Well I will await that translation with some eagerness because on my initial reading the authors seem to have failed to analyze the specific provisions of the bill in re dumping and tailoring plans. For one thing there are monetary costs for the employer for each employee that disenrolls from EIS. For another after a certain grace period all employer plans have to conform to the ‘Acceptable Benefits Package’ and various cost-sharing limitations. For example the authors example of a plan tailored to provide low or no cost preventive services while imposing hi-copy’s for hospititalization will become illegal in that all conforming plans will have to offer no cost prevention and there are statutory limits on possible cost sharing. And all this within the first couple pages.
So while I would have to read the whole article and then cross reference against the specific text of the law as enacted, something I will not attempt after midnight on a Saturday, I do expect to follow your analysis and translation closely. Because at first glance I am not impressed by the authors here.
On reading more in the article it would appear that the main cost savings for employers would be excluding whole areas of coverage, e.g. Certain genetic diseases. Although I haven’t read the bill language for awhile and was more familiar with the bill language this seems in conflict with language requiring all “qualified insurance plans” which after a grace period would apply (IIRC) even to self-insured large employers to cover all “medically necessary” conditions as defined by the advisory panel.
On th other hand my recollection may be wrong, or the statute may separt significantly from the last version of the legislation that I reviewed, determine this should be relatively simple, is the “medically necessary” clause applicable or not?
Hopefully Rusty can supply the answer to this key question in his translation.
I’ve been thinking in terms of “keep the plan, dump the plan” rather than self-insurance plans and migration of only a part of the workforce. Now rethinking some things.
I also need to rethink some of this in terms of the recent regs on essential services.
http://economistsview.typepad.com/economistsview/2012/01/the-purpose-of-macroeconomic-policy.html Here’s something interesting I found on Mark Thoma’s blog. The author says that the most common use put to macroeconomics is to use it as a justification for shrinking government. He also argues that the various explanations for favoring one fiscal policy versus another are, not to put too fine a point on it, fabrications. In short, macroeconomics used to argue for austerity is bull masquerading as the dismal science. NancyO
you and Thoma are right. but don’t expect the experts to agree with you.
as for Medical insurance, there is this
Most people will face high costs for medical care at some point in their lives, mostly toward the end. Even if costs are reduced to European levels… about half of U.S. levels… this will still be more than most people can afford.
Since not everyone will actually have those costs, “insurance” was invented so you only have to pay for your “expected” costs.
Genetic research allows us to predict that some people will face much higher costs than others… more than they can pay over a lifetime.
We have private insurance unable to provide insurance at an affordable price for low income workers, people with prior conditions, or people with genetic propensity for expensive diseases.
At one point we invented Medicare to allow people to pay over a life time, while they were working, a small premium that would pay for their medical expenses after they stopped working in old age.
We compromised the principle of people paying for their own insurance by paying for much of “Medicare” with general taxes. Sounded generous at the time, “progressive,” don[‘t you know.
Now we have the Congress trying to cut benefits, forcing old people who are no longer working to find the money to pay for their medical costs or “expected” medical costs. Something they could have paid for with a slightly higher Medicare “tax” (that is a direct dedicated payment for insurance.)
Workers can afford now, and will be able to afford better in the future, to pay for their own expected costs with a reasonable Medicare tax. This would save them from “budget” cuts, and from the very simple fact that private insurers cannot afford to charge less than they do today for people with the known higher risks of old age, prior condition, or genetic predisposition.
The conclusion ought to be obvious, but we get a political rube goldberg device which doesn’t even solve the original problem, makes everybody mad, and costs most people more than a dedicated tax for medical care.
Yes this is single payer, but it need not be”government run” health care. The government could let the care, or even the day to day “insurance” management out to bid and the glories of free market competition would work together with government oversight to bring costs down while seeing that everyone got the reasonable care they need.
Not that anyone remembers that was the whole point in the first place.
Interesting story this morning on NPR – Freddie Mac traders were apparently betting against their own customers ability to refinance at lower rates. Conflict of interest much?
Potential employer responses to PPACA.
This is a very indepth legal analysis that highlights some ideas I hadn’t thought of.
http://www.virginialawreview.org/content/pdfs/97/125.pdf
I am still, as time allows, working on a financial “plain English” commentary.
Well I will await that translation with some eagerness because on my initial reading the authors seem to have failed to analyze the specific provisions of the bill in re dumping and tailoring plans. For one thing there are monetary costs for the employer for each employee that disenrolls from EIS. For another after a certain grace period all employer plans have to conform to the ‘Acceptable Benefits Package’ and various cost-sharing limitations. For example the authors example of a plan tailored to provide low or no cost preventive services while imposing hi-copy’s for hospititalization will become illegal in that all conforming plans will have to offer no cost prevention and there are statutory limits on possible cost sharing. And all this within the first couple pages.
So while I would have to read the whole article and then cross reference against the specific text of the law as enacted, something I will not attempt after midnight on a Saturday, I do expect to follow your analysis and translation closely. Because at first glance I am not impressed by the authors here.
On reading more in the article it would appear that the main cost savings for employers would be excluding whole areas of coverage, e.g. Certain genetic diseases. Although I haven’t read the bill language for awhile and was more familiar with the bill language this seems in conflict with language requiring all “qualified insurance plans” which after a grace period would apply (IIRC) even to self-insured large employers to cover all “medically necessary” conditions as defined by the advisory panel.
On th other hand my recollection may be wrong, or the statute may separt significantly from the last version of the legislation that I reviewed, determine this should be relatively simple, is the “medically necessary” clause applicable or not?
Hopefully Rusty can supply the answer to this key question in his translation.
I’ve been thinking in terms of “keep the plan, dump the plan” rather than self-insurance plans and migration of only a part of the workforce. Now rethinking some things.
I also need to rethink some of this in terms of the recent regs on essential services.
Ridiculously complicated.
http://economistsview.typepad.com/economistsview/2012/01/the-purpose-of-macroeconomic-policy.html
Here’s something interesting I found on Mark Thoma’s blog. The author says that the most common use put to macroeconomics is to use it as a justification for shrinking government. He also argues that the various explanations for favoring one fiscal policy versus another are, not to put too fine a point on it, fabrications. In short, macroeconomics used to argue for austerity is bull masquerading as the dismal science. NancyO
Nancy
you and Thoma are right. but don’t expect the experts to agree with you.
as for Medical insurance, there is this
Most people will face high costs for medical care at some point in their lives, mostly toward the end. Even if costs are reduced to European levels… about half of U.S. levels… this will still be more than most people can afford.
Since not everyone will actually have those costs, “insurance” was invented so you only have to pay for your “expected” costs.
Genetic research allows us to predict that some people will face much higher costs than others… more than they can pay over a lifetime.
We have private insurance unable to provide insurance at an affordable price for low income workers, people with prior conditions, or people with genetic propensity for expensive diseases.
At one point we invented Medicare to allow people to pay over a life time, while they were working, a small premium that would pay for their medical expenses after they stopped working in old age.
We compromised the principle of people paying for their own insurance by paying for much of “Medicare” with general taxes. Sounded generous at the time, “progressive,” don[‘t you know.
Now we have the Congress trying to cut benefits, forcing old people who are no longer working to find the money to pay for their medical costs or “expected” medical costs. Something they could have paid for with a slightly higher Medicare “tax” (that is a direct dedicated payment for insurance.)
Workers can afford now, and will be able to afford better in the future, to pay for their own expected costs with a reasonable Medicare tax. This would save them from “budget” cuts, and from the very simple fact that private insurers cannot afford to charge less than they do today for people with the known higher risks of old age, prior condition, or genetic predisposition.
The conclusion ought to be obvious, but we get a political rube goldberg device which doesn’t even solve the original problem, makes everybody mad, and costs most people more than a dedicated tax for medical care.
Yes this is single payer, but it need not be”government run” health care. The government could let the care, or even the day to day “insurance” management out to bid and the glories of free market competition would work together with government oversight to bring costs down while seeing that everyone got the reasonable care they need.
Not that anyone remembers that was the whole point in the first place.
Interesting story this morning on NPR – Freddie Mac traders were apparently betting against their own customers ability to refinance at lower rates. Conflict of interest much?
http://www.npr.org/2012/01/30/145995636/freddie-mac-betting-against-struggling-homeowners
ProPublica version:
http://www.propublica.org/article/freddy-mac-mortgage-eisinger-arnold