Total Posts:14|Showing Posts:1-14
Jump to topic:

Obamacare

Ren
Posts: 7,102
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 11:31:03 AM
Posted: 4 years ago
The Patient Protection and Affordable Care Act -- colloquially termed "Obamacare" -- appears to be a hot topic on these forums, although there seems to be little reference to the legislation itself (as seems to be the norm in highly opinionated conversations about legislation). So, I'm making a thread about the legislation itself, and we can start there to begin to approach questions about or contentions with it.

What Is This Legislation?

It is actually a compilation of a series of related subsections of a larger legislation called Healthcare and Education Reconciliation Act of 2010. Indeed, there is a lot of writing pertaining to education in addition to healthcare. However, there is a whole lot written about the workforce, as well. You can look through it yourself here: http://www.gpo.gov...

This legislation outlines all sorts of intriguing language, such as:

"(3) BEHAVIORAL CHANGE COMPONENT.—A be-
21 havioral change component which provides for alter-
22 ing employee lifestyles to encourage healthy living
23 through counseling, seminars, on-line programs, or
24 self-help materials which provide technical assistance

1 and problem solving skills. such component may in-
2 clude programs relating to—
3 (A) tobacco use;
4 (B) obesity;
5 (C) stress management;
6 (D) physical fitness;
7 (E) nutrition;
8 (F) substance abuse;
9 (G) depression; and
10 (H) mental health promotion (including
11 anxiety)."

This is some of that workforce input the legislation has. Employers are now responsible, by law, for their employee's well-being. Of course, this is subject to limitations, but the government will be providing funds to those that apply to make it possible.

What is Obamacare Specifically?

So, why are we singling out "Obamacare" in a bill that encompasses so much more? Naturally, because it applied to a great deal of Obama's platform. He promised that he would approach many negative aspects of the healthcare industry while he was running for office, and the ratification of this Bill adds credence to these promises that he rendered. In fact, he also promised to work on the state of the workforce and the state of education, and this Bill actually proves the fulfillment of those promises, as well. I would say that's already more promises kept than most presidents.

In any case, the healthcare-related sections of the legislation remains at the center of discussion, because it's actually rather groundbreaking. It introduces a historical tax relief to give Americans more access to their earned money for needed healthcare. It places a cap on out-of-pocket expenses for Americans when they receive healthcare. Americans rejected for given coverage now have an appeals process through which they can still procure the healthcare they need. Preexisting conditions are no longer a contingency when seeking healthcare. I mean, it's actually nothing to snub your nose at -- it's pretty excellent, and it's precisely what this nation needed in an evolving industry that is ready to unleash an entire new generation of advances in medical science. This legislation will actually help facilitate those advances by making them generally accessible.

In any case, to reference that part of the legislation, you can find it compiled here: http://housedocs.house.gov...

Using this as a basis, I would like to encourage discussion from both sides of the issue (pro an con), while helping those who are undecided (because they don't know enough about it.

Cheers. ^_^
Lordknukle
Posts: 12,788
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 11:35:20 AM
Posted: 4 years ago
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.
"Easy is the descent to Avernus, for the door to the Underworld lies upon both day and night. But to retrace your steps and return to the breezes above- that's the task, that's the toil."
Ren
Posts: 7,102
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 11:52:40 AM
Posted: 4 years ago
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

(I) Under sections 2704 and 2705 of the Public Health
Service Act (as added by section 1201 of this Act), if there
were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will
minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will
lower health insurance premiums. The requirement is essential to creating effective health insurance markets in
which improved health insurance products that are guaranteed issue and do not not exclude coverage of pre-existing
conditions can be sold."

As you can see, this potion of the legislation illustrates precisely what I was referring to when I said:

"it's pretty excellent, and it's precisely what this nation needed in an evolving industry that is ready to unleash an entire new generation of advances in medical science. This legislation will actually help facilitate those advances by making them generally accessible."

It isn't to simply rob companies of their ability to be selective about their clientele. Instead, it makes it possible for most people to access advances that may otherwise remain out of their reach under previous conditions.
Lordknukle
Posts: 12,788
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 11:54:51 AM
Posted: 4 years ago
At 8/12/2012 11:52:40 AM, Ren wrote:
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

(I) Under sections 2704 and 2705 of the Public Health
Service Act (as added by section 1201 of this Act), if there
were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will
minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will
lower health insurance premiums. The requirement is essential to creating effective health insurance markets in
which improved health insurance products that are guaranteed issue and do not not exclude coverage of pre-existing
conditions can be sold."

As you can see, this potion of the legislation illustrates precisely what I was referring to when I said:

"it's pretty excellent, and it's precisely what this nation needed in an evolving industry that is ready to unleash an entire new generation of advances in medical science. This legislation will actually help facilitate those advances by making them generally accessible."

It isn't to simply rob companies of their ability to be selective about their clientele. Inst.ead, it makes it possible for most people to access advances that may otherwise remain out of their reach under previous conditions.

Did you just seriously say that an individual would purchase insurance when they get sick; no insurance company would let them do this.
"Easy is the descent to Avernus, for the door to the Underworld lies upon both day and night. But to retrace your steps and return to the breezes above- that's the task, that's the toil."
Ren
Posts: 7,102
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 12:03:10 PM
Posted: 4 years ago
At 8/12/2012 11:54:51 AM, Lordknukle wrote:
At 8/12/2012 11:52:40 AM, Ren wrote:
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

(I) Under sections 2704 and 2705 of the Public Health
Service Act (as added by section 1201 of this Act), if there
were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will
minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will
lower health insurance premiums. The requirement is essential to creating effective health insurance markets in
which improved health insurance products that are guaranteed issue and do not not exclude coverage of pre-existing
conditions can be sold."

As you can see, this potion of the legislation illustrates precisely what I was referring to when I said:

"it's pretty excellent, and it's precisely what this nation needed in an evolving industry that is ready to unleash an entire new generation of advances in medical science. This legislation will actually help facilitate those advances by making them generally accessible."

It isn't to simply rob companies of their ability to be selective about their clientele. Inst.ead, it makes it possible for most people to access advances that may otherwise remain out of their reach under previous conditions.

Did you just seriously say that an individual would purchase insurance when they get sick; no insurance company would let them do this.

Well, yes, that's why the statement was preceded by the qualifier, "If there were no restrictions."
Wnope
Posts: 6,924
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 12:04:57 PM
Posted: 4 years ago
At 8/12/2012 11:52:40 AM, Ren wrote:
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

(I) Under sections 2704 and 2705 of the Public Health
Service Act (as added by section 1201 of this Act), if there
were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will
minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will
lower health insurance premiums. The requirement is essential to creating effective health insurance markets in
which improved health insurance products that are guaranteed issue and do not not exclude coverage of pre-existing
conditions can be sold."

As you can see, this potion of the legislation illustrates precisely what I was referring to when I said:

"it's pretty excellent, and it's precisely what this nation needed in an evolving industry that is ready to unleash an entire new generation of advances in medical science. This legislation will actually help facilitate those advances by making them generally accessible."

It isn't to simply rob companies of their ability to be selective about their clientele. Instead, it makes it possible for most people to access advances that may otherwise remain out of their reach under previous conditions.

Um...I'm not positive, but I'm fairly sure that this is describing the rationale behind the individual mandate, not the rationale behind pre-existing conditions.
Ren
Posts: 7,102
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 12:13:17 PM
Posted: 4 years ago
At 8/12/2012 12:04:57 PM, Wnope wrote:
At 8/12/2012 11:52:40 AM, Ren wrote:
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

(I) Under sections 2704 and 2705 of the Public Health
Service Act (as added by section 1201 of this Act), if there
were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will
minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will
lower health insurance premiums. The requirement is essential to creating effective health insurance markets in
which improved health insurance products that are guaranteed issue and do not not exclude coverage of pre-existing
conditions can be sold."

As you can see, this potion of the legislation illustrates precisely what I was referring to when I said:

"it's pretty excellent, and it's precisely what this nation needed in an evolving industry that is ready to unleash an entire new generation of advances in medical science. This legislation will actually help facilitate those advances by making them generally accessible."

It isn't to simply rob companies of their ability to be selective about their clientele. Instead, it makes it possible for most people to access advances that may otherwise remain out of their reach under previous conditions.

Um...I'm not positive, but I'm fairly sure that this is describing the rationale behind the individual mandate, not the rationale behind pre-existing conditions.

It's a rationale for both:

"By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act,"

The description of the terms of pre-existing conditions offers no rationale:

"(1) IN GENERAL.—The Secretary may carry out the program under this section directly or through contracts to eligible
entities.
(2) ELIGIBLE ENTITIES.—To be eligible for a contract under
paragraph (1), an entity shall—
(A) be a State or nonprofit private entity;
(B) submit to the Secretary an application at such
time, in such manner, and containing such information as
the Secretary may require; and
(C) agree to utilize contract funding to establish and
administer a qualified high risk pool for eligible individuals.
(3) MAINTENANCE OF EFFORT.—To be eligible to enter into
a contract with the Secretary under this subsection, a State
shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools
during the year preceding the year in which such contract is
entered into.
(c) QUALIFIED HIGH RISK POOL.—
(1) IN GENERAL.—Amounts made available under this section shall be used to establish a qualified high risk pool that
meets the requirements of paragraph (2).
(2) REQUIREMENTS.—A qualified high risk pool meets the
requirements of this paragraph if such pool—
(A) provides to all eligible individuals health insurance
coverage that does not impose any preexisting condition
exclusion with respect to such coverage;
(B) provides health insurance coverage—
(i) in which the issuer's share of the total allowed
costs of benefits provided under such coverage is not
less than 65 percent of such costs; and
(ii) that has an out of pocket limit not greater
than the applicable amount described in section
223(c)(2) of the Internal Revenue Code of 1986 for the
year involved, except that the Secretary may modify
such limit if necessary to ensure the pool meets the actuarial value limit under clause (i);
(C) ensures that with respect to the premium rate
charged for health insurance coverage offered to eligible
individuals through the high risk pool, such rate shall—
(i) except as provided in clause (ii), vary only as
provided for under section 2701 of the Public Health
Service Act (as amended by this Act and notwithstanding the date on which such amendments take effect);
(ii) vary on the basis of age by a factor of not
greater than 4 to 1; and
(iii) be established at a standard rate for a standard population; and
(D) meets any other requirements determined appropriate by the Secretary."

So, in other words, I neatly approached both of his contentions.
Wnope
Posts: 6,924
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 12:22:57 PM
Posted: 4 years ago
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

This is bass-ackwards.

Ideally, the price of a good should be dictated by an interaction of its demand and supply. Excluding certain customers from purchasing this product has no economic benefit for the suppliers.

However, insurance doesn't work this way.

Consider two companies A and B which are competing for market supremacy with an insurance product. They can do this through modifying the quality/ quantity of the product or by excluding certain customers.

The population served by Companies A and B consists of two populations, one which "is likely to remain healthy" and one which "is likely to need medical attention." These represent different risks of the insurer having to pay up.

A plays by normal rules and modifies prices based only supply and demand regardless of customer.

B serves the exact same product at the same price, but they exclude anyone from the "is likely to need medical attention" population from buying.

Over time, A will lose money because they have more high-risk people who cash in on insurance (they have a higher risk pool).

A can only recoup this by dividing the cost of the risk pool among the customers. This forces prices up without any change in quantity or quality while denying "high-risk" people from having any healthcare protection.

If A and B cannot adversely select customers, they must compete with lower prices and higher quality. This rectifies the market failure.

However, one of my main problems with Obamacare is that it does not allow sufficient price discrimination between customers. The answer (which was proposed by some Republicans) would be that insurance companies must have the option of a special high-risk pool for people to buy. The downside (depending on your view) is that this would mean people with pre-existing conditions would have to, on average, pay more for healthcare insurance than those without.
Wnope
Posts: 6,924
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 12:25:55 PM
Posted: 4 years ago
At 8/12/2012 12:13:17 PM, Ren wrote:
At 8/12/2012 12:04:57 PM, Wnope wrote:
At 8/12/2012 11:52:40 AM, Ren wrote:
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

(I) Under sections 2704 and 2705 of the Public Health
Service Act (as added by section 1201 of this Act), if there
were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will
minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will
lower health insurance premiums. The requirement is essential to creating effective health insurance markets in
which improved health insurance products that are guaranteed issue and do not not exclude coverage of pre-existing
conditions can be sold."

As you can see, this potion of the legislation illustrates precisely what I was referring to when I said:

"it's pretty excellent, and it's precisely what this nation needed in an evolving industry that is ready to unleash an entire new generation of advances in medical science. This legislation will actually help facilitate those advances by making them generally accessible."

It isn't to simply rob companies of their ability to be selective about their clientele. Instead, it makes it possible for most people to access advances that may otherwise remain out of their reach under previous conditions.

Um...I'm not positive, but I'm fairly sure that this is describing the rationale behind the individual mandate, not the rationale behind pre-existing conditions.

It's a rationale for both:

"By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act,"

The description of the terms of pre-existing conditions offers no rationale:

"(1) IN GENERAL.—The Secretary may carry out the program under this section directly or through contracts to eligible
entities.
(2) ELIGIBLE ENTITIES.—To be eligible for a contract under
paragraph (1), an entity shall—
(A) be a State or nonprofit private entity;
(B) submit to the Secretary an application at such
time, in such manner, and containing such information as
the Secretary may require; and
(C) agree to utilize contract funding to establish and
administer a qualified high risk pool for eligible individuals.
(3) MAINTENANCE OF EFFORT.—To be eligible to enter into
a contract with the Secretary under this subsection, a State
shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools
during the year preceding the year in which such contract is
entered into.
(c) QUALIFIED HIGH RISK POOL.—
(1) IN GENERAL.—Amounts made available under this section shall be used to establish a qualified high risk pool that
meets the requirements of paragraph (2).
(2) REQUIREMENTS.—A qualified high risk pool meets the
requirements of this paragraph if such pool—
(A) provides to all eligible individuals health insurance
coverage that does not impose any preexisting condition
exclusion with respect to such coverage;
(B) provides health insurance coverage—
(i) in which the issuer's share of the total allowed
costs of benefits provided under such coverage is not
less than 65 percent of such costs; and
(ii) that has an out of pocket limit not greater
than the applicable amount described in section
223(c)(2) of the Internal Revenue Code of 1986 for the
year involved, except that the Secretary may modify
such limit if necessary to ensure the pool meets the actuarial value limit under clause (i);
(C) ensures that with respect to the premium rate
charged for health insurance coverage offered to eligible
individuals through the high risk pool, such rate shall—
(i) except as provided in clause (ii), vary only as
provided for under section 2701 of the Public Health
Service Act (as amended by this Act and notwithstanding the date on which such amendments take effect);
(ii) vary on the basis of age by a factor of not
greater than 4 to 1; and
(iii) be established at a standard rate for a standard population; and
(D) meets any other requirements determined appropriate by the Secretary."

So, in other words, I neatly approached both of his contentions.

Ah, didn't realize they got the high-risk pool thing in there. That's good.
16kadams
Posts: 10,497
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 12:30:48 PM
Posted: 4 years ago
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

I disagree. Well... depends.

If you are paying for a service, for years, and you get cancer they should not be allowed to drop you as you paid for the service.

If you never paid them, and they drop you for being a cancer patient, then I am undecided. As it seems logical to allow them acess as otherwise they will use the ER. The insurance would get paid via premiums and pay for the care then. And then [hopefully] keep them longer. But I see how it hurts the free market.

I dunno, though I would prefer my insurance accepts me regardless of my asthma (they almost denied be because of that).
https://www.youtube.com...
https://rekonomics.wordpress.com...
"A trend is a trend, but the question is, will it bend? Will it alter its course through some unforeseen force and come to a premature end?" -- Alec Cairncross
MrBrooks
Posts: 831
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 12:46:02 PM
Posted: 4 years ago
However, insurance doesn't work this way.

It does actually, but not if you put it into over-simplified, black and white terms like you are now.

Consider two companies A and B which are competing for market supremacy with an insurance product. They can do this through modifying the quality/ quantity of the product or by excluding certain customers.

These two companies will compete, you are right, and the competition will provide a better product for the consumer. This isn't true in the current system though, because the current system curves competition and forces unnatural regulations upon insurance companies.

The population served by Companies A and B consists of two populations, one which "is likely to remain healthy" and one which "is likely to need medical attention." These represent different risks of the insurer having to pay up.

Over-simplification, but for argument's sake we'll say that there are indeed only two groups.

A plays by normal rules and modifies prices based only supply and demand regardless of customer.

A has a poor business strategy, because it is charging everyone the same price regardless of their pre-existing conditions. Nearly all other insurance industries charge different rates based on pre-existing conditions; car insurance companies charge different rates based on age, gender, and driving record.

B serves the exact same product at the same price, but they exclude anyone from the "is likely to need medical attention" population from buying.

B also has a poor strategy, because they are losing customers. While it is true that they'll be more likely to pay out, they'll still be able to make money if they charge higher rates for higher risk clients.

A can only recoup this by dividing the cost of the risk pool among the customers. This forces prices up without any change in quantity or quality while denying "high-risk" people from having any healthcare protection.

This is why insurance companies should be allowed to charge whatever rates consumers are willing to pay, rather than having government institute price controls.

If A and B cannot adversely select customers, they must compete with lower prices and higher quality. This rectifies the market failure.

The problem with insurance companies isn't a market failure, it is a government failure.

However, one of my main problems with Obamacare is that it does not allow sufficient price discrimination between customers.

We agree at least on that point.

The answer (which was proposed by some Republicans) would be that insurance companies must have the option of a special high-risk pool for people to buy.

If you remove the regulations, insurance companies that specifically cater to those in the high-risk pool will form, because there will be a demand for such insurance. The prices will be high, but at least you'll have coverage.

The downside (depending on your view) is that this would mean people with pre-existing conditions would have to, on average, pay more for healthcare insurance than those without.

Reality sucks, doesn't it?
Lordknukle
Posts: 12,788
Add as Friend
Challenge to a Debate
Send a Message
8/12/2012 2:41:42 PM
Posted: 4 years ago
At 8/12/2012 12:30:48 PM, 16kadams wrote:
At 8/12/2012 11:35:20 AM, Lordknukle wrote:
Other than the individual mandate, the worst part of the legislation is the insurance companies cannot choose people based on pre-existing conditions, which skews the whole market and makes adverse selection an extremely large problem.

I disagree. Well... depends.

If you are paying for a service, for years, and you get cancer they should not be allowed to drop you as you paid for the service.

They can't drop you. We are talking about trying to buy insurance- not already bought insurance.

If you never paid them, and they drop you for being a cancer patient, then I am undecided.

Er.... If you didn't pay them then they have no obligation to do anything to you.

As it seems logical to allow them acess as otherwise they will use the ER. The insurance would get paid via premiums and pay for the care then. And then [hopefully] keep them longer. But I see how it hurts the free market.

No idea what you are saying here.

I dunno, though I would prefer my insurance accepts me regardless of my asthma (they almost denied be because of that).

What you prefer=/=What is good for the company
"Easy is the descent to Avernus, for the door to the Underworld lies upon both day and night. But to retrace your steps and return to the breezes above- that's the task, that's the toil."