King v. Burwell: Two American Health Insurance Markets?

ACA/Obamacare: Just Like Shopping at Amazon

“The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.

With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act's anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years.

More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions and may ... violate the (law's) nondiscrimination provisions."

Among the groups were the AIDS Institute, the American Lung Association, Easter Seals, the Epilepsy Foundation, the Leukemia & Lymphoma Society, the National Alliance on Mental Illness, the National Kidney Foundation and United Cerebral Palsy. All supported the law.

Coverage of expensive drugs tops their concerns.

The advocates also say they are disappointed by how difficult it's proved for consumers to get a full picture of plans sold on the new insurance exchanges. Digging is often required to learn crucial details such as drugs covered, exact copayments and which doctors and hospitals are in the network.”

“Much of the concern is about coverage for prescription drugs. Also worrisome are the narrow networks of hospitals and doctors that insurers are using to keep premiums down. Healthy people generally shop for lower premiums, while people with health problems look for access to specialists and the best hospitals.”

“Some plans are requiring patients to pay 30 percent or more for drugs that go for several thousand dollars a month. HIV drugs, certain cancer medications, and multiple sclerosis drugs are among them.

Although the law sets an overall annual limit on what patients are required to pay, the initial medication cost can be a shock.”

“The insurance industry trade group America's Health Insurance Plans says there's no discrimination because patients have many options on the insurance exchanges. Gold and platinum plans feature lower cost-sharing, but have higher premiums. Standard silver plans generally require patients to pay a greater share of medical bills, but some have fairly robust drug coverage.

"There are plans on the exchanges that are right for people who have these health conditions," said Brendan Buck, a spokesman for the group.” - Groups claim insurance discrimination in new forms, MSNnews, 08/17/2014


Upon further review, the purchase of health insurance upon the ACA exchanges was advertised as being much like, if not exactly like, the experience consumers have when shopping at Amazon. Implicit in the advertised mantra was consumers with great knowledge in the field of health insurance. Stated alternatively, the implicit argument is that consumers when shopping at Amazon, with great knowledge of blue jeans, shoes, toasters and microwave ovens also have the same basic knowledge in health insurance.

Price really is a signal. Yep, that platinum colored microwave seems nice, but that silver microwave is less expensive. But the bronze microwave is cheap!

Total price as a signal, that is, premium outlay, maximum out-of-pocket (MOOP), doctor office co-pay, specialist co-pay, drug co-pay, network width and breath …..that was merely a shopping experience like Amazon. Total price was considered every time, all the time: Consumer knowledge was king!

Maybe not so much, huh?


Link to the entire MSN article appears below:

http://news.msn.com/us/groups-claim-insurance-discrimination-in-new-forms

ACA/Obamacare: A Closer Inspection of the Much Anticipated RAND Study

“Last week, I wrote about an article in the Los Angeles Times, on a then-as-yet unpublished report from the RAND Corporation. The report indicated that only one-third of Obamacare’s purported 7.1 million exchange sign-ups were from the previously uninsured. But Noam Levey, the author of the Times article, didn’t disclose RAND’s actual findings as to the actual number of previously uninsured exchange enrollees. Well, now we know why. RAND published the full report yesterday; it indicates that Obamacare’s exchanges only enrolled 1.4 million previously uninsured individuals.

That 1.4 million is out of a total of 3.9 million exchange enrollees overall. That is to say, a little over a third of enrollees—36 percent—were previously uninsured. RAND’s figures don’t take into account the last few weeks of the Obamacare open enrollment period, and they contain a substantial margin of error, due to the study’s small sample size. (RAND surveyed 2,425 individuals aged 18 to 64; the 1.4 million figure has a margin of error of 700,000, meaning that there is a 95 percent probability that the actual number is between 700,000 and 2.1 million previously uninsured enrollees.)

If you assume that 80 percent of signer-uppers will eventually pay their premiums, the true number of previously uninsured exchange enrollees is likely closer to 2 million. That’s far from what the Congressional Budget Office has projected; the CBO estimated that 80 to 90 percent of the first-year enrollees would come from the previously uninsured population. Instead, it appears to be more like 24 to 36 percent.

Because the RAND survey is quite small—a comparable survey by the U.S. Census Bureau surveys around 250,000 individuals—its results aren’t as reliable. But the RAND authors, Katherine Grace Carman and Christine Eibner, perform a useful service, because they break out how people of varying insurance statuses in 2013 fared in 2014. For example, of the 40.7 million people they consider to have been uninsured in 2013, RAND can break out the fraction of those who gained insurance via the exchanges, via Medicaid, via employer-sponsored insurance, et al.

RAND finds that, overall, 9.3 million more U.S. residents have health insurance in 2014 relative to 2013. That figure has a margin of error of 3.5 million. But that’s not the interesting part. The interesting part is that 8.2 million of that comes from growth in employer-sponsored insurance. Labor force participation has been steadily declining, especially among younger individuals, which would seemingly make this result unlikely. Other surveys from ADP and Aon Hewitt have found that employer-sponsored coverage among the young has been flat to down.” - RAND Comes Clean: Obamacare's Exchanges Enrolled Only 1.4 Million Previously Uninsured Individuals, Forbes, 04/09/2014

　

Link to the entire article appears below:

http://www.forbes.com/sites/theapothecary/2014/04/09/rand-comes-clean-obamacares-exchanges-enrolled-only-1-4-million-previously-uninsured-individuals/?partner=yahootix