Trump Signs Executive Order on Obamacare

Taylor · Jan 22, 2017

Cardinal said:
I have no idea what your post is trying to communicate here.

It doesn't matter if people like perks if they're not willing to pay for them, or if they can't afford to pay for them.

JasperL · Jan 22, 2017

Taylor said:
It doesn't matter if people like perks if they're not willing to pay for them, or if they can't afford to pay for them.

All you have to do is spend 5 minutes on here and it's easy to figure out people don't know that the point of the mandate is to take care of people with pre-existing conditions. Doesn't help that the GOP insists every time they open their mouth about healthcare that you can have the cake (no more denials of insurance for a wife with a history of breast cancer, for example) without the mandate.

This poll is typical: Poll: Americans show strong support for Obamacare provisions, including Medicaid expansion | Arkansas Blog

If it doesn't show up, 16% of republicans support the mandate, but 69% support guaranteed issue. Those are contradictory/illogical positions.

The Mark · Jan 22, 2017

DA60 said:
This is what happens when you pass a law - by the skin of your teeth - that you know the other side will kill the minute they get the power to do so.

It's pointless.

If you do not have at least relatively broad consensus, the law is on life support the day it is passed.

Why the Dems pushed this bloated whale called Obamacare through knowing full well the Reps would kill it the minute they could is beyond me. Arrogance I guess.

I have said it before...the Dems should have passed a bill that ONLY affected those Americans who did not have healthcare...that would have been noble and there is no way the Reps would have killed it. But the Dems got greedy, went too far and now their precious Obamacare is about to die.

I hope both sides learn from this mess.

And more importantly, I hope when this finally ends that those Americans who had no health coverage before will not have no health coverage again.

It's possible they hoped it would convince enough people who used it that it was necessary so that an expansion or fix would be demanded by the people.

In some ways it may have partially worked, even if unintended - there's a majority out there who think that the rule against denying coverage due to preexisting condition should stay.

Edit: I think I'm giving the establishment democrats too much credit though, probably they were just told to push it by their owners.

cpwill · Jan 23, 2017

Greenbeard said:
Remedies that retain rating restrictions on insurers? Given that the entire point of the across-state-lines concept is to backdoor regulate the industry, I'm not sure how you square that circle.

That doesn't seem to be borne out by the 2017 premiums. From 2014-2016 exchange premiums were far below expectations (i.e. the premiums assumed by the CBO in developing cost projections); however, that led to something like a -5% margin across exchange business in 2014. As most people probably know, 2017 saw a correction to that underpricing.

Looking back at the CBO's projections from 2009, the benchmark premium in 2016 was expected to be $5,200 on average. If you assume a relatively modest 3% growth, that gets us to around $5,360 this year or just under $450/month this year.

We know from ASPE that the average benchmark premium for a 27-year-old in 2017 is $302/month. Under the ACA's age rating rules, if the CBO estimate was correct that translates into an average age of 47 in the exchanges. Now we don't know the age profile for enrollees in 2017 yet, but we know what it was in 2016--or at least the distribution within the age bands ASPE uses when reporting enrollment. If you use the midpoint of those age bands to get the average age last year you get 41, if you use the less charitable--and unrealistic--assumption that everyone enrolled is at the very top of their age band you get just under 46.

So unless the exchanges got a little older this year (and given that enrollment seems to be running ahead of last year, the opposite is more likely to be the case), the age and risk profile this year seems to be running a little better than the CBO expected when calculating the cost of the law seven years ago. Assuming that after collecting three years of claims data insurers know how to accurately price their products (which may have even been more the case last year than publicly acknowledged, despite the PR game).

So I'm not convinced by the argument that exchanges right now are older and sicker than anticipated. Premiums today (admittedly following the upward correction this open enrollment period) appear to be close to--even a bit lower than--the bean counters predicted back in 2009/10. In other words, the CBO predicting the risk profile in the exchanges seven years ago seems to have been on pretty much the same page as the actuaries of exchange-participating insurance companies in 2016/17.

:lol: So, your argument against the mathematical reality that fewer people joined the exchanges than anticipated, and the argument that these people were older and sicker than anticipated....

.... is that premiums based on the earlier estimates seriously underestimated costs, and so had to be adjusted upwards once the real numbers came in?

cpwill · Jan 23, 2017

Cardinal said:
The main perks he wants to keep that are most noteworthy are pre-existing conditions and not dropping someone for getting sick. It's not possible to keep those and not pay for them. That was the point of the mandates.

Yup. We are Very Very Much In Favor of Free Stuff, and Very Much Against Having To Pay For It, Ever.

Greenbeard · Jan 23, 2017

cpwill said:
:lol: So, your argument against the mathematical reality that fewer people joined the exchanges than anticipated, and the argument that these people were older and sicker than anticipated....

.... is that premiums based on the earlier estimates seriously underestimated costs, and so had to be adjusted upwards once the real numbers came in?

Early estimates didn't underestimate costs. That's the point. Premiums have consistently run below the CBO projections. Only in 2017 after adjusting upward are they even in the neighborhood of what the CBO assumed they would be--and they're still lower!

Which means either insurers still don't know how to price (and with three years of claims data in hand, if that's the case there's very little argument they should be in this business at this point), or the current risk profile of the exchanges is slightly healthier and younger than projections.

Premiums tell you what the risk is and the premiums are still lower than projected. So I don't know where the argument that the exchange population is sicker/older than expected is coming from.

cpwill · Jan 23, 2017

Greenbeard said:
Early estimates didn't underestimate costs. That's the point. Premiums have consistently run below the CBO projections. Only in 2017 after adjusting upward are they even in the neighborhood of what the CBO assumed they would be--and they're still lower!

Which means either insurers still don't know how to price (and with three years of claims data in hand, if that's the case there's very little argument they should be in this business at this point), or the current risk profile of the exchanges is slightly healthier and younger than projections.

Premiums tell you what the risk is and the premiums are still lower than projected. So I don't know where the argument that the exchange population is sicker/older than expected is coming from.

CNN: Obamacare patients sicker and pricier than expected

Huffington Post: Hey, the people on the exchanges seem to be really sick

How Slow Uptake by 'Young Invincibles' is Driving Premiums Higher

How much higher?

Obamacare Premiums to soar 22%

The CBO was off by a total of about 24 million people.

As a single example, March of last year: The CBO now projects 12 million people will enroll in the exchanges in 2016. One year ago, it estimated that 21 million would enroll in 2016. Looking out to 2018, the CBO projects that 18 million will be enrolled in the exchanges, which is down from its last estimate of 24 million.

So, Yeah. Fewer people than anticipated, who are sicker and older than anticipated. As anticipated by those who assume that folks will follow their incentive structures.

Greenbeard · Jan 23, 2017

cpwill said:
CNN: Obamacare patients sicker and pricier than expected

Huffington Post: Hey, the people on the exchanges seem to be really sick

How Slow Uptake by 'Young Invincibles' is Driving Premiums Higher

You continue to miss the point somehow. Yes, many insurers underpriced for three years. We know that. They underpriced relative to projections and relative to the actual risk of their enrollees. And that's because the actual risk of their enrollees turned out to be pretty close to the (CBO) projections.

Obviously the enrollees of insurers that underpriced are sicker than they priced for; that's a tautology. The point is that their underpriced premiums were already ~20% below projections.

How much higher?

Obamacare Premiums to soar 22%

Those premiums aren't higher than the CBO projections used to price the law back in 2009/10. They're lower. Which, again, suggests the CBO projections actually assumed a slightly sicker population than we've got right now.

As a single example, March of last year: The CBO now projects 12 million people will enroll in the exchanges in 2016. One year ago, it estimated that 21 million would enroll in 2016. Looking out to 2018, the CBO projects that 18 million will be enrolled in the exchanges, which is down from its last estimate of 24 million.

So, Yeah. Fewer people than anticipated, who are sicker and older than anticipated. As anticipated by those who assume that folks will follow their incentive structures.

The CBO projected the ACA would cost $940 billion over the 2010-2019 period. Actual costs have been lower. Year-over-year, actual costs and future projected costs have been falling--something your garbage source curiously doesn't convey. E.g, see WSJ:

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

In 2019, for example, the agencies project Obamacare will cost $116 billion, which is down 33% from the initial forecast for the same year made in 2010.

JasperL · Jan 23, 2017

cpwill said:
Yup. We are Very Very Much In Favor of Free Stuff, and Very Much Against Having To Pay For It, Ever.

To be fair, most democrats recognize that the mandate is an essential part of the guaranteed issue, and support both. It's mainly republicans who seem confused, and want the free stuff without having to pay for it with the mandates.

trblmkr · Jan 24, 2017

I get several things from this EO.
One, it took only three days for Trump to attempt to circumvent a legally enacted law. So much for the conservative hatred of EO's.
Two, he was a complete ***** about it. It is written so that he didn't tell any agency, company, state or person what to do or what to take away. He left it up to anyone who felt "burdened" to do something to relieve that burden. So he tried to act tough on the ACA but ended up afraid to make any decision that had any serious consequence directly attributable to him. Or Congress. Or his cabinet. They are clueless on what to do about the ACA because they have to screw someone in every segment of society, except the wealthy, no matter what they do. And they don't want to be blamed.
Someone should have told him. This stuff is HARD.

Trump Signs Executive Order on Obamacare

Sporadic insanity normal.