CHART: 'Winners And Losers From Obamacare'

[Kitsune]

http://talkingpointsmemo.com/livewire/c ... -obamacare

CHART: 'Winners And Losers From Obamacare'

Igor Bobic – October 31, 2013, 3:13 PM EDT11924

University of Michigan professor and senior Brookings fellow Justin Wolfers on Thursday created a chart depicting the "winners and losers" under the Affordable Care Act, sourced to a Ryan Lizza article that used estimates from M.I.T. economist Jon Gruber, a former adviser to Mitt Romney.

The chart portrays the degree to which Republicans and critics of Obamacare have amplified the media's coverage around the relatively small percentage of Americans who have received cancellation notices for stripped-down individual market plans that failed to meet the benefit requirements of the ACA.

Gruber, called the architect of Romney's successful health care plan in Massachusetts, argues that of the six percent of Americans who buy their own health care on the individual market, three percent would have negligible change to their policies. He also addresses President Obama's memorable but over-simplified promise, that if you like your plan, you would be able to keep it. From Lizza's writeup:

“We’ve decided as a society that we don’t want people to have insurance plans that expose them to more than six thousand dollars in out-of-pocket expenses,” Gruber said. Obama obviously should have known that his blanket statement about “keeping what you have” could not apply to this class of policyholders.

Gruber summarized his stats: ninety-seven per cent of Americans are either left alone or are clear winners, while three per cent are arguably losers. “We have to as a society be able to accept that,” he said. “Don’t get me wrong, that’s a shame, but no law in the history of America makes everyone better off.”

[Knife]

Yeah, I've been listening to the whole 'you told us we could keep ours' choir this week, and it's silly. Not Obama's nor ACA's fault that insurance companies had really shitty deals out there prior to this.

[TheHammer]

Knife, the problem is the majority of the people who had those sub-standard plans (and wanted to keep them) were too stupid to understand why they couldn't keep them. If they'd had any sense they wouldn't have paid for the shitty plans to begin with.

[Gaidin]

re: 'you told us we could keep ours' choir, the thing I keep hearing is that their plans were grandfathered in, but the plans that were grandfathered in were changed between now and when the law was passed anyway, making them no longer grandfathered in anyway. Granted, I keep hearing this as I walk by tvs in break areas at work, and have no source I can link so...grain of salt or entire salt shaker if you desire. I've hardly kept up on the details of what doesn't effect me of that law.

[Grumman]

Their definition of "clear winners" is flawed. Being forced to buy a product from a third party for 25% more than it is worth is not a win.

[TimothyC]

Got to love how that graphic ignores the costs associated with the new plans.

President Obama repeatedly assured Americans that after the Affordable Care Act became law, people who liked their health insurance would be able to keep it. But millions of Americans are getting or are about to get cancellation letters for their health insurance under Obamacare, say experts, and the Obama administration has known that for at least three years.

Four sources deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a “cancellation” letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience “sticker shock.”

None of this should come as a shock to the Obama administration. The law states that policies in effect as of March 23, 2010 will be “grandfathered,” meaning consumers can keep those policies even though they don’t meet requirements of the new health care law. But the Department of Health and Human Services then wrote regulations that narrowed that provision, by saying that if any part of a policy was significantly changed since that date -- the deductible, co-pay, or benefits, for example -- the policy would not be grandfathered.

Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, “the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.”

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

Yet President Obama, who had promised in 2009, “if you like your health plan, you will be able to keep your health plan,” was still saying in 2012, “If [you] already have health insurance, you will keep your health insurance.”

“This says that when they made the promise, they knew half the people in this market outright couldn’t keep what they had and then they wrote the rules so that others couldn’t make it either,” said Robert Laszewski, of Health Policy and Strategy Associates, a consultant who works for health industry firms. Laszewski estimates that 80 percent of those in the individual market will not be able to keep their current policies and will have to buy insurance that meets requirements of the new law, which generally requires a richer package of benefits than most policies today.

The White House does not dispute that many in the individual market will lose their current coverage, but argues they will be offered better coverage in its place, and that many will get tax subsidies that would offset any increased costs.

“One of the main goals of the law is to ensure that people have insurance they can rely on – that doesn’t discriminate or charge more based on pre-existing conditions. The consumers who are getting notices are in plans that do not provide all these protections – but in the vast majority of cases, those same insurers will automatically shift their enrollees to a plan that provides new consumer protections and, for nearly half of individual market enrollees, discounts through premium tax credits,” said White House spokesperson Jessica Santillo.

“Nothing in the Affordable Care Act forces people out of their health plans: The law allows plans that covered people at the time the law was enacted to continue to offer that same coverage to the same enrollees – nothing has changed and that coverage can continue into 2014,” she said.

Individual insurance plans with low premiums often lack basic benefits, such as prescription drug coverage, or carry high deductibles and out-of-pocket costs. The Affordable Care Act requires all companies to offer more benefits, such as mental health care, and also bars companies from denying coverage for preexisting conditions.

Today, White House spokesman Jay Carney was asked about the president’s promise that consumers would be able to keep their health care. “What the president said and what everybody said all along is that there are going to be changes brought about by the Affordable Care Act to create minimum standards of coverage, minimum services that every insurance plan has to provide,” Carney said. “So it's true that there are existing healthcare plans on the individual market that don't meet those minimum standards and therefore do not qualify for the Affordable Care Act.”

Other experts said that most consumers in the individual market will not be able to keep their policies. Nancy Thompson, senior vice president of CBIZ Benefits, which helps companies manage their employee benefits, says numbers in this market are hard to pin down, but that data from states and carriers suggests “anywhere from 50 to 75 percent” of individual policy holders will get cancellation letters. Kansas Insurance Commissioner Sandy Praeger, who chairs the health committee of the National Association of Insurance Commissioners, says that estimate is “probably about right.” She added that a few states are asking insurance companies to cancel and replace policies, rather than just amend them, to avoid confusion.

A spokesman for America's Health Plans says there are no precise numbers on how many will receive cancellations letters or get notices that their current policies don’t meet ACA standards. In both cases, consumers will not be able to keep their current coverage.

Those getting the cancellation letters are often shocked and unhappy.

George Schwab, 62, of North Carolina, said he was "perfectly happy" with his plan from Blue Cross Blue Shield, which also insured his wife for a $228 monthly premium. But this past September, he was surprised to receive a letter saying his policy was no longer available. The "comparable" plan the insurance company offered him carried a $1,208 monthly premium and a $5,500 deductible.

And the best option he’s found on the exchange so far offered a 415 percent jump in premium, to $948 a month.

"The deductible is less," he said, "But the plan doesn't meet my needs. Its unaffordable."

"I'm sitting here looking at this, thinking we ought to just pay the fine and just get insurance when we're sick," Schwab added. "Everybody's worried about whether the website works or not, but that's fixable. That's just the tip of the iceberg. This stuff isn't fixable."

Heather Goldwater, 38, of South Carolina, is raising a new baby while running her own PR firm. She said she received a letter last July from Cigna, her insurance company, that said the company would no longer offer her individual plan, and promised to send a letter by October offering a comparable option. So far, she hasn't received anything.

"I'm completely overwhelmed with a six-month-old and a business,” said Goldwater. “The last thing I can do is spend hours poring over a website that isn't working, trying to wrap my head around this entire health care overhaul."

Goldwater said she supports the new law and is grateful for provisions helping folks like her with pre-existing conditions, but she worries she won’t be able to afford the new insurance, which is expected to cost more because it has more benefits. "I'm jealous of people who have really good health insurance," she said. "It's people like me who are stuck in the middle who are going to get screwed."

Richard Helgren, a Lansing, Mich., retiree, said he was “irate” when he received a letter informing him that his wife Amy's $559 a month health plan was being changed because of the law. The plan the insurer offered raised his deductible from $0 to $2,500, and the company gave him 17 days to decide.

The higher costs spooked him and his wife, who have painstakingly planned for their retirement years. "Every dollar we didn't plan for erodes our standard of living," Helgren said.

Ulltimately, though Helgren opted not to shop through the ACA exchanges, he was able to apply for a good plan with a slightly lower premium through an insurance agent.

He said he never believed President Obama’s promise that people would be able to keep their current plans.

"I heard him only about a thousand times," he said. "I didn't believe him when he said it though because there was just no way that was going to happen. They wrote the regulations so strictly that none of the old polices can grandfather."

For months, Laszewski has warned that some consumers will face sticker shock. He recently got his own notice that he and his wife cannot keep their current policy, which he described as one of the best, so-called "Cadillac" plans offered for 2013. Now, he said, the best comparable plan he found for 2014 has a smaller doctor network, larger out-of-pocket costs, and a 66 percent premium increase.

“Mr. President, I like the coverage I have," Laszweski said. "It is the best health insurance policy you can buy."

It's almost as if the administration and the democrats who passed the ACA were to short-sighted to see that forcing an increase of coverage (both of individuals who are higher risk and of more expensive treatments*) was going to drive up costs.

*I am for both of these, but anyone with a brain could have told you that costs were going to go up.

[Vehrec]

I'm not sure why you expect the costs of the american health-care system to be anything like logical when they obviously aren't. I mean, people with pre-existing conditions make nice scapegoats, but they even when they didn't have insurrance, the cost of health care in this country was still really crazily high, and that has nothing to do with the fact that it was mandated or not and everything to do with the fact that some people will pay out any amount to stay alive and healthy. Even just alive in a pinch. Health care isn't really something that can have a true free market, because at the end of the day, the provider sets whatever cost they like and the buyer has to pay it if they want to stay alive.

[Kitsune]

Notice the article is kind of tricky as well

Ultimately, though Helgren opted not to shop through the ACA exchanges, he was able to apply for a good plan with a slightly lower premium through an insurance agent.

[Connor MacLeod]

Remember we're 'winners' in the sense we got any actual improvement at all, rather than actually, you know, getting the single payer which would have been the sane option.

We know who we can blame for that though (and yes I leave that deliberately vague lol).

[aerius]

You have a clusterfuck of a system, which no can understand and confuses the shit out of everyone, and enables & encourages health insurance companies to engage in monopoly cartel practices, plus it gets the IRS involved in everyone's books to ensure that everything is compliant with that 2000 page screwup. I'm having a hard time finding any winners in this other than the healthcare industry and the IRS.

[Dominus Atheos]

re: 'you told us we could keep ours' choir, the thing I keep hearing is that their plans were grandfathered in, but the plans that were grandfathered in were changed between now and when the law was passed anyway, making them no longer grandfathered in anyway.

Yes, exactly. Actually this was predicted back in 2010 by the Department of Health and Human Services:

...40 percent to 67 percent of individual policies will lose grandfathered status by 2011;

[Irbis]

It's almost as if the administration and the democrats who passed the ACA were to short-sighted to see that forcing an increase of coverage (both of individuals who are higher risk and of more expensive treatments*) was going to drive up costs.

You mean, like when that Evil Muslim Obama killed single payer, you know, that option that was actually supposed to drive these costs down?

[energiewende]

They could still do that: just legislate maximum coverage rather than minimum, and limit liability.

[PainRack]

Got to love how that graphic ignores the costs associated with the new plans.

It's almost as if the administration and the democrats who passed the ACA were to short-sighted to see that forcing an increase of coverage (both of individuals who are higher risk and of more expensive treatments*) was going to drive up costs.

*I am for both of these, but anyone with a brain could have told you that costs were going to go up.

........ Given that literally 2/3 of the bill was focused ENTIRELY on how to meet said costs and either raise revenue or control it, you're trying to score a cheap political trick here.


The real problem is that Obama promised something that he couldn't deliver, namely, that most people would keep their plans, this even as his law mandated that said plans must be changed and laws about grandfathering in and etc etc etc.

Meanwhile, your own source is ignoring how insurance plans preniums rise routinely, and so far, MOST of the price increases are entirely within norm. They aren't lower, but neither are they higher.

The drastic price changes are actually for those Americans who were covered by low cost, catastrophic insurance which are no longer available. They were supposed to be grandfathered in but a mixture of ignorance on both the government and private sector meant that nobody acted to prevent policies from not being grandfathered in.

[Patroklos]

That 80% is only unaffected because business implementation was delayed. The idea that the same thing isn't going to happen then is wishful thinking and the delay a great example of who Obama cares about and doesn't.

[xthetenth]

I just got done with going to a doctor for everything that could be going wrong soon because the health insurance plan I've got has had its price raised to the point it's simply unaffordable for my family. So now we're looking at a $500 increase in premiums for a plan with ten times the deductible and my retired mother is talking about having to get a job after a good deal we got for a year and only a year ends.

I'm not sure if it's just a thing in North Carolina or the rest of the country, but what we're looking like is pretty similar to the guy in North Carolina in Timothy's article. I've got a sneaking suspicion it might be a regional experience because did anybody else notice that all the bad stories in that article are from states with Republican governors? If I remember right there's been a strong correlation between that and other problems with the whole program.

[Losonti Tokash]

Have you tried checking the health care exchange? If you're not able to get in through the website you can call the helpline and they'll be able to help you out and see what kind of subsidies you'd be able to get through there. The insurance plans offered outside of the exchanges aren't eligible for those subsidies so you'd need to check through the exchange itself.

[xthetenth]

Yeah, it's a huge mess. We've found a decent enough plan that'll last a year, which should be enough time to see if there's anything good out there for longer.

[Kitsune]

Yeah, it's a huge mess. We've found a decent enough plan that'll last a year, which should be enough time to see if there's anything good out there for longer.

What program, when it first starts out, is not a mess. . .

[Kitsune]

Aways check prices on the exchange

http://talkingpointsmemo.com/dc/insuran ... -obamacare

Special Investigation: How Insurers Are Hiding Obamacare Benefits From Customers

Dylan Scott – November 4, 2013, 5:13 AM EST221909

Donna received the letter canceling her insurance plan on Sept. 16. Her insurance company, LifeWise of Washington, told her that they'd identified a new plan for her. If she did nothing, she'd be covered.

A 56-year-old Seattle resident with a 57-year-old husband and 15-year-old daughter, Donna had been looking forward to the savings that the Affordable Care Act had to offer.

But that's not what she found. Instead, she'd be paying an additional $300 a month for coverage. The letter made no mention of the health insurance marketplace that would soon open in Washington, where she could shop for competitive plans, and only an oblique reference to financial help that she might qualify for, if she made the effort to call and find out.

Otherwise, she'd be automatically rolled over to a new plan -- and, as the letter said, "If you're happy with this plan, do nothing."

If Donna had done nothing, she would have ended up spending about $1,000 more a month for insurance than she will now that she went to the marketplace, picked the best plan for her family and accessed tax credits at the heart of the health care reform law.

"The info that we were sent by LifeWise was totally bogus. Why the heck did they try to screw us?" Donna said. "People who are afraid of the ACA should be much more afraid of the insurance companies who will exploit their fear and end up overcharging them."

Donna is not alone.

Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies' own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces -- which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.

The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.

The insurance companies argue that it's simply capitalism at work. But regulators don't see it that way. By warning customers that their health insurance plans are being canceled as a result of Obamacare and urging them to secure new insurance plans before the Obamacare launched on Oct. 1, these insurers put their customers at risk of enrolling in plans that were not as good or as affordable as what they could buy on the marketplaces.

TPM has confirmed two specific examples where companies contacted their customers prior to the marketplace's Oct. 1 opening and pushed them to renew their health coverage at a higher price than they would pay through the marketplace. State regulators identified the schemes, but they weren't necessarily able to stop them.

It's not yet clear how widespread this practice became in the months leading up to the marketplace's opening -- or how many Americans will end up paying more than they should be for health coverage. But misleading letters have been sent out in at least four states across the country, and one offending carrier, Humana, is a company with a national reach.

"If you're an insurance company, you're trying to hang onto the consumers you have at the highest price you can get them," Laura Etherton, a health policy analyst at the U.S. Public Interest Research Group, told TPM. "You can take advantage of the confusion about what people get to have now. It's a new world. It's disappointing that insurance companies are sending confusing letters to consumers to take advantage of that confusion. The reality is that this could do real harm."

_____

Before Obamacare, Donna paid a $724 monthly premium for $10,000 deductible, catastrophic health coverage from LifeWise, a subsidiary of the state's Blue Cross/Blue Shield affiliate. She asked that TPM withhold her last name because she was disclosing personal financial information.

The Sept. 16 letter from LifeWise told her that her existing plan was being canceled to comply with the new requirements of Obamacare and that she would automatically be rolled over into a new plan that was the "closest match" to her old plan. "If we don't hear from you, we'll automatically move you to this plan and you'll be covered starting January 1, 2014," the notice read.

Under the new LifeWise plan, Donna would have to pay more than $1,000 a month, a nearly $300 per month increase and a huge hit for a family with an income around $40,000. It was bare-bones coverage by ACA standards, with a $6,350 deductible.

The letter, which you can read here, made no mention of the insurance marketplace that was about to open, where she could shop around for other options. It did mention that she might qualify for financial help in the form of a tax credit but the onus was on Donna to call the insurer for more information.


Fast forward a month, and Donna was able to log onto Washington's marketplace and shop for insurance. And what did she find? Options. A LifeWise plan with the same deductible they offered her outside the exchange was a little cheaper. Plans with a lower deductible had the same or lower premiums as the LifeWise plan. What she ended up buying was a plan through Community Health Plan of Washington with a $250 deductible.

And crucially, she also discovered she would qualify for a federal tax subsidy that would knock her monthly premium to $80. Her daughter could enroll in Medicaid, at no cost to the family.

So here's the bottom line: If Donna had taken the default option that LifeWise offered outside of the marketplace, she would have paid nearly $1,000 more per month for a worse plan than she was able to obtain on the marketplace.

A LifeWise spokesman told TPM that the Washington marketplace had done plenty of its own advertising and the company assumes that customers know they have other options. He also noted that more information was available on the company's website.

"Our experience is that our customers are already aware that they have other options in the market and that we've never had to tell them in the past that we have competitors," Eric Earling, director of corporate communications at Premera Blue Cross/Blue Shield, said. "We knew that (the marketplace) would have a robust marketing campaign for themselves and knew they didn't need any additional help from us."

As a result of the letter LifeWise sent to Donna and other customers, state regulators in Washington issued a consumer alert on Sept. 19, warning residents about the misleading information. "Don't just take what your insurance company says, make sure you shop around. You have the right to buy any plan inside the new exchange or in the outside market," Insurance Commissioner Mike Kreidler said in the alert.

But the agency doesn't have the statutory authority to stop LifeWise from sending the misleading letters, a spokeswoman told TPM. The company controls one-third of the state's 300,000-person individual health insurance market -- leaving a lot of people at risk of being duped.

"Yes, that's possible," Stephanie Marquis, the spokeswoman, said when asked if some Washingtonians could be paying much more for insurance than they could if they went on the exchange because of LifeWise's actions.

"One of our concerns has been that people don't know they have these new rights," Marquis said. "The insurance companies can manipulate or withhold that information to increase their market share. It's just really disingenuous."

_____

Donna's experience isn't an isolated incident, however. And the wider spread the issue is, the likelier it becomes that some people have been manipulated into spending more for insurance than they should.

Kentucky fined Louisville-based Humana for sending out letters with similarly misleading information to customers in that state. They received complaints about an Aug. 21 letter that pressed customers to renew their policy now or risk increased rates under Obamacare.

But like LifeWise, Humana downplayed the fact that people could search the marketplace for other insurance options or that they might qualify for Obamacare's financial assistance, state insurance commissioner Sharon Clark, pictured, told TPM in an interview. A footnote referenced the "open enrollment period" that started Oct. 1. Humana directed customers to their website for more information, but offered no further explanation.

After receiving the letter, which you can read here, some customers were badgered through phone calls to make a decision, Clark said. Of the 6,500 people who received a letter, 2,200 actually responded and gave the company their answer before they had a chance to look at what the Kentucky marketplace had to offer.

But Clark's office soon stepped in. They fined Humana $65,000 for the "misleading" information, and the 2,200 respondents were released from their obligation to Humana and freed to shop for insurance through the Obamacare marketplace starting Oct. 1.

The most troubling part of the Humana case is that the company was pushing customers into a Humana insurance plan that was more expensive than the plan Humana was selling on the Obamacare marketplace, without the financial help available under Obamcare.

Clark gave the example of a single mother with children who was urged to sign up for a Humana plan with a monthly premium of $719.86. That price is higher than any comparable plan for sale on the state's insurance marketplace, Clark said -- not to mention that the mother might have qualified for tax subsidies to help pay for it if she went through the marketplace, as Donna did.

"People don't think about insurance every day," Clark said, "and in an environment with so many changes, this has been a period of confusion and uncertainty for people."

Colorado regulators also received complaints about a similar Humana letter, dated Aug. 28 on a copy obtained by TPM, that went out to 3,400 customers in their state.

It explained options available on the Obamacare marketplace and financial help in, again, a footnote. The company wasn't fined as it was in Kentucky, but state officials forced Humana to send out an apology and a corrected letter that met the state's standards.

"The letter appeared threatening," Vincent Plymell, a spokesman for the state insurance department, told TPM. "You've got to let people know their options. You can't make it seem like they have to stick with your company."

State officials in Missouri also told TPM that they have received complaints about misleading letters from Humana and were in the process of investigating them.

Asked by TPM about the Kentucky letter that resulted in a fine, Humana senior vice president for corporate communications Tom Noland offered the following statement via email, but declined to comment further.

"In retrospect, the letter could have been more consumer-friendly and we've rewritten it with that in mind. We are continuing to work closely with the Department of Insurance to ensure our messaging is clear and not adding confusion to consumers during this period of adjustment and transition."

Clark, the Kentucky insurance commissioner, told TPM that Humana executives had told state officials that there had been "a major disconnect" between the marketing and government compliance arms of the company.

"That was the excuse they gave us," she said. "That was the rationale."

"This is a great example of the kind of consumer abuses that are typical of the insurance industry, and they're supposed to stop under the ACA," Ethan Rome, executive director of Health Care For America Now, a pro-Obamacare advocacy group, told TPM. "In this case, they're trying to get in just one more abuse."

[Grumman]

http://talkingpointsmemo.com/dc/insuran ... -obamacare

This is the second time the same idiotic decision has caused problems. Advertising the exchanges is a task that should have been handled at the federal level. It should not have been passed down to the states so the same job could be done fifty times over, and it should not have been passed down even further to individual insurers.

The second is especially stupid: you're a bloody moron if your plan hinges on insurers advertising to their preexisting customers when the primary market for your service is people who aren't preexisting customers, let alone expecting them to advertise their competitors' products out of the goodness of their hearts.

[Kitsune]

http://talkingpointsmemo.com/dc/insuran ... -obamacare

This is the second time the same idiotic decision has caused problems. Advertising the exchanges is a task that should have been handled at the federal level. It should not have been passed down to the states so the same job could be done fifty times over, and it should not have been passed down even further to individual insurers.

The second is especially stupid: you're a bloody moron if your plan hinges on insurers advertising to their preexisting customers when the primary market for your service is people who aren't preexisting customers, let alone expecting them to advertise their competitors' products out of the goodness of their hearts.

Isn't it the Republican way that the market by itself is the best way. . . .Yet, now they are against it
One item I ws reading is that if you are privately insured, the turnover since 2010 when signed) means that very few are actually covered by grandfather clauses.
My personal thought are that these insurance companies are using using Obamacare as an excuse for their games.

[aerius]

My personal thought are that these insurance companies are using using Obamacare as an excuse for their games.

Of course they are. Obamacare is essentially a healthcare industry protection racket, what do expect the insurance companies to do, suddenly grow a conscience? Of course not, they're going to milk it for all it's worth and suck everyone dry.

[Kitsune]

Have an interesting idea. . . .How about state ballot initiatives for socialized medicine
Suspect in many of the more liberal states, it would pass