Healthcare Reform

[HALL85]

FWIW, here is an update on what is happening down in D.C. on healthcare:

Despite what seems as everyone is involved in the investigations, the Rep. Senate leadership is spending about 70% of their time devoted to getting a bill through before August, maybe sooner. They have asked bi-partisan support, but no Dems have expressed any interest in helping. The "replacement" bill will have several limitations because of those procedural issues which requires a direct budget impact with less than 60% support. So you will not see anything with regards to tort reform, selling insurance across lines, etc. in the replacement bill.

The two issues that will be addressed are:
1) Medicaid-Plan is to keep Medicaid expansion at the state level, but reduce federal funding from 90% to eventually 58%. As you can imagine, the 30 states (governors) are not happy with that, but the feeling is that they unanimously agreed it is critical to keep it, so they should try to figure out how to fund more. Sen. Portman and Toomey are driving this. They are also proposing putting growth limits on Medicaid that tie to inflation (Medicaid has been growing at a much faster rate and it's the number one component of what's driving the overall costs).
2) Subsidies to families-Plan is to deregulate some of the mandates to enable insurers to offer a more diverse set of plans that have choices/lower costs/less service. Goal is to shift more power back to the patient rather than have government determine their choice.

From an objective view, this does slow the collapse created by the ACA, but IMO doesn't get at the real issues that could "bend the curve". 99% sure we'll see something passed.

Couple of other things:
* It may seem like not much, but the recent legislation that was passed re: the VA, enables management to be fired more easily than before. The most damaging thing in the VA today is the ingrained culture that needs to change, so you need to cut it off at the neck. The new head of the VA (David Shulkin) is a hard-ass (reputation he had when he was CEO at Morristown Memorial).
* The 98-2 vote on reducing the President's authority (eliminating the Unilateral Waiver Authority) on removing sanctions was partially because the Senate felt uncomfortable with Trump having too much authority, but equally to prevent what happened with Obama and Iran.
* Tax reform will be next up after healthcare. Most of the energy will be spent on corporate tax reductions, with less on personal.

 

[Merge]

They have asked bi-partisan support, but no Dems have expressed any interest in helping.

Lol. Obama would have loved bipartisan support for the ACA! You said it was the democrats fault for - "lack of leadership" not getting republicans on board with the ACA, and now it's the democrats fault because they haven't expressed any interest in dismantling the ACA?

This is political posturing by the democrats the same as it was by republicans in 2010. Republicans gambled in 2010 that it would help them in the midterms and dems are doing the same thing now.

Was wrong by republicans, and is wrong by democrats now. The public will hate congress but it is always the fault of every other congressman other than their own and nothing will change

 

[HALL85]

Lol. Obama would have loved bipartisan support for the ACA! You said it was the democrats fault for - "lack of leadership" not getting republicans on board with the ACA, and now it's the democrats fault because they haven't expressed any interest in dismantling the ACA?

This is political posturing by the democrats the same as it was by republicans in 2010. Republicans gambled in 2010 that it would help them in the midterms and dems are doing the same thing now.

Was wrong by republicans, and is wrong by democrats now. The public will hate congress but it is always the fault of every other congressman other than their own and nothing will change

That's the one thing you took away from my post??? wow....

 

[Merge]

That's the one thing you took away from my post??? wow....

No. The rest has been in the news. You laid out what is currently happening. Republicans will likely pass a bill through budget reconciliation the same way the democrats did, and it will be politically damaging to the party.

We've debating the finer points on here many times, I think what is expected to pass will be a mistake and like you said does nothing to address bending the cost curve.

My comment to you was that you always cry partisanship against liberals here, but have taken both sides of the same argument to blame democrats on healthcare reform.

 

[HALL85]

No. The rest has been in the news. You laid out what is currently happening. Republicans will likely pass a bill through budget reconciliation the same way the democrats did, and it will be politically damaging to the party.

We've debating the finer points on here many times, I think what is expected to pass will be a mistake and like you said does nothing to address bending the cost curve.

My comment to you was that you always cry partisanship against liberals here, but have taken both sides of the same argument to blame democrats on healthcare reform.

I should have clarified. Everything I posted was spoken by a politician intimately involved in the process. My only opinion in that post was that one paragraph about the chances for passing and expected outcome.

 

[Merge]

I should have clarified. Everything I posted was spoken by a politician intimately involved in the process. My only opinion in that post was that one paragraph about the chances for passing and expected outcome.

My mistake. I apologize for jumping on you.

Point still stands about how politicians are playing this though. It's just a game to them with zero impact on their lives. Just wish a few of them would have the balls to sand up to their party on both sides.

 

[HALL85]

My mistake. I apologize for jumping on you.

Point still stands about how politicians are playing this though. It's just a game to them with zero impact on their lives. Just wish a few of them would have the balls to sand up to their party on both sides.

Fair enough...agree. The day Congress is subject to healthcare legislation like the rest of us, I will take them seriously. For the record IMO, both parties have failed us on healthcare.

 

[Section112]

I commented on an article in the WSJ the other day about this plan. To summarize my quote I asked when the knuckleheads on both sides of the aisle were going to address getting small businesses into larger pools and tort reform. These two issues have been a big problem and neither party has the balls to address them because it would mean the insurance companies and lawyers will make less money. It was the most liked comment on the article by far. This is why our politicians suck - they are bought and paid for by the biggest lobbies and simple, common-sensical ideas are not even being addressed. Sad. ACA sucked and this new bill they are discussing will equally suck. Same shit different party or day.

 

[knowknow456]

To summarize my quote I asked when...both sides of the aisle were going to address getting small businesses into larger pools and tort reform.

Tort reform is always a good thing, but can you elaborate a little more on small businesses in larger pools? I don't understand how that would work.

 

[knowknow456]

Here is how I understand it - Say Business #1 has a health cost factor of x. Business #2 has a cost of x+3 because their corporate population is older and generally sicker. Business #3 would normally be x+1 but due to some unfortunate luck (catastrophic workplace injury and a rare cancer) their rating is x+4.

People with bad experiences are happy to join a pool; the good experience businesses prefer to go it alone. How do you incentivize group 1 to get in and stay in the pool?

 

[Section112]

You don't share with one or two businesses. You create a large pool of small businesses to create a balanced pool of insureds. No different than a large corporation with many employees having a policy with one insurer bringing a large pool. This is not brain surgery and has been done in the past by a few states and with ACA went away. NY used to have a small business pool through a small business consortium. NJ would do it in a second with NJBIA if the insurance companies and politicians would play ball. As far as incentives go the cost might be a little higher in the beginning until more small business owners join. But it would inevitably get better as more join and it would have to be less expensive right from the outset than going it alone which has become crazy expensive. Most small business owners are looking at a 10-20% increase in the coming year per some recent articles, have lousy coverage at a high expense with high-copays and high deductibles. It is a disincentive to insure your employees (even though we do anyway) because the cost is so high.

 

[knowknow456]

You don't share with one or two businesses.

Understood. However, whether the group is 3 or 300 or 3,000, you wind up with some combination of the good the bad and the unlucky. In theory small groups banding together provide greater leverage when shopping for insurance. But even under ACA healthy small business premiums rise less than sick company premiums.

Healthy companies will stay on the sidelines until the whole new structure works out. Insurance companies are not interested in setting up small business pools until they know the pool will be representative of the whole and not just a high risk pool posing as a small business pool.

 

[Section112]

Understood. However, whether the group is 3 or 300 or 3,000, you wind up with some combination of the good the bad and the unlucky. In theory small groups banding together provide greater leverage when shopping for insurance. But even under ACA healthy small business premiums rise less than sick company premiums.

Healthy companies will stay on the sidelines until the whole new structure works out. Insurance companies are not interested in setting up small business pools until they know the pool will be representative of the whole and not just a high risk pool posing as a small business pool.

You sound like a politician who sponsored ACA or worse a health insurance company exec or actuary. You have all the apologies down pat. I'd suggest talking to some real business owners to see what is actually happening. Small business pools would certainly save money for insureds and possibly make money for insurance companies if they were able to attract more insureds. They can manage their risk by looking at the different geographies and the general health of the insureds in those geographies. Small companies are no more or less healthy than big ones. Big difference though is that small company owners have to go to work or they don't make any money. You can always use the excuse you used above about the new structure coming or a new congress coming in or Pres? Bottom line is, doing nothing is better for them. They can either be very profitable or back out of a state which is what they are doing to manage risk and I can't blame them. But again if the politicians really gave a shit about the small businesses that significantly impact the US economy, they would be looking to help small businesses get into larger pools which has long been discussed with no action. The silence or lack of action answers the question. Rand Paul is the only Senator I know who has brought this up and he continues to push it but to no avail because the big money usually wins.

 

[knowknow456]

if they were able to attract more insureds.

Attracting more insureds in a pool does not help if they aren’t healthy insureds.

Everyone has to go to work or they don’t make any money. The cost of health insurance is one cost component of a business. If the small business owner gets sick and dies, being in a pool does not help the other workers who are now presumably out of jobs.

Companies that perceive their employee census is healthier than the average census will be disinclined to join a pool unless they are given an incentive. That’s the way it is and in your own way you agree with it. How do you get those people in the pool?

 

[Section112]

You are talking about big companies again. You don't seem to get it. I can tell you that insurance companies do not tell small businesses if they have a healthy pool or not. They quote based on the age of their insureds and family vs individual policies. Feels like I'm speaking to an academic who has spent too many years in academia instead of a real business person who actually pays the bills and reviews the few choices that are out there annually.
And this statement you made "If the small business owner gets sick and dies, being in a pool does not help the other workers who are now presumably out of jobs" is a gross generalization of your perception of small businesses. I can tell you most small business owners worth their salt have a contingency plan if they get sick or die and also have partners who can continue the business and care about their employees. The employees will continue to be covered in my company well after I go if the company is still in existence. This conversation is going nowhere fast. Later I'll go back to the basketball board.

 

[HALL85]

You are talking about big companies again. You don't seem to get it. I can tell you that insurance companies do not tell small businesses if they have a healthy pool or not. They quote based on the age of their insureds and family vs individual policies. Feels like I'm speaking to an academic who has spent too many years in academia instead of a real business person who actually pays the bills and reviews the few choices that are out there annually.
And this statement you made "If the small business owner gets sick and dies, being in a pool does not help the other workers who are now presumably out of jobs" is a gross generalization of your perception of small businesses. I can tell you most small business owners worth their salt have a contingency plan if they get sick or die and also have partners who can continue the business and care about their employees. The employees will continue to be covered in my company well after I go if the company is still in existence. This conversation is going nowhere fast. Later I'll go back to the basketball board.

Due to the nature of our company, I work and speak with a lot of small business owners and what you are saying, I hear echoed every day. The ACA has hurt the small business owner and employee of the small business most of all. This is where stimulating competition would force insurers to offer products for pools. And FWIW, you would be hard-pressed to find a small business owner who does not have a succession or business contingency plan in place. The business is their baby and their (and their families) livelihood. While many may joke about "dying in the chair" (they never retire, until....), they all have a plan in place. In most small businesses, many employees are long term and like an extended family. Their employees get extra benefits (time off) when there is a family tragedy, they bail employees out of jail, they are god parents to employees children. That doesn't happen in a larger company.

The other dynamic of the ACA that has hurt the employee is the 29'er and 49'er phenomenon. Employers are offering more positions at less than 30 hours/week so they don't need to offer healthcare insurance to those workers (mostly young/new to the workforce). What happens is a 20-something takes a 20 hour a week job at Burger King and takes a similar one with different hours at McDonalds....working 40 hours and forced to go out on the exchange with very few options. Or the 49'er, employers don't hire that 50th employee so they don't have to pay the $40,000 penalty for not providing coverage.

 

[knowknow456]

Big difference though is that small company owners have to go to work or they don't make any money.

Are these your words? This is a gross generalization of your perception of employees. Small business owners aren't the only ones who have to go to work or they don't make any money. Employees have the same problem.

 

[knowknow456]

A small business owner is going to do what is best for the business. If the pool offers comparable rates at a better price because their census and loss ratios are better than the average company, the owner stays in the pool. Any reasonable owner will also have a quote from an insurance company outside the pool. If that quote is better, the small business owner will drop from the pool.

There will be one insurance company that won't participate in the pool who will target stronger, more profitable businesses and pick them off from the pool. The weaker ones will remain. So I ask again, how do you get and retain the strong companies?

Speaking of doing what's best for the business, owner's love the 29 hour rule. Each employee they can keep off the health care roll is a complete 100% cost savings. No amount of savings from the pool will make a business owner change their mind.

 

[HALL85]

Of course any business owner is going to do what's best for the business. They are the ones that took the risk and without a business, there are no jobs. But in general, I have found small business owners care more about their employees. They need to be able to attract and retain good employees as well. As it stands with the ACA and they are put in a more difficult position to be able to provide competitive health care benefits. And when the government imposes penalties, the natural reaction is to work around and avoid them.

 

[Merge]

There will be one insurance company that won't participate in the pool who will target stronger, more profitable businesses and pick them off from the pool. The weaker ones will remain. So I ask again, how do you get and retain the strong companies?

Are there any small businesses that are getting a better rate than the largest companies in nj?

I don't know the answer to that but I tend to doubt there are.

If we had an entity representing all small businesses (making up close to 2 million employees in New Jersey) negotiating rates with insurance companies, I would imagine that they would be offered a better and cheaper package than any single small business, no?

Wouldn't all small businesses want to be a part of that type of system?

 

[HALL85]

Are there any small businesses that are getting a better rate than the largest companies in nj?

I don't know the answer to that but I tend to doubt there are.

If we had an entity representing all small businesses (making up close to 2 million employees in New Jersey) negotiating rates with insurance companies, I would imagine that they would be offered a better and cheaper package than any single small business, no?

Wouldn't all small businesses want to be a part of that type of system?

We should be finding ways to aggregate lives in order to create pools where everyone benefits. It can be done, but you need to enable a competitive market as well. We employ 1,000 people and moved our prescription program from the health insurer to a local business coalition and will save a healthy six figures in doing so.

 

[Section112]

Speaking of doing what's best for the business, owner's love the 29 hour rule. Each employee they can keep off the health care roll is a complete 100% cost savings. No amount of savings from the pool will make a business owner change their mind.[/QUOTE]

This depends on the business and the owners. You can also retain really good talent if you keep them full time and offer them health insurance. It comes at exhorbitant rates but sometimes it is simply the right thing to do. Your generalizations and knowledge of small business are consistently unimpressive.

 

[knowknow456]

The other dynamic of the ACA that has hurt the employee is the 29'er and 49'er phenomenon. Employers are offering more positions at less than 30 hours/week so they don't need to offer healthcare insurance to those workers (mostly young/new to the workforce). What happens is a 20-something takes a 20 hour a week job at Burger King and takes a similar one with different hours at McDonalds....working 40 hours and forced to go out on the exchange with very few options.

Section 112 has just informed me that the dynamic you mentioned is incorrect. You can retain really good talent if you keep them full time and offer them health insurance. It comes at exorbitant rates but sometimes it is simply the right thing to do. Please advise the small business owners you are speaking with.

 

[SPK145]

Here is how I understand it - Say Business #1 has a health cost factor of x. Business #2 has a cost of x+3 because their corporate population is older and generally sicker. Business #3 would normally be x+1 but due to some unfortunate luck (catastrophic workplace injury and a rare cancer) their rating is x+4.

You do know that catastrophic workplace injuries are covered by workmens comp and not a company's healthcare plan, right?

 

[SPK145]

Speaking of doing what's best for the business, owner's love the 29 hour rule.

Big companies love that rule, they made a ton of workers part-time after that.

Government and unintended consequences? Can't be!!!

 

[HALL85]

Section 112 has just informed me that the dynamic you mentioned is incorrect. You can retain really good talent if you keep them full time and offer them health insurance. It comes at exorbitant rates but sometimes it is simply the right thing to do. Please advise the small business owners you are speaking with.

No, 112 is right. You are trying to brush all small business with the same broad stroke which is your first mistake. He is right because a small business that has talent would prefer to have affordable healthcare to retain them. My example was regarding a fast food worker that is a very different job. The ACA is forcing penalties on these companies so they need to find ways to offset or work around them.

 

[Merge]

Big companies love that rule, they made a ton of workers part-time after that.

Government and unintended consequences? Can't be!!!

Did they though?
There was a large increase of part time work during the recession, but the percentage of part time workers has been declining each year since the ACA passed.

 

[knowknow456]

My example was regarding a fast food worker that is a very different job.

It comes at exorbitant rates but sometimes it is simply the right thing to do.

 

[HALL85]

It comes at exorbitant rates but sometimes it is simply the right thing to do.

But the business doesn't live in a vacuum. If the exorbitant costs drive you out of business that hurts the worker even more.

 

[knowknow456]

You do know that catastrophic workplace injuries are covered by workmens comp and not a company's healthcare plan, right?

You are correct and WC reform is a whole different topic.

Perhaps a better sentence would have been -

Business #3 would normally be x+1 but due to some unfortunate luck (catastrophic injury and a rare cancer) their rating is x+4.

 

[knowknow456]

But the business doesn't live in a vacuum. If the exorbitant costs drive you out of business that hurts the worker even more.

So you are saying the small business owner has to do what is best for the business? If that is the case you agree with me and Section 112 is wrong. Healthcare reform is so confusing.

But moving on from this circular conversation, let's get back to pools. How do insurance companies design pools that attract and retain the better companies?

 

[HALL85]

So you are saying the small business owner has to do what is best for the business? If that is the case you agree with me and Section 112 is wrong. Healthcare reform is so confusing.

But moving on from this circular conversation, let's get back to pools. How do insurance companies design pools that attract and retain the better companies?

You are talking in circles and no, I don't agree with you. First priority for any business owner is to STAY for in business.

 

[knowknow456]

First priority for any business owner is to STAY for in business.

Let's recap
If you believe small business owners do what is best for the business, you agree with me.

If you believe business should pay exorbitant costs because it is the right thing to do, you agree with 112.

I can only conclude you agree with me. Thanks for your support.

 

[Section112]

The unimpressiveness continues. You seem to enjoy being contrary and not really understanding the issue and just want to talk about pools. Bye bye.

 

[HALL85]

Let's recap
If you believe small business owners do what is best for the business, you agree with me.

If you believe business should pay exorbitant costs because it is the right thing to do, you agree with 112.

I can only conclude you agree with me. Thanks for your support.

I'm trying to be polite and my responses, but if you keep twisting my words you can forget about that. Can't be any more clear… I don't agree with you.

 

[SPK145]

You are correct and WC reform is a whole different topic.

Perhaps a better sentence would have been -

Business #3 would normally be x+1 but due to some unfortunate luck (catastrophic injury and a rare cancer) their rating is x+4.

And with a large number of small businesses pooling together, your examples will have no effect on the pool.

 

[Merge]

And with a large number of small businesses pooling together, your examples will have no effect on the pool.

I think his post is a bit theoretical, like theoretically if there was a company paying 1k per person for insurance because they only employ healthy people, they wouldn't choose to join the larger pool.

That's not happening though. Small business premiums are higher because of the inherent risk of insuring a small population where their healthcare utilization could change dramatically if 1 person has something catastrophic happen. They would all be happy to join a bigger pool.

 

[Pirata]

owner's love the 29 hour rule. Each employee they can keep off the health care roll is a complete 100% cost savings. No amount of savings from the pool will make a business owner change their mind.

I think owner's liked life before ACA when they could have employees work any number of hours and not be forced to provide health care.

 

[Pirata]

The ACA had little to do with "care" and little to do with "affordable". Remember that its legality was upheld by the Supreme Court because it was determined to be a tax.

It should have been named the Health Insurance Tax act or better yet, the Suppressive Health Insurance Tax act.

 

[HALL85]

The ACA had little to do with "care" and little to do with "affordable". Remember that its legality was upheld by the Supreme Court because it was determined to be a tax.

It should have been named the Health Insurance Tax act or better yet, the Suppressive Health Insurance Tax act.

Or Healthcare Redistribution of Wealth Act....