CW said "leads us back to our main point" that as long as we allow both the right and the left in concert with the big monied interests to drive the discussion and determine the data sets used and we as citizens or well meaning pundits do not demand and make known our expectations, we can have all of the patience in the world but, the discussion will never change from the current form of poor math and general data sets driving the "it does or doesn't work" 24 hour news cycle discussion we have now. Unless we demand the data sets that contain something meaningful for the middle the only thing, no matter how long we wait, that is certain is any "fixes" will only benefit the top and the bottom and the middle will just be left to muddle along and pay the freight.

Since we can't trust Washington to look out for our interests it is up to us to be demanding the fixes that need to be made now while the numbers argument has yet to be solved. The smart people should be stating loudly ACA is here to stay, and while we are waiting for this information lets plan to analyze and use it to improve and fix the system for all. Unfortunately that call to action is missing from the mantra of patience as it sits.

Since I my soap box is to big for carry on, I'll leave it behind for you to kick around...time to fly. Remember way back when congress used to come together and compromise for the betterment of all once the discussion was over and a battle had been won?

Wonk Blog had a good piece on THE DEATH SPIRAL back in November:

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/07/wonkbook-seven-reasons-obamacare-isnt-facing-a-death-spiral/

On the Individual Mandate:

"There's a lot of confusion over the actual costs of the individual mandate, so here's a reminder: In 2014, it's $95 or 1 percent of adjusted income (which is income minus the tax filing threshold, which is $10,000 for individuals and $20,000 for families), whichever is greater. In 2015, it's $325, or 2 percent of adjusted income, whichever is greater. In 2016, it's $695 or 2.5 percent of adjusted income, whichever is greater.

The reason I keep italicizing "whichever is greater" is because it's the part that really matters. A lot of people believe the mandate's penalty in year one is $95. It isn't. Almost everyone who faces the mandate makes more than $9,500. So imagine someone making $53,000. For them, the mandate's cost in year one is $430. By year three, it's $1,075. That's a lot of money."

Just to get down into the weeds a bit...

..."it is not just the total number of signups so far which is important, but also the mix of who has signed up. If the mix isn't right, the insurance companies will hike their premiums next year so much that the marketplace could enter what is known as a "death spiral."

The ACA incorporates a number of mechanisms to ward off THE DREADED DEATH SPIRAL. Among them are:

Risk Adjustments, to redistribute funds between insurance plans with higher and lower risk enrollees.

Reinsurance, which basically subsidizes high risk pools for the first 3 years.

Risk Corridors, which limit potential profits and potential losses, also for the first three years.

This is conventional insurance risk mitigation stuff, even if Flo, Maxwell and the Gecko don't mention it.

The Kaiser Family Foundation site has a helpful chart on this subject:

http://kff.org/health-reform/issue-brief/explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors/

You might want to down a couple of NoDOz before you wade in.

You win the prize for the best comment on this subject I have ever had the pleasure of reading - here or anywhere else ... not that I read comments in many other places, you understand, just to be clear.

Bravo!

Just one of those nights.

I wasn't trying to address anything, really, just ask a simple question.

To be perfectly blunt, I find the whole discussion on Obamacare incredibly tedious.

I will say one more thing about it, though ... if this new healthcare law isn't just the first step toward single-payer, in the final analysis, then I wish y'all a lot of luck with it 'cause I think you're gonna need it.

Carrying health insurance is NOW THE LAW. It is NOT optional. It is the law. And yet, the "no amnesty to lawbreakers" crowd take it as a given that everyone will break the law and refuse to sign-up for ACA. Which is why Obama's numbers COULDN'T be right!

Because NOW, suddenly, breaking the law is every persons "right," if you disagree with it.--Which, of course, is news to Mexicans who immigrated illegally, blacks who smoke pot, women who want abortions, or gays who want to marry.

Apparently the law applies to everyone--except old white folks.

Then there's the outrage over being forced to carry adequate health insurance, while forcing poor people to drug test, prove they're seeking work, or do community service work is just fine. Old white folks having a right to be a "burden on society" no one else enjoys.

And if the policy proposals Conservatives created are truly such socialistic unconstitutional democracy destroying assaults on the forth amendment then why did Conservatives propose them in the first place?--And why is no one asking them that question?

How is the ACA not bipartisan because Conservatives created its provisions but didn't vote for it? You create the parts of a bomb but have no responsibility because someone else put them together and pushed the button?

Call me crazy, but I just don't see why we should care about the "accuracy" of Obama's numbers when we don't care about the "accuracy," logical consistency, or even the rationality of the claims from the Right. Carrying health insurance is the law. Of course almost everyone is going to sign-up!--Aren't they?!

No active unexpired policy may be cancelled for ANY reason other than policyholders failing to meet their contractual obligations under the policy, such as failing to make premium payments. Exactly when, and how, policy lines may be cancelled depend on the individual terms of the policy. No policies were cancelled because of PPACA. NO policies were cancelled without the prior written consent of the policyholders. Any such cancellations would be contractual violations and illegal.

Policyholders whose policies were nonrenewable due to cancellation of the policy line are offered alternatives as a matter of course by insurers, and as a matter of law under the PPACA.

The only ones who might experience immediate short-term "harm" are those who have unrenewable policies for which all available alternatives offer less value for the money. VERY few, if ANY, policyholders fall in that category. Reducing premium costs, eliminating lifetime caps, prohibiting rejection due to "preconditions", and requiring everyone to pay for their healthcare, instead of passing costs on to others through unpaid emergency room visits, benefit EVERYONE.

The ONLY ones who MAY suffer true "harm" are providers' profits. EVERYONE else benefits. The only question is "how much?" Some will benefit more than others, but their ARE NO "winners and losers." Only "winners" and "bigger winners."

The rightwing misinformation promulgated to sabotage the PPACA is so pervasive, and so accepted by the media as the baseline for beginning discussion that nearly ALL "comparisons" are misleading.--I've a radical suggestion, why don't we talk about the "accuracy" of Obama's numbers and the comparisons to the number of people "harmed" when someone has actually produced an "accurate" number for people who've actually proven to have BEEN "harmed!"

Even the claim that young healthy people are harmed is untrue. They won't be young and healthy forever. The small increase in costs they may experience now will pay dividends for them later.--Which is the whole point of insurance. Its not about gambling on whether you'll need it, (with the public underwriting your bet through emergency rooms,) its about managing your risks, and costs, by participating in a pool.

Being young and healthy certainly doesn't guarantee you'll never need care. And neither does it guarantee you've a right to care at everyone elses expense should you need it. Requiring the young healthy to carry insurance too isn't "harming" them, its requiring them, like everyone else, to support themselves instead of taking advantage of the rest of us. We're willing to help those who need help, not provide for those simply unwilling to pay their own expenses.

Wow, you're up late!

:-)

I think what you were trying to address was the grandfather thing, which Mopshell spoke to. I left it out of this article, I admit, because I didn't want to get "too far into the weeds," but maybe I should have mentioned it.

-CW

Not necessary. Thanks for the edit.

LizM [2] -

OK, you really need to go back and re-read that whole section, because it makes the argument, and then deconstructs it a bit. Not to the level that you point out, but still... it is acknowledging that the other side is making an argument, and then attempting to see if there is any data to back it up.

Cancellations happen. They happened before Obamacare, and they will happen after Obamacare. I don't know if this really applies, but allow me to try to use a metaphor. It's like banks and checking accounts. They offer certain terms, and sign you up for "ExtraMegaChecking" and you get certain benefits for a while. But then they decide to change their whole system around and they tell you EMC is no longer available, and you have to choose between new plans.

This happens all the time in insurance. How much of it was "due to Obamacare" is an open question, but it's not like it didn't happen previously to some out there every year. So it's a pretty vague thing all around.

Don't know if that fully answers your question, but it might be enough to clarify things a bit.

YoYo [3] -

The whole ball game is (politically) whether more people are harmed than helped, you're right. But we really won't be able to definitively say that until better data comes in. I'd bet on it being a net positive, personally.

But then I'm an incurable optimist, at times. Hey, I wonder whether Obamacare treats that? Heh. Sorry...

LizM [5] -

I'm not sure of the exact rules. Pre-Ocare, they could do pretty much anything they wanted. But post-Ocare, they may be able to do the same.

Two points: they will not be able to cancel a certain individual's policy BECAUSE HE GOT SICK. That is verboten, now (used to happen all the time). Secondly: insurance companies cancel policies that don't make money for them (maybe not enough people sign up). But that doesn't mean they won't come up with a plan to replace it, for most of their customers. To put it another way, it's not as brutal as it sounds just to "cancel a policy."

YoYo [7] -

Exactly right.

[10] -

Obama himself hates this the most about Washington: the absolute inability of anyone to see past the 24-hour news cycle. In such an atmosphere, long-term planning is almost impossible. I wrote this article mostly as a "benchmark" type of article I could refer to in future writing, to update figures and provide better data, and see how certain predictions panned out.

Mopshell -

OK, I have to admit, you answered LizM a lot better than I did! Well done! The big problem with the concept of "grandfathering" in plans was that the grandfathering date was set very early (2010?) while the full implementation of Obamacare waited until 2014. This was written into the law to satisfy both the insurance companies and the Blue Dog Dems. But this 4-yr gap caught a lot of folks unawares -- many of them in that "6 million cancellations" figure. This, though, will be a one-time problem which will work its way out one way or another. Obamacare, however, is an ongoing thing, so eventually all these people should be (theoretically) helped in one way or another.

Whew! OK, that's it for now.

-CW

Now, I can get some rest. :)

IF I'm understanding this correctly, insurance companies can cancel policies that pre-date Obama, if they so choose ... for any reason? or only if these policies don't measure up to the new Obamacare standard?

In any case, is it correct to say that insurance policies under the new Affordable Care Act cannot be canceled by the insurance companies?

Firstly, your questions are very valid ones and I'm going to do my best to answer them for you.

Insurance companies could only cancel plans which were not ACA-compliant. That some of them cheated in this respect is now the subject of at least two court cases that I know of:

Anthem Blue Cross tricked tens of thousands of Calfornia policyholders into giving up health insurance plans from which they could not be dropped and pushing them into policies that Anthem knew would be cancelled, according to two lawsuits filed in Los Angeles.

Further, the insurer misrepresented that certain Obamacare-required benefits like no pre-existing condition limits for dependent children would be available only in non-grandfathered health plans, when in fact such benefits must be incorporated into grandfathered and non-grandfathered plans.

From: The International Business Times

http://www.ibtimes.com/anthem-blue-cross-wellpoint-wlp-unit-sued-allegedly-tricking-tens-thousands-dropping-grandfathered

So that is the answer to your first question - they could only cancel policies if they didn't measure up to the new Obamacare standard.

Secondly: yes, it is correct to say that insurance policies under the new Affordable Care Act cannot be canceled by the insurance companies. As far as I'm aware, the only exception to this is the non-payment of premiums in a timely manner.

As for those who received cancellation notices (including the tens of thousands embroiled in these two lawsuits), there is some information coming through from the insurance companies which estimates how many there were (close to 5.8 million is the most likely figure) and what happened to them:

Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.

That is not supported by survey data or insurance companies, many of which report they have retained the vast majority of their 2013 customers by renewing old policies, which is permitted in about half the states, or by moving customers to new plans.

From: The LA Times

To put this in perspective: 5.8 million received cancellation notices; 4.8+ million of those were re-covered by their insurance companies either through policy renewals (thanks to a delay in scrapping non-compliant plans) or signing up to alternate plans offered by their insurance companies.

This leaves under a million people with cancelled plans. We do know what happened to the majority of them:

# some qualified for Medicaid under existing rules or the new ACA Medicaid expansion and either registered at their local Medicaid office or via the ACA exchanges.

# some chose to seek out better deals via the ACA exchanges rather than sign up to alternate plans offered by their insurance companies.

# some were small businesses which chose to wait for better deals in 2014 on the ACA exchanges.

As Chris noted, it will be some time before we know the exact figures for people in each of these three groups and how many of these one million people chose to remain uninsured for whatever reason. It seems likely (but cannot be verified as yet) that the remaining uninsured from the original group of 5.8 million is a very small figure indeed and that at least some of them chose this voluntarily rather than for indigent reasons. But, at this stage, it's impossible to be sure.

I hope this is helpful. :-)

:-P @chris

But, my question remains unanswered.

Really we should have gone with a statistically proven single payer system, but the blue dogs put an end to that. And really I can't see how that would have changed the debate or dynamic at all, going with the heritage foundation plan didn't win any Republicans over.

Only 'blame' was to be italicized.

[Ed: Fixed. -CW]

Where did I go wrong - and, my point was not to blame the insurance companies but to understand what they could do before Obamacare versus what they can do now, with respect to canceling policies ...

Their argument (before the 7.1 figure was announced) was, in essence: more people would be harmed by Obamacare than helped. This argument hinged on the number of people who received cancellation notices in the mail from their insurance companies.

Okay, this is where mine eyes begin to glaze over ...

I mean, it seems to me that this is an argument with absolutely no basis. In fact, it's better than that, it's an argument that makes the other side's case!

IF I'm understanding this correctly, insurance companies can cancel policies that pre-date Obama, if they so choose ... for any reason? or only if these policies don't measure up to the new Obamacare standard?

In any case, is it correct to say that insurance policies under the new Affordable Care Act cannot be canceled by the insurance companies?

And, if this is the case, then this is, to be polite, an extremely spurious argument against Obamacare, is it not?

Which means we can get back to the fun!

Michale I call you out, you're wrong! About everything!

I welcome your data and statistic based rebuttal. But I'm obviously unassailable here.

:-P