Health Care Reform Questions

[BBB725]

one thing everyone needs to keep in mind about this is you can't just throw out a blanket number and call it good. There are a lot of things that go in to calculating premium. 2 really important factors are age and men/women ratio. So you can have two equal plan designs in two identical companies that have radically different premiums. For example, if company A's average age is 24 and mostly male their premium will be significantly lower than the same company with the same average age but is predominately female. The older you are the higher your premium is going to be. Along the same lines, the same company with the same Male to Female ratio but a 2 or 3 year increase in average age will have a significantly higher premium.

So the same plan design could trigger the excessive tax in one company and not in another. Some of the other factors that go into the calculation is location, type of business (SIC), network, claims experience, Percent on COBRA etc, etc, etc.

people have lost sight of the fact that insurance is to protect you against a mathematically calculable unknown risk. Once it becomes known, well there is not much insurance can do - because it is only downside after that.

Correct, when my company is quoted it is the average age of the group and history

[Chris]

Fortune 1000 cos which probably employ the bulk of non-public "covered" individuals. PPO coverage with minimal deductibles (<=$1k) and low co-pays.

Every public employee is covered by a private health insurer also. Don't expect for a second the ins cos cut municipalities a break on premiums. Call the finance department of your local municipality and ask them what they pay for ins premiums. Be sitting down when you get the answer.

HMO coverage is going to be cheaper.

The preponderance of enployed, insure Americans work for small and medium-sized companies. But I agree on the governmentals- they're the last frontier on this.

Interestingly, our local university is coming under fire for threatening a work stoppage after receiving "only" 4% and guaranteed no increases in health coverage.

[rbhudelson]

Correct, when my company is quoted it is the average age of the group and history

And it gets a lot more complicated after that. Insurance companies assign a credibility factor based on the number of employees/members. The credibility factor gets bigger until it reaches 100% at around 400 employees. This credibility factor is used because the smaller the company the more wildly the claims experience will typically be year over year. A 10 life group may go years before anyone gets sick and then boom you have a 300k claim. But, a 400 life group will have about the same stuff happen year after year.

[BBB725]

Same goes for our work comp insurance

[CRC]

So if you, God forbid, came down with cancer and racked up over 500k in medical bills as my son did, who pays for your free ride?

Well that's just it. I'm not looking for a free ride. I had double hernia surgery done in Canada for about $3,000 US. That included a week stay in the hospital. When I turned 50 and needed a colonoscopy the hospital wanted around $5,000 to do it. I did some research and found a doctor who does them in his office and since all went well it cost me only $360! If I were diagnosed with cancer I would find a non hospital affiliated oncology center to get treated. Being uninsured is a gamble. Yes I could end up injured or need heart surgery. If that happens I will take responsibility for the bills. No free ride. Health insurance is routinely abused. Folks run to the doctor when they don't need to just because it is free. Doctors routinely overbill insurance. Whenever possible, try to avoid hospitals because they need to cover indigent care. The cost of American hospitals is out of control. If possible go to an urgent care center or other alternative. If you need hospital care bite the bullet and pay the bills. They will work with you. I don't spend anywhere near even $1,000 a year in health care. I'd like to continue to be self insured in this free democracy.

[rbhudelson]

Well that's just it. I'm not looking for a free ride. I had double hernia surgery done in Canada for about $3,000 US. That included a week stay in the hospital. When I turned 50 and needed a colonoscopy the hospital wanted around $5,000 to do it. I did some research and found a doctor who does them in his office and since all went well it cost me only $360! If I were diagnosed with cancer I would find a non hospital affiliated oncology center to get treated. Being uninsured is a gamble. Yes I could end up injured or need heart surgery. If that happens I will take responsibility for the bills. No free ride. Health insurance is routinely abused. Folks run to the doctor when they don't need to just because it is free. Doctors routinely overbill insurance. Whenever possible, try to avoid hospitals because they need to cover indigent care. The cost of American hospitals is out of control. If possible go to an urgent care center or other alternative. If you need hospital care bite the bullet and pay the bills. They will work with you. I don't spend anywhere near even $1,000 a year in health care. I'd like to continue to be self insured in this free democracy.

You can call it what you want but it is no different than driving your car without insurance. Those that can afford to "self insure" their health (don't). There are affordable plans that you can buy that will protect you against the catastrophic claims. Get a $10,000 deductible plan.

there is a term in the business called "Adverse Selection". It basically states the only people that pay for insurance are those that need it. That is why insurance companies have rules round minimum company contribution and participation. it would help all of us if everyone had some type of health insurance.

[CRC]

You can call it what you want but it is no different than driving your car without insurance. Those that can afford to "self insure" their health (don't). There are affordable plans that you can buy that will protect you against the catastrophic claims. Get a $10,000 deductible plan.

there is a term in the business called "Adverse Selection". It basically states the only people that pay for insurance are those that need it. That is why insurance companies have rules round minimum company contribution and participation. it would help all of us if everyone had some type of health insurance.

It is entirely different than driving my car with no insurance. My auto insurance covers liability and medical bills to others who may be injured in an accident. My boat insurance does also as does my homeowners insurance. I do not want health insurance. You are wrong about it being affordable. I'd rather put that $8,000 a year into paying down debt or investments. I can get my hands on quite a bit of cash if need be. I have assets and credit lines available. This is a free country and I should not be forced to purchase health insurance. A lot of self employed people choose this route. Read this article:

[rbhudelson]

I just went to my state's (OK) Blue Cross Blue Shield website and configured a quote for a 50 YO Man and Wife Non-Smoker and average build. on a 10k out of pocket plan your premium is $286. Thats for both man and woman. If it is just you then it is $146.

Now most would say that is a crappy plan and no one would disagree but it cuts your exposure to 10k. Essentially, you are self insuring the first 10k of your heath care.

We all have choices as to what we spend our money on. Some decide to "self insure" their cars and it works great until they have a wreck. I'm not making any assumptions about anyone's ability to pay for their healthcare. I'm just saying why would you want to risk hundreds of thousands of dollars when you can cap your losses at 10k for 286 per month? The trouble is most people can't raise the money to pay for those kinds of events and in turn it costs those of us that pay for insurance more.

[MarylandMark]

Good post rbhudelson.

$146 to hedge your bets, silly not to have it. Hope we all have good health, but all it takes is one trip to the ER and you could be $100K+ in the hole realy quick.

Verizon provides 835,000 retirees, employees and family members 100% medical, dental and vision coverage.

At "strike time" we were told our insurance was worth $9K single to $16K for a family of 4. Any thing after a family of 4 we have to pay extra for; $10-$12 a week I think. The wife-to-be says my insurance is the best she has even seen come through her office by far. I'm not sure if that figure is just medical or includes dental, vision, prescription plan and life insurance (1X base pay).

I feel it is part of my job- I took this gig knowing my insurance was free for life. Overall compensation package- I want to be paid more money if they are going to tax that benefit as income or if they took that benefit away.

Everyone hired after 8/3/2003 are under different rules (if they still have a job, I can't be laid off where they can and seems they are being axed at record rates these days). They have to pay some thing for insurance and they don't get coverage after they retire.

[VtSteve]

Good post rbhudelson.

$146 to hedge your bets, silly not to have it. Hope we all have good health, but all it takes is one trip to the ER and you could be $100K+ in the hole realy quick.

I feel it is part of my job- I took this gig knowing my insurance was free for life. Overall compensation package- I want to be paid more money if they are going to tax that benefit as income or if they took that benefit away.

Everyone hired after 8/3/2003 are under different rules (if they still have a job, I can't be laid off where they can and seems they are being axed at record rates these days). They have to pay some thing for insurance and they don't get coverage after they retire.

Still not bad for them either. Definitely better than the way most companies are headed. About the only good things of the new Senate plan are changing the way the industry can screw people.

1) No more canceling policies when someone gets sick.
2) Cannot deny coverage if you have pre-existing conditions
3) Attempts to allow crossing state's lines to shop around

Insurance companies were furious that the penalties weren't stiffer, especially for the young healthy people they clean up on. They were also furious that the plan called for insurance companies to stop cherry picking.

All in all, a little better than now, nothing earth-shattering. Health care costs in this country have become one of the biggest taxes around. If you look at what the premiums are for big companies, some of them are staggering. They have an adverse impact on wages, which gets worse every year.

[rbhudelson]

Still not bad for them either. Definitely better than the way most companies are headed. About the only good things of the new Senate plan are changing the way the industry can screw people.

1) No more canceling policies when someone gets sick.
2) Cannot deny coverage if you have pre-existing conditions
3) Attempts to allow crossing state's lines to shop around

Insurance companies were furious that the penalties weren't stiffer, especially for the young healthy people they clean up on. They were also furious that the plan called for insurance companies to stop cherry picking.

All in all, a little better than now, nothing earth-shattering. Health care costs in this country have become one of the biggest taxes around. If you look at what the premiums are for big companies, some of them are staggering. They have an adverse impact on wages, which gets worse every year.

You bring up another point that most people don't understand. This bit about insurance companies can't sell across state lines is 100% wrong. Insurance companies can and do sell across state lines. Insurance is regulated at the state level. And I pray to GOD, Budda, Ala, all the idols of man, cows and anything else that will help that doesn't change. We do not want the federal government to take that power away from the states - but i digress.

back to topic. The reason why a lot of insurance companies choose to focus in on specific market places is because they have to build networks. building networks requires them to negotiate with doctors and hospitals. in markets they don't have networks, they can't compete with carriers that do. that is why they may sell in one state but not in another. so if they want to move into say texas, they have to build or rent a network and get approval from the texas insurance commission.

The only way a pre-existing condition should be allowed is if the person had insurance when that condition first presented itself - else it is like waiting to insure your house until it catches on fire. Again, it gets back to adverse selection. If you don't treat pre-existing that way then people will not buy insurance until they get sick. Which in turn, gets us right back to where we are today. Those with insurance are funding, indirectly, those that don't.

[boostbros]

i agree with crc the issue is modern medical is out of control there is no reason to control cost or ethical care the more they charge the more insurance pays who then pass it on hes right on colonoscopie too 2000-2500 around here for a simple 15min non medical procedure is like me charging 2500 to change a set of plugs i have very first hand knowledge of doctors and how dirty the drug companys are in pushing drugs and kick backs i also went thru hell with my father so i have seen hospitals and nursing homes and 6 months of hospice hell that no human should have to endure if i treated my dog that way they would hit me with animal cruelty ! i am in the drivers seat and am driving all the way to the grave that means no chemo no nursing home no progressive turn you into a vegetable or skeleton my dad looked like jeff dunhams achmed it was not good i think its so out of control the only fix is people like crc starting our own system of true health care at reasonable rates ...has anyone here looked at a hospital bill? i say every one healthy drop insurance and bring them to their knees and really look at the big picture i think of it as a cruise ship 1500 foot long to cross a 1/2 mile wide river

[Big Time]

2) Cannot deny coverage if you have pre-existing conditions

One of the problems that could come out of this though is that why get insurance if you know you can get it at any time. In other words you could have people that don't ever put into the system and then when their time comes they all of a sudden "want what is due to them." And based on this current Administrations policies (and/or proposed policy's), people are being groomed to think like that...thinking they deserve something for nothing. It is a moot point if Healthcare becomes mandatory and the penalty is monetarily significant enough that it wouldn’t make sense to not carry insurance, but these are all things that need to be considered.

[BBB725]

I feel it is part of my job- I took this gig knowing my insurance was free for life. Overall compensation package- I want to be paid more money if they are going to tax that benefit as income or if they took that benefit away.

Mark I have the identical insurance as my employees, same policy same everything, the difference between us? the US government considers it income to me and taxes me on it while it's tax free to my employees

[MarylandMark]

Your income is too high, put me in for a job bank job and when you need a losing year I'll pop up to run the show for a few months

[Big Time]

Agreeement reach on Cadillac Tax:

http://www.foxnews.com/politics/2010...adillac-plans/

[MarylandMark]

A senior Democratic official speaking on background told Fox News that the threshold for exemption would be raised from $23,000 to $24,000 per family but would remain the same at $8,500 for singles with high-value plans. Dental and vision plans would be removed from that calculation, however.

State and local workers and union members are exempted until 2017.

[Playn]

A senior Democratic official speaking on background told Fox News that the threshold for exemption would be raised from $23,000 to $24,000 per family but would remain the same at $8,500 for singles with high-value plans. Dental and vision plans would be removed from that calculation, however.

State and local workers and union members are exempted until 2017.

That means the union policies are valued at $23,999/year.......