Please help. Where in the speech is there any reference

[OwnedByFerrets]

to insurance premiums? If the price of premiums isn't regulated AND its not possible for those "with" existing insurance to buy into a public plan, what is to keep our rates to keep rising exponentially?

I am editing this to include small business owners. If insurance premiums keep rising, which I feel sure they will, wont this continue to put the squeeze on small businesses? I just have SO many questions about the proposed plan.:scared:

[SheilaT]

1. I likewise heard nothing that

addressed that issue.

All the way through I kept on thinking that this is giving almost everything to the insurance companies with no effective restraints on them.

I'm disappointed.

[flpoljunkie]

29. House bill requires insurance companies meet a "Medical Loss Ratio' as defined by the government.

http://yglesias.thinkprogress.org/archives/2009/08/the-noble-eightfold-path-of-consumer-protection.php

Bruce Webb Says:

August 11th, 2009 at 1:37 pm

The Obama team, perhaps wisely, left a Ninth path hidden. People who are scratching their heads wondering why the insurance companies, being presented as they are with millions of new customers via the mandates are still crying foul. Well this is because they certainly have read Sec 116 even if others have not.

SEC. 116. ENSURING VALUE AND LOWER PREMIUMS.

(a) IN GENERAL.—A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio.

What does this mean in practical terms? That even if the insurance companies find a way to game the protections in Sec 111-115 and game the risk pool, if they don’t pay out a set percentage of actual payment for service (the quaintly named ‘medical loss ratio’) they have to rebate the difference. No medical risk, no reward. The result is that the insurance companies will have an incentive to compete for volume while finding ways to prevent really high cost claims.

In plainer words we are talking straight out profit controls, and those controls set by the government. That is why insurance companies are jumping up and down, there old model meant they made money by denying care, the new model means they make money by providing the right amount of care to keep their overall costs down in a way that the market competitive premium still allows them to get as close to the profit limit as they can.

These provisions are from the House Bill but are pretty much mirrored in the HELP Bill, you can bet that Finance is really trying to find a way to gut them and so preserve uncapped profits.

[orpupilofnature57]

2. Competition

[Tansy_Gold]

6. bwaaa haa haa haa haa haaa

In case you haven't noticed, we already have that.

[orpupilofnature57]

12. I've noticed the 5

[OwnedByFerrets]

15. From where?

The McCarran-Ferguson Act (”the Act”) exempts the “business of insurance” from federal antitrust law. Which is to say that federal antitrust law applies only to the extent that “the business of insurance” is not regulated by state law. The Act goes so far as to permit price fixing — joint ratemaking — if permissible under state law.

They dont have to follow the same laws as most corporations.

[orpupilofnature57]

19. Thank you ,

[polichick]

27. What competition if the po is only available to a few? nt

[ShortnFiery]

3. Excellent point: The Devil's in the details. eom

[grantcart]

4. the plans that are accepted into the health exchange will have to meet

certain criteria.

Based on the OPM health exchange for federal employees - price and the amount of coverage - is a key issue on whether or not you get OPM approval or not.


We will not know how effective the health care bill is until we see what the plans approved to be in the health care exchange are and what the premiums are, including the pubic option.

We also do not know what the level of the subsidy is yet either.

[Tansy_Gold]

8. Watch your typos, or you'll be labeled

a moran.

[grantcart]

13. ?? its early here on the left coast but I don't see what your talking about

I ran the spell check and it didn't either.

Your help appreciated


sincerely


Moran

[Tansy_Gold]

16. Spell check sees

"PUBIC" as a perfectly good word, which it is, unless you mean "PUBLIC"

[orpupilofnature57]

20. We knew what you meant ,not to split hairs. bwaaaa

[orpupilofnature57]

10. If it doesn't raise " One Red Cent " and premiums are regulated by demand.

how isn't that better?What controls premiums now?

[Tansy_Gold]

5. Well, since the insurance companies won't be able to raise

rates on those with pre-existing conditions, and since this thing has four years from signature to implementation -- and it hasn't even been written and presented to Congress yet -- my guess is that the insurance companies will start raising their premiums right now and just keep on a-raisin' 'em until health insurance is the largest single budget item for a "typical" American family. More than rent or mortgage, more than utilities or vehicle operation (payment + gas), more than groceries.

There's a very Dickensian "decrease the surplus population" sense about this, isn't there?



TG

[peace13]

9. It already is the single most expensive item in my budget...

go figure.

[Tansy_Gold]

23. It would be in mine, if I had it n/t

[peace13]

34. I hear you!

I hope that you will not be without for long. This is insanity.

[orpupilofnature57]

14. No ,there something Orwellian about citizens with Corporate Conscience

[OwnedByFerrets]

17. That is what I am most afraid of.

[orpupilofnature57]

21. Thats where the Bailout should stop them in their tracks , If we collect.

[peace13]

7. The way I heard it was ...

that if an insurance company had packages with high prices (I am assuming that the feds would set a cap) they would pay a fee or tax for that, making it unprofitable to gouge the consumer.

[OwnedByFerrets]

18. Im not sure the federal government can do this as it stands...

The McCarran-Ferguson Act (”the Act”) exempts the “business of insurance” from federal antitrust law. Which is to say that federal antitrust law applies only to the extent that “the business of insurance” is not regulated by state law. The Act goes so far as to permit price fixing — joint ratemaking — if permissible under state law.

Its very confusing.

[TankLV]

11. The REPUKE "Savings Accounts" silly!!!

You know, people can use ALL THAT MONEY THEY'VE BEEN SAVING to PAY for the PREMIUMS!!!

don't EVER mention the fact that if people who NEED health CARE actually HAD the money to SAVE, they wouldn't be BANKRUPT in the FIRST place!!!

Yep - same "repuke" "logic"...

kinda hard to get money from "savings" accounts when you have to choose between EATING or MEDICINE - and that food is likely to be from a CAN labled "dog" or "cat" food...

[Barack_America]

22. Well, that's the truth of the matter. No public option = no break in insurance premiums.

The next best thing we've got is reducing medical costs, but then the insurance CEO's will just jack our premiums up more and pocket the profit.

[Clio the Leo]

24. If dairy farmers could pick and choose who they sold milk to....

.... and, more importantly, if they could deny a person the ability to buy ANYTHING that came out of a cow, milk would be $20 a gallon.

If it is illegal to deny coverage or drop coverage, then you can get coverage from any company who's willing to sell it. This will then force companies to offer their services at competitive prices.

I'm as big of a socialist as they come, but capitalism isn't all bad either.

And what the insurance companies are doing now is NOT capitalism.

[OwnedByFerrets]

25. What happens when your states health insurance is

controlled by ONE insurance company like it is in ALA? How likely is it that there is going to be meaningful competition? Middle America needs the OPTION of buying into a public option. This proposal disqualifies 180 million people, as far as I can tell. Please tell if I am wrong.

[Clio the Leo]

26. Interstate Health Insurance.....

.... which is, brace yourself, a REPUBLICAN idea! lol

http://healthcare.ncpa.org/commentaries/interstate-competition-in-the-individual-health-insurance-marketplace

(but it was one of those "good ideas" the President was talking about last night.)

[OwnedByFerrets]

28. This is what I found on the issue with the limited amount of time I have this morning...

Mr. MIKE KREIDLER (Insurance Commissioner, Washington State): The states that do offer health insurance are going to be those with the least regulation; are going to be those with the least resources to aid consumers. Now we as states, by being pre-empted from our authority to be able to intervene for consumers, are going to be left not able to represent them.

ROVNER: In other words, that if an individual in New Jersey buys a policy from Montana and has a problem, he or she may have trouble getting help. Shadegg says the bill has already been altered to give insurance commissioners some authority to enforce other states' policies, but the bill is still likely to face spirited opposition when it gets to the House floor. Julie Rovner, NPR News, Washington.

more here:http://www.npr.org/templates/story/story.php?storyId=4769291

I think the Democrats are worried about regulation of an interstate system.

[lumberjack_jeff]

31. The exchanges will encourage insurers to compete in new territories.

The 180 million you refer to are those who already have insurance. If you're going to start somewhere, it is logical to start with the rest.

[lumberjack_jeff]

30. Premiums for plans within the exchange will be regulated by the state exchange.

Premiums will probably still continue to rise, but not as fast as they would have without reform.

[OwnedByFerrets]

32. I'm sorry to be dense, but could you expound on that?

The way I understand it, insurance companies are not controlled by anti-trust laws and many states have little or not competition. How would this "state exchange" work?

The McCarran-Ferguson Act (”the Act”) exempts the “business of insurance” from federal antitrust law. Which is to say that federal antitrust law applies only to the extent that “the business of insurance” is not regulated by state law. The Act goes so far as to permit price fixing — joint ratemaking — if permissible under state law.

[lumberjack_jeff]

37. Because the federal law establishes uniform guidelines

The regulatory factors which discourage insurers from participating in any given state mostly go away.

Every insurer knows pretty much what to expect from each state's insurance exchange. The exchange enables consumers to choose among comparable offerings, knowing that any of them can (by law) be counted on in event of major medical crisis, consumers will generally select based on price.

[depakid]

38. "based on price"

Which of course includes rising deductibles and copays. Of course, those only count if you actually have to use the insurance. I.e. if you're planning on utilizing services.

[lumberjack_jeff]

39. No, the bills all establish tiers "bronze, silver, gold"

Those tiers define coverage, deductibles and copays of any plan offered within the exchange.

An insurer can't change elements of the plan which are defined in the law, and they can't arbitrarily change the premiums for a subscriber individually. Further, they can't change premiums for all subscribers without negotiating with the exchange administrator.

[depakid]

42. How that's going to work in practice isn't very clear- but just think about how this tiering sounds

People's lives depend on whether they are worth bronze, silver and gold?

How sick is that?

[lumberjack_jeff]

43. I know what you're saying

But some people would prefer a lower premium and higher copays than the "gold" coverage would provide.

My low family income probably will allow us to get a relatively high subsidy, so I'd probably opt for the gold plan.

Everyone has a different risk tolerance, and I think it's sensible to allow people to assess their own risk, provided they aren't really just transferring that risk to someone else.

[mopinko]

33. the speech is not the bill.

just sayin'.

[OwnedByFerrets]

35. I asked about "the speech" not the "bill"...yes, I understand

we could get far less that what was offered last nite. Its extremely unlikely that we will get more.

[andym]

36. Interesting that this OP gets plenty of attention, but most post about capping premiums are ignored

it's a good point. In fact, more than 1/2 of health care reform could just be made by capping premiums.

For example,
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6488988

[lumberjack_jeff]

40. It depends on your view of the problem.

If you think that the problem is that people are dying because they can't get coverage and those that do can have it yanked arbitrarily, then no... premium caps aren't a solution.

[high density]

41. I have to read between the lines on premiums

The President said:

Then there's the problem of rising cost. We spend one and a half times more per person on health care than any other country, but we aren't any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It's why so many employers -- especially small businesses -- are forcing their employees to pay more for insurance, or are dropping their coverage entirely. It's why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally -- like our automakers -- are at a huge disadvantage.
...
Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. (Applause.) And the insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care

It seems to me that if the health insurance exchange with the public option becomes significantly cheaper, companies will stop buying/providing their current private insurance plans and instead pay the taxes assessed for access to the health insurance exchange. From there people can choose the public option if they want. If insurance companies want to compete they will have to keep their premiums competitive.