PPACA Discussion Thread: 2015 If You Like Your Subsidies You Can Keep Your Subsidies

The Something Awful Forums > Discussion > Debate & Discussion > PPACA Discussion Thread: 2015 If You Like Your Subsidies You Can Keep Your Subsidies

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Vladimir Putin: Mar 17, 2007; by R. Guyovich

Grundulum posted:

So a non-negligible portion of payouts by these insurance companies went to pay for extremely expensive treatments for select diseases. In order to recoup this money, insurers are trying to raise rates on everyone.

If they aren't allowed to raise rates that much they have two options: (1) let the drug costs eat into their profit margin, or (2) negotiate down the price they will pay for those drugs. So really there is only one option. That means drug manufacturers get a choice of selling their drug at below their expected cost, or taking their ball and going home. Not sure what additional knock-on effects that will have, as I assume the drug manufacturers would rather sell some drugs than no drugs. Reduced R&D spending in favor of increased marketing budget to sell more of their suddenly lower-profit-margin drugs, slowing the pace of new privately funded discoveries and shifting the balance of research back towards government sponsored labs?

Of course, all this depends on the existence of a regulatory body with enough teeth to tell the insurance companies where they can stick their proposed increases. How many people live in states like that? And what other complications am I forgetting?

Drugs only account for 10-20% of health care spending. It's the thing most people encounter and the PR image for pharma is worse than gun manufacturers so that's what most people latch on to. The really high cost poo poo lays elsewhere in the system.

# ? Jul 4, 2015 17:58

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# ? Apr 26, 2024 22:40

Grundulum: Feb 28, 2006

It may be only 10-20%, but I wonder how skewed that money is towards the high-cost drugs. That $100k hepatitis treatment mentioned upthread is 10,000 or more generic prescriptions. Note: I genuinely have no clue on this and would like to learn more if people have the info.

What are the other hidden costs that are contributing heavily to the desired rate hikes?

Edit: back on that 10-20%, if many of the people receiving these expensive treatments had no insurance previously (because they couldn't afford it, or were booted for hitting the lifetime max payment, or whatever other reason), I could see an influx of sick people requiring these treatments as driving a larger-than-before fraction of healthcare dollars spent on medicine. Or, :tinfoil:

, is that what I am supposed to think to mask the other more nefarious causes? Again, I don't know.

Grundulum fucked around with this message at 18:16 on Jul 4, 2015

# ? Jul 4, 2015 18:12

evilweasel: Aug 24, 2002

Grundulum posted:

It may be only 10-20%, but I wonder how skewed that money is towards the high-cost drugs. That $100k hepatitis treatment mentioned upthread is 10,000 or more generic prescriptions. Note: I genuinely have no clue on this and would like to learn more if people have the info.

What are the other hidden costs that are contributing heavily to the desired rate hikes?

It is very common when insurers need to negotiate rate hikes with regulators that they come in with obscenely high asks so that the increase they actually want/need seems like a win for the regulator. I do not know if that applies here and the article says at least one of these big hikes was approved in Oregon.

What they're saying though is that the pool of people they got are sicker than they expected, so they're just using more medical treatment generally. You get a 70 year old guy instead of the 22 year old guy you were expecting, you pay out a lot more in claims. No idea how correct this is but it is worrying if it's evidence of a systemic issue.

# ? Jul 4, 2015 18:17

Willa Rogers: Mar 11, 2005

The 70-year-old guy would be covered under Medicare, not an ACA plan. And I think about half the states have no mechanism to reject carrier increases; I know this is true in both CA and IL (in other words, it's not just deep-red states that allow carriers to name their price.)

In other news, there's some serious merger mania going on among carriers: Centene has acquired HealthNet, Aetna has acquired Humana, and Blue Cross has (so far unsuccessfully) tried to acquire Cigna. Oh, and UnitedHealth wants to acquire Aetna. (Keep in mind that the largest proposed rate increases are among carriers with current monopoly or near-monopoly market shares for ACA plans.)

CMS has released its reinsurance payments to insurers for 2014.

# ? Jul 4, 2015 18:28

Shifty Pony: Dec 28, 2004; Up ta somethin'

The article also notes that people in most of the affected states can simply switch insurance providers and retain the same premiums. I'm sure with higher deductables.

I wonder if what happened was that people with chronic conditions were the most experienced at reading insurance coverages and rational-actored it up to select the plan that paid out the best for their particular situation. Even a modest amount of that would lead to the plans with the better coverages (or least onerous approval process) getting dogpiled.

# ? Jul 4, 2015 18:42

Vladimir Putin: Mar 17, 2007; by R. Guyovich

Grundulum posted:

It may be only 10-20%, but I wonder how skewed that money is towards the high-cost drugs. That $100k hepatitis treatment mentioned upthread is 10,000 or more generic prescriptions. Note: I genuinely have no clue on this and would like to learn more if people have the info.

What are the other hidden costs that are contributing heavily to the desired rate hikes?

Edit: back on that 10-20%, if many of the people receiving these expensive treatments had no insurance previously (because they couldn't afford it, or were booted for hitting the lifetime max payment, or whatever other reason), I could see an influx of sick people requiring these treatments as driving a larger-than-before fraction of healthcare dollars spent on medicine. Or, , is that what I am supposed to think to mask the other more nefarious causes? Again, I don't know.

The hepatitis C cure (not treatment) is a special case and isn't really a standard. It cures hepatics c and is first in class/best in class. The price (~10k and it has been negotiated down) is actually a long term savings for insurers when you take into account that these patients won't have to go on to require long term chronic treatments or expensive hospitalization. Furthermore as more people are cured from this drug, there will be less people in the world with hep C and you're going to spend less and less on this drug as time goes on. It's a huge upfront payment but everyone who knows anything in he industry knows it's a long term savings and it's a long term benefit to human health overall. But like I said this isn't typical in the drug arena.

# ? Jul 4, 2015 19:07

Konstantin: Jun 20, 2005; And the Lord said, "Look, they are one people, and they have all one language; and this is only the beginning of what they will do; nothing that they propose to do will now be impossible for them.

Shifty Pony posted:

The article also notes that people in most of the affected states can simply switch insurance providers and retain the same premiums. I'm sure with higher deductables.

I wonder if what happened was that people with chronic conditions were the most experienced at reading insurance coverages and rational-actored it up to select the plan that paid out the best for their particular situation. Even a modest amount of that would lead to the plans with the better coverages (or least onerous approval process) getting dogpiled.

People with complex chronic conditions really don't want to switch doctors, they want to stick with the person they trust who is familiar with their case. Most of them won't willingly change plans just because of a lower premium, unless they are sure that their doctors are all in-network.

# ? Jul 4, 2015 22:50

hobbesmaster: Jan 28, 2008

Shifty Pony posted:

The drumbeat of "RATE HIKES!" is beginning.

NY Times reports:
WASHINGTON � Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back.

Blue Cross and Blue Shield plans � market leaders in many states � are seeking rate increases that average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota, according to documents posted online by the federal government and state insurance commissioners and interviews with insurance executives.

The Oregon insurance commissioner, Laura N. Cali, has just approved 2016 rate increases for companies that cover more than 220,000 people. Moda Health Plan, which has the largest enrollment in the state, received a 25 percent increase, and the second-largest plan, LifeWise, received a 33 percent increase.

But this is later in the article:
In its proposal to increase rates by an average of 25 percent for more than 397,000 consumers, Blue Cross and Blue Shield of North Carolina cited �inpatient costs, particularly in treatment of cancer and heart conditions, emergency room utilization, and cost for specialty drug medications� to treat hepatitis C, breast cancer and cystic fibrosis.

I would be very interested to know how much of it is specialty drug prices, which have been skyrocketing lately as has been noted in this thread. The new hep-C treatments run ~$100k for the course of treatment and the new cystic fibrosis treatments can hit $200k annually. One month of that and you've easily hit the out of pocket maximum on any plan, no matter what stupidly high deductible the plan had.

You missed the most interesting part about the evil money grubbing insurance companies

quote:

Federal officials have often highlighted a provision of the Affordable Care Act that caps insurers� profits and requires them to spend at least 80 percent of premiums on medical care and related activities. �Because of the Affordable Care Act,� Mr. Obama told supporters in 2013, �insurance companies have to spend at least 80 percent of every dollar that you pay in premiums on your health care � not on overhead, not on profits, but on you.�

In financial statements filed with the government in the last two months, some insurers said that their claims payments totaled not just 80 percent, but more than 100 percent of premiums. And that, they said, is unsustainable.

At Blue Cross and Blue Shield of Minnesota, for example, the ratio of claims paid to premium revenues was more than 115 percent, and the company said it lost more than $135 million on its individual insurance business in 2014. �Based on first-quarter results,� it said, �the year-end deficit for 2015 individual business is expected to be significantly higher.�

BlueCross BlueShield of Tennessee, the largest insurer in the state�s individual market, said its proposed increase of 36 percent could affect more than 209,000 consumers.

�There�s not a lot of mystery to it,� said Roy Vaughn, a vice president of the Tennessee Blue Cross plan. �We lost a significant amount of money in the marketplace, $141 million, because we were not very accurate in predicting the utilization of health care.�

Greedy insurance companies demanding more than a -15% profit margin. :argh:

# ? Jul 5, 2015 02:59

Mercury_Storm: Jun 12, 2003; *chomp chomp chomp*

Maybe these companies should be doing their jobs and negotiating down prices for drugs and treatment, rather than asking BIG GOV'T and the American people for a handout

# ? Jul 5, 2015 03:55

Dr. Killjoy: Oct 9, 2012

Maybe these companies should stop employing brown nosing analysts who gave them laughably conservative estimates.

# ? Jul 5, 2015 06:15

esquilax: Jan 3, 2003

Grundulum posted:

It may be only 10-20%, but I wonder how skewed that money is towards the high-cost drugs. That $100k hepatitis treatment mentioned upthread is 10,000 or more generic prescriptions. Note: I genuinely have no clue on this and would like to learn more if people have the info.

What are the other hidden costs that are contributing heavily to the desired rate hikes?

Edit: back on that 10-20%, if many of the people receiving these expensive treatments had no insurance previously (because they couldn't afford it, or were booted for hitting the lifetime max payment, or whatever other reason), I could see an influx of sick people requiring these treatments as driving a larger-than-before fraction of healthcare dollars spent on medicine. Or, , is that what I am supposed to think to mask the other more nefarious causes? Again, I don't know.

In the active employee space (not medicare) specialty costs are about 1/3 of total prescription drug spend. Due to new specialty drugs coming on market, most people think it will be over 1/2 within a few years.

For example, there's a new cholesterol lowering specialty drug that just got approved. It's supposed to be a blockbuster.

hobbesmaster posted:

You missed the most interesting part about the evil money grubbing insurance companies

Greedy insurance companies demanding more than a -15% profit margin.

Good point. All increases over 10% are subject to review by the federal government. They typically are approved, because they are justified.

This information is all public at https://ratereview.healthcare.gov/#search

esquilax fucked around with this message at 14:14 on Jul 5, 2015

# ? Jul 5, 2015 14:09

Willa Rogers: Mar 11, 2005

http://www.politico.com/story/2015/07/marilyn-tavenner-to-ahip-120152.html

quote:

Former Medicare chief Marilyn Tavenner has been hired as the new CEO of America�s Health Insurance Plans, representing an industry that she helped regulate during the turbulent launch of Obamacare.

The powerful K Street lobbying group�s announcement Wednesday comes months after Tavenner, a nurse and former hospital CEO, stepped down as the administrator of the Centers for Medicare and Medicaid Services. At the agency, she was responsible for writing many of Obamacare�s rules and oversaw the troubled rollout � and repair � of the HealthCare.gov enrollment website.

She�ll now lead an industry that�s lost its longtime leader, Karen Ignagni, a K Street powerhouse who navigated the industry through Obamacare�s massive overhaul and left this summer to run a New York insurer. Ignagni helped build support for the health law among insurers, a contrast to when the health plans helped kill President Bill and Hillary Clinton�s health reform effort in the 1990s.

Tavenner, who starts in August, takes over at a time of change and challenge for AHIP and the health insurance industry. The nation�s largest health insurer just left AHIP, major insurance mergers are on the horizon, and hardline Republicans are still dedicated to repealing a health-care law the industry is still learning to live with.

But AHIP�s decision to hire a former Obama administration official as its next leader also signals that health insurers are committed to the health reform law.

�This choice, combined with the widespread participation by major insurers in the ACA�s marketplaces, signals that the industry is all in with Obamacare,� said Larry Levitt of the Kaiser Family Foundation.

As if there were any doubt.

# ? Jul 16, 2015 01:40

The MUMPSorceress: Jan 6, 2012; ^SHTPSTS; Gary’s Answer

Willa Rogers posted:

http://www.politico.com/story/2015/07/marilyn-tavenner-to-ahip-120152.html

As if there were any doubt.

Doubt of what? That people with government experience are frequently hired as lobbyists and industry leaders? Oh hey, this lady helped roll out Obamacare, perhaps this experience can help us maximize our participation in it!

Please lay out an actual argument as to why this is bad or shady instead of just acting like reality supports your opinions.

# ? Jul 16, 2015 18:48

Willa Rogers: Mar 11, 2005

LeftistMuslimObama posted:

Doubt of what?

"This choice, combined with the widespread participation by major insurers in the ACA�s marketplaces, signals that the industry is all in with Obamacare,� said Larry Levitt of the Kaiser Family Foundation."

The industry wrote Obamacare, so the signal that it was "all in" has been evident since the end of 2008, when AHIP debuted its proposal and Obama turned it over to Baucus (and his chief of staff, a former Wellpoint lobbyist) to legislate.

These aren't my opinions; they're well-documented facts.

# ? Jul 16, 2015 19:22

Bifner McDoogle: Mar 31, 2006; "Life unworthy of life" (German: Lebensunwertes Leben) is a pragmatic liberal designation for the segments of the populace which they view as having no right to continue existing, due to the expense of extending them basic human dignity.

I understand what you mean but I suspect the context of this article give the phrase "all in" implies a different meaning than how you're reading it. Since passage of the ACA there have been two points where it could have been gutted by a supreme court decision, now that those have been cleared up one could definitely argue that we'd expect to see insurance agencies invest more into compliance with the ACA, I believe the point of the politico piece is to explore that as opposed to the investment of insurance companies in writing the ACA back in 2008. Like Marilyn Tavenner is being brought up because she has left the administration back in February, but was not hired until shortly after the supreme court ruling established that the ACA is not going anywhere. That could definitely be a coincidence, but politico is pretty big on speculation and seems to have concluded that the vague connection is enough to write an article about.

I'm admittedly biased, though, in that I think most politico articles are worthless garbage that don't really say anything about anything, and my above interpretation definitely reinforces that bias.

# ? Jul 16, 2015 20:13

AreWeDrunkYet: Jul 8, 2006

LeftistMuslimObama posted:

Doubt of what? That people with government experience are frequently hired as lobbyists and industry leaders? Oh hey, this lady helped roll out Obamacare, perhaps this experience can help us maximize our participation in it!

Please lay out an actual argument as to why this is bad or shady instead of just acting like reality supports your opinions.

It can lead to policy choices that favor the industry rather than the population the government is intended to represent. The influence of industry money on representatives means that those lobbyists can speak a lot louder than average people who may be impacted.

It's not unusual or unexpected, it's just another symptom of the overarching corruption of a supposedly representative government.

# ? Jul 16, 2015 20:14

evilweasel: Aug 24, 2002

Willa Rogers posted:

"This choice, combined with the widespread participation by major insurers in the ACA�s marketplaces, signals that the industry is all in with Obamacare,� said Larry Levitt of the Kaiser Family Foundation."

The industry wrote Obamacare, so the signal that it was "all in" has been evident since the end of 2008, when AHIP debuted its proposal and Obama turned it over to Baucus (and his chief of staff, a former Wellpoint lobbyist) to legislate.

These aren't my opinions; they're well-documented facts.

Yeah, you're being an idiot (again). What this is referring to is the changeover from the pre-Obamacare market to the current market. For a long time (especially with the Supreme Court cases) there's been concern that Republicans could manage to kill it and that the investments insurers made in the transition would be wasted. That person is saying that insurers do not view there as being any realistic chance anymore Obamacare will be killed in some way.

# ? Jul 16, 2015 20:15

evilweasel: Aug 24, 2002

Before you start, it does not prove that there's no regulatory capture or the like, merely that you pointed at a hippo and said "see, from this rhinoceros we can conclude..."

# ? Jul 16, 2015 20:18

Willa Rogers: Mar 11, 2005

Some other PPACA news:

* USAToday has a good overview of Medicaid expansion across the states: http://www.usatoday.com/story/news/2015/07/15/medicaid-expansion-effect-on-patients-taxpayers-states-hospitals/25612707/

* Kaiser Health News looks at the rocky start to the SHOP program for small employers: http://khn.org/news/small-business-health-insurance-exchanges-are-off-to-a-rocky-start/

* Recent studies show that the "narrow networks" under exchange plans offer about one-third fewer access to providers as people with traditional employer-provided coverage: http://khn.org/morning-breakout/choice-of-doctors-and-hospitals-more-limited-in-health-law-plans-study-says/

* Tavenner has vowed to not personally lobby (as the other link said, AHIP has plenty of "minions" for that) until Obama leaves office: http://www.washingtonpost.com/news/powerpost/wp/2015/07/15/former-cms-chief-to-become-top-lobbyist-for-health-plans/

# ? Jul 16, 2015 21:08

The MUMPSorceress: Jan 6, 2012; ^SHTPSTS; Gary’s Answer

Willa Rogers posted:

Some other PPACA news:

* USAToday has a good overview of Medicaid expansion across the states: http://www.usatoday.com/story/news/2015/07/15/medicaid-expansion-effect-on-patients-taxpayers-states-hospitals/25612707/

* Kaiser Health News looks at the rocky start to the SHOP program for small employers: http://khn.org/news/small-business-health-insurance-exchanges-are-off-to-a-rocky-start/

* Recent studies show that the "narrow networks" under exchange plans offer about one-third fewer access to providers as people with traditional employer-provided coverage: http://khn.org/morning-breakout/choice-of-doctors-and-hospitals-more-limited-in-health-law-plans-study-says/

* Tavenner has vowed to not personally lobby (as the other link said, AHIP has plenty of "minions" for that) until Obama leaves office: http://www.washingtonpost.com/news/powerpost/wp/2015/07/15/former-cms-chief-to-become-top-lobbyist-for-health-plans/

SHOP was such a mess to start with. It took CMS until the day before healthcare.gov went live to give anyone a final specification of the electronic message format. They went with a really janky XML file, even though all the other electronic message formats they used were variations of the industry-standard X12 ANSI formats. It was bad enough and different enough that software vendors that were 100% ready to deal with the exchange's other electronic messaging were completely unable to accommodate SHOP's stupid message format for several months, and then they went and changed the whole thing anyway, so the rush work people did to be compatible was pointless. I know of several health plans that were having their administrative staff hand-type SHOP XML files to send to the exchange for several months. Lowest-bidder-wins is just not the way to do IT, but that seems to be the federal mantra for that sort of thing.

# ? Jul 17, 2015 05:56

nelson: Apr 12, 2009; College Slice

LeftistMuslimObama posted:

Lowest-bidder-wins is just not the way to do IT, but that seems to be the federal mantra for that sort of thing.

To be fair even the high priced bidders sometimes screw up. IT is hard. The reason everything looks (mostly) good on the commercial side is most smart firms don't tell the public they are trying to do something complicated until it works (or they fail and go out of business before we know they exist). The government doesn't have those options, at least not on something as politically divisive as health care.

# ? Jul 18, 2015 04:23

VideoTapir: Oct 18, 2005; He'll tire eventually.

Anyone remember the conservameme "Facebook was built in a dorm room!"

When that's the bullshit Healthcare.gov is being judged against, yeah, it'll look bad.

# ? Jul 18, 2015 06:41

The MUMPSorceress: Jan 6, 2012; ^SHTPSTS; Gary’s Answer

VideoTapir posted:

Anyone remember the conservameme "Facebook was built in a dorm room!"

When that's the bullshit Healthcare.gov is being judged against, yeah, it'll look bad.

In case it wasn't obvious from my last post, I work for a healthcare software firm. I'm certainly not making that comparison. All I'm saying is SHOP worked even worse than the rest, particularly because they last-minute went with a message format that didn't follow the same standard as all the other formats the exchange uses.

# ? Jul 18, 2015 08:23

ComradeCosmobot: Dec 4, 2004; USPOL July

VideoTapir posted:

Anyone remember the conservameme "Facebook was built in a dorm room!"

When that's the bullshit Healthcare.gov is being judged against, yeah, it'll look bad.

Yep. Healthcare.gov should be comparable to Facebook today since everything you see today was built in a dorm room.

# ? Jul 18, 2015 18:47

Chokes McGee: Aug 7, 2008; This is Urotsuki.

LeftistMuslimObama posted:

In case it wasn't obvious from my last post, I work for a healthcare software firm. I'm certainly not making that comparison. All I'm saying is SHOP worked even worse than the rest, particularly because they last-minute went with a message format that didn't follow the same standard as all the other formats the exchange uses.

Working as a contractor for healthcare software development, I can confirm most companies are absolutely hosed and dysfunctional. (Shock, I know.) Most of them are suffering from the same problem as everywhere: some high level douchebag decides to hire contractors from oversea companies that are basically meat grinders for sub-par developers, their poo poo is either completely unfinished or falls apart with the least prodding, and then they have to spend even more money on specialists to make the drat thing work.

Don't get me wrong, it's great for my bank account, but I absolutely cannot see how these companies stay in business.

# ? Jul 19, 2015 18:12

Anubis: Oct 9, 2003; It's hard to keep sand out of ears this big.; Fun Shoe

Chokes McGee posted:

Working as a contractor for healthcare software development, I can confirm most companies are absolutely hosed and dysfunctional. (Shock, I know.) Most of them are suffering from the same problem as everywhere: some high level douchebag decides to hire contractors from oversea companies that are basically meat grinders for sub-par developers, their poo poo is either completely unfinished or falls apart with the least prodding, and then they have to spend even more money on specialists to make the drat thing work.

Don't get me wrong, it's great for my bank account, but I absolutely cannot see how these companies stay in business.

To be fair to the healthcare industry, this is true pretty much across the board in corporate america. There's lots of reasons for it and unfortunately some of those reasons even make a semblance of sense but that starts getting into IT project management theory and a bunch of statistics that show how few IT projects actually meet all 3 of their original Time, Money and Quality objectives.

# ? Jul 19, 2015 18:25

Chokes McGee: Aug 7, 2008; This is Urotsuki.

Anubis posted:

To be fair to the healthcare industry, this is true pretty much across the board in corporate america. There's lots of reasons for it and unfortunately some of those reasons even make a semblance of sense but that starts getting into IT project management theory and a bunch of statistics that show how few IT projects actually meet all 3 of their original Time, Money and Quality objectives.

Which is why we switched to agile so now project managers can micromanage at a finer granularity than ever before! :iamafag:

Until people include "whoops that's not what we wanted start over" into the allotment then we'll continue to miss targets :sigh:

# ? Jul 19, 2015 22:20

Ballz: Dec 16, 2003; it's mario time

Isn't contraception supposed to be fully covered by insurance under the ACA? It had been under my old insurance, but I started a new job recently and when I went to pick up the wife's birth control, it was $15.

# ? Jul 20, 2015 03:04

IdeoPhanthus: Oct 22, 2004

I thought the rule was that generics had to be fully covered, but anything else could just be a copay or whatever. And/or that some plans had a loophole allowing them to get around it in certain ways?

Every plan I've been on has been $0 for generics, but a copay that went up based on what tier the brand was in within their copay pricing chart.

# ? Jul 20, 2015 04:02

Ballz: Dec 16, 2003; it's mario time

IdeoPhanthus posted:

I thought the rule was that generics had to be fully covered, but anything else could just be a copay or whatever. And/or that some plans had a loophole allowing them to get around it in certain ways?

Every plan I've been on has been $0 for generics, but a copay that went up based on what tier the brand was in within their copay pricing chart.

That's how I thought it was too, but this was a generic that cost $15. I'll have to call my insurance tomorrow, their website has absolutely no useful info on it.

# ? Jul 20, 2015 04:29

Devor: Nov 30, 2004; Lurking more.

Ballz posted:

That's how I thought it was too, but this was a generic that cost $15. I'll have to call my insurance tomorrow, their website has absolutely no useful info on it.

From Wikipedia, so grain of salt:

https://en.wikipedia.org/wiki/Contraceptive_mandate_%28United_States%29#ACA_mandatory_coverage_for_contraceptives

quote:

In May 2015 the Obama administration stated that under the ACA, at least one form of all 18 FDA-approved methods of birth control must be covered without cost-sharing.

So from my reading, you have to talk to your plan to find out which birth control pill is free. And if you have side effects, too bad.

# ? Jul 20, 2015 18:10

Sundae: Dec 1, 2005

Devor posted:

From Wikipedia, so grain of salt:

https://en.wikipedia.org/wiki/Contraceptive_mandate_%28United_States%29#ACA_mandatory_coverage_for_contraceptives

So from my reading, you have to talk to your plan to find out which birth control pill is free. And if you have side effects, too bad.

I can second this because it's exactly what happened with my wife's birth control through our insurance.

# ? Jul 21, 2015 00:21

The MUMPSorceress: Jan 6, 2012; ^SHTPSTS; Gary’s Answer

Sundae posted:

I can second this because it's exactly what happened with my wife's birth control through our insurance.

That is very likely violation of your benefits, even if they gave you the runaround. They are obligated to cover the medication your provider deems to be most effective if your provider has determined that the cheapest covered medication is having unmanageable side effects.

If your insurance really fucks around with you, you can end-run it by having your doctor diagnose you with an allergy to the birth control giving you side effects. This leaves the insurer without any real choice but to pay for something else. Cheaper for them to pony up than go through the legal efforts of trying to prove you're not actually allergic.

# ? Jul 21, 2015 01:59

sullat: Jan 9, 2012

Or go off the Birth Control, knock up the wife, then laugh as the insurance company now has to pony up for the kid for the next 25 years. All to save 50 bucks on a prescription.

# ? Jul 21, 2015 05:08

VideoTapir: Oct 18, 2005; He'll tire eventually.

sullat posted:

Or go off the Birth Control, knock up the wife, then laugh as the insurance company now has to pony up for the kid for the next 25 years. All to save 50 bucks on a prescription.

They aren't calculating the risk that birth control will fail when they set a policy like this. They're calculating the risk that you'll call their bluff.

# ? Jul 21, 2015 18:55

Volmarias: Dec 31, 2002; EMAIL... THE INTERNET... SEARCH ENGINES...

sullat posted:

Or go off the Birth Control, knock up the wife, then ~~laugh~~ cry as ~~the insurance company~~ you now have to pony up for the kid for the next 25 years. All to save 50 bucks on a prescription.

# ? Jul 22, 2015 01:20

Sundae: Dec 1, 2005

sullat posted:

Or go off the Birth Control, knock up the wife, then laugh as the insurance company now has to pony up for the kid for the next 25 years. All to save 50 bucks on a prescription.

Ha, you think insurance companies won't weasel out of paying for children's care the same way they weasel out of paying for adults' care. It's almost adorable.

# ? Jul 23, 2015 01:10

Klaus88: Jan 23, 2011; Violence has its own economy, therefore be thoughtful and precise in your investment

I'm running into road blocks thanks to Rick Scott's for profit medical changes. :capitalism:

Specifically I can't get my scripts filled without a whole lot of hoop jumping.

# ? Jul 23, 2015 18:54

WhiskeyJuvenile: Feb 15, 2002; by Nyc_Tattoo

good effects of the PPACA

quote:

I had a friendly series of e-mails with a commenter late last week. His bargaining unit at Verizon is now working without a contract. I don�t know how the contracts that the CWA and IBEW have with Verizon treat healthcare. My experience and knowledge is solely personal as my family�s health insurance as a child was provided through a benefit/welfare fund administered by my dad�s union for its members who worked for hundreds of companies. I don�t know if Verizon creates a massive ASO with defined benefit structures for its union contracts or offloads all of the risk onto union welfare funds. That difference will matter.

My correspondant�s big worry would be what would happen to his health insurance if he either went on strike or was locked out. He stated that Verizon had stated that health insurance would disappear as soon as a work stoppage of any sort started. He knew COBRA insurance at 102% of monthly premium would be available, but no one could afford COBRA if they aren�t working anyways. Pulling health insurance is an effective (and underhanded) way of dividing union solidarity as it pits the members who are either old or sick or who have old or sick dependants against members who don�t have pressing medical needs. Someone whose daughter needs chemotherarapy next week will push leadership to take a lovely deal far faster than someone whose kids eventually need to go in and get their teeth cleaned.

However, the ACA changes this power dynamic a bit.

Losing employer sponsored coverage is a qualifying event. It creates a special enrollment period for all locked out or striking workers to go on the Exchanges and get coverage. That coverage will not be anywhere near as good as the coverage they currently have in their union contract (Verizon workers have the equvilent of Platinum plus plans) but it provides oh-poo poo coverage possibilities for the families of workers who don�t use a lot of services, and it provides cheaper than COBRA platinum coverage for the worker whose daughter is mid-way through her chemo. It reduces a pressure point that Verizon can use as health insurance is no longer directly tied to employment.

This is a subtle value add of PPACA. It is a slight corrective to the massive bargaining differential between Capital and Labor that has tilted so many agreement zones towards capital instead of labor over the past forty years.

# ? Aug 3, 2015 12:55

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# ? Apr 26, 2024 22:40

Ballz: Dec 16, 2003; it's mario time

Devor posted:

From Wikipedia, so grain of salt:

https://en.wikipedia.org/wiki/Contraceptive_mandate_%28United_States%29#ACA_mandatory_coverage_for_contraceptives

So from my reading, you have to talk to your plan to find out which birth control pill is free. And if you have side effects, too bad.

To follow up on this, I called my insurance, and they said my company hasn't updated their health insurance policy since before ACA went into effect and were thus "grandfathered in." 15 bux a month for the pill it is, then.

I... I didn't know they could do that.

# ? Aug 11, 2015 18:08

The Something Awful Forums > Discussion > Debate & Discussion > PPACA Discussion Thread: 2015 If You Like Your Subsidies You Can Keep Your Subsidies

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