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States have already tried Trump’s health care order. It went badly.

Greenbeard

Greenbeard

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Some historical perspective on association health plans and the perils associated with them.

States have already tried Trump’s health care order. It went badly.
A version of these self-insured association health plans first became widespread in the 1980s, but they failed in droves because many were undercapitalized. More troubling, these earlier association plans had a history of becoming what the Labor Department termed “scam artists” and the Government Accountability Office reported were “bogus entities [that] have exploited employers and individuals seeking affordable coverage.” More than two dozen states reported in 1992 that these early association plans had committed “fraud, embezzlement or other criminal law” violations.
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Because less-regulated association health plans compete with fully regulated markets, actuaries and regulators have long warned that association plans create an uneven playing field that can disrupt markets. People who don’t need to cover preexisting conditions or don’t want to pay community rates gravitate to the better deals offered by associations, leaving sicker people in the regulated markets. Naturally, regulated insurance prices increase as a result, sometimes causing a death spiral that crashes the market.

That’s just what happened in Kentucky in the 1990s when it reformed its individual market but exempted association plans from the reforms. Enrollment with associations shot up, and most insurers selling in the regulated market pulled out. Within two years, the state repealed its reforms. Association health plans were only one part of Kentucky’s failed market reforms, but they are still a major reason why the so-called Kentucky disaster now serves as a lesson for other states to avoid similar measures.

We could avoid such market disruption by making association health plans abide by the same regulations that govern individuals and small groups, but the whole point of Trump’s executive order is to sidestep existing regulations. The only other option for avoiding market disruption is to keep association plans separate from the regular market by ensuring that people cannot simply choose between association plans and regulated insurance based solely on their health status.
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Given the rules in place now, the entire purpose of the EO does indeed seem to be to repeat the mistakes of the past by creating different sets of rules for different plans:

The Affordable Care Act did not outlaw association health plans. It took several steps to limit their abuses, however. First, it imposed reporting requirements on MEWAs, imposed criminal penalties on MEWA fraud, and authorized the Department of Labor to take immediate action to deal with fraudulent MEWAs. It also dropped from the “guaranteed availability” provision of the PHSA an exception that had existed for bona fide association plans. An insurer that offers coverage through an association must offer the same plan to non-members who want it, if they can find out about it. Associations themselves are not subject to guaranteed availability requirements and will likely be able to find ways to winnow healthy from unhealthy applicants.

But most importantly, the ACA nowhere recognizes associations as having special status. Distinctions under prior law for “bona fide” associations, more or less disappear. The ACA simply defines large group, small group, and individual plans, without reference to how they are offered. Association plans continue under the ACA, but under regulations and guidance, associations that offer coverage to individuals are subject to the individual market rules and associations that offer coverage to small groups are subject to the small group coverage rules. These include the essential health benefit requirements and rules intended to prohibit cherry picking.
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It's sad that many on the right don't seem to remember that we were ALL worried about the health care system in 2006-2008. All potential and eventual candidates campaigned on it.



McCain wanted some tax credits (which were a bandaid) and Obama wanted his plan (which didn't control costs - because how can you without single payer). But once the Evil Leftist (Obama) passed his plan, suddenly the early 00's became another fake golden age.

Trump has sent us on a collision course with 2006-08, except it'll be worse. Some are cheering now. Just look me up in a couple years....





He lied about having a plan.

The GOP lied about having a plan.

Obamacare could have been improved, but Trump seems to have made a bet that if he makes things worse than it was in the past, his base will blame Obama/Dems. I can only pray they aren't that ****ing gullible.

Someone should bookmark this post. I'd love to be told I'm wrong in 2 years. I really would. That would mean I'm wrong, and things worked out.
 
apdst said:
The EO overturned an unconstitutional EO.
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You've confused some things here. Just because multiple things happened in the same week doesn't mean they were all the same thing.
 
Greenbeard said:
You've confused some things here. Just because multiple things happened in the same week doesn't mean they were all the same thing.
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Clear it up for me.
 
Mr Person said:
It's sad that many on the right don't seem to remember that we were ALL worried about the health care system in 2006-2008. All potential and eventual candidates campaigned on it.



McCain wanted some tax credits (which were a bandaid) and Obama wanted his plan (which didn't control costs - because how can you without single payer). But once the Evil Leftist (Obama) passed his plan, suddenly the early 00's became another fake golden age.

Trump has sent us on a collision course with 2006-08, except it'll be worse. Some are cheering now. Just look me up in a couple years....





He lied about having a plan.

The GOP lied about having a plan.

Obamacare could have been improved, but Trump seems to have made a bet that if he makes things worse than it was in the past, his base will blame Obama/Dems. I can only pray they aren't that ****ing gullible.

Someone should bookmark this post. I'd love to be told I'm wrong in 2 years. I really would. That would mean I'm wrong, and things worked out.
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I remember seeing McCain interviewed on this subject during his campaign. He said that government health insurance wasn't right for Americans. When the interviewer pointed out that he'd been on government health insurance for his whole life he played the POW card, said that a different government had taken care of his health for a few years and hadn't done a good job of it.
 
Grand Mal said:
I remember seeing McCain interviewed on this subject during his campaign. He said that government health insurance wasn't right for Americans. When the interviewer pointed out that he'd been on government health insurance for his whole life he played the POW card, said that a different government had taken care of his health for a few years and hadn't done a good job of it.
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I should preface this by saying I don't think McCain personally knows anything about health care policy: to his campaign's credit, they were ultimately right that we need to get away from the employer-based system. (The very group-based coverage concept that's being pushed with this EO.) And they were attacked without mercy for that one by the Obama campaign because that's a pretty easy position to attack.

Where they were wrong is in not creating fair, level-playing-field markets outside the employer-based system where people can get insurance (i.e., exchanges). So in total what he ran on was garbage, but it had a kernel of a great--and unpopular--idea in there.
 
Greenbeard said:
I should preface this by saying I don't think McCain personally knows anything about health care policy: to his campaign's credit, they were ultimately right that we need to get away from the employer-based system. (The very group-based coverage concept that's being pushed with this EO.) And they were attacked without mercy for that one by the Obama campaign because that's a pretty easy position to attack.

Where they were wrong is in not creating fair, level-playing-field markets outside the employer-based system where people can get insurance (i.e., exchanges). So in total what he ran on was garbage, but it had a kernel of a great--and unpopular--idea in there.
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No, I like my employer based coverage, im not rearing to take massive cuts to the quality of my insurance.
 
Greenbeard said:
Indeed, this is the problem we face.
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It's not a problem.

Well it is if you want to put everyone on equally crappy insurance, but since most people do not want that it isn't a problem
 
EMNofSeattle said:
It's not a problem.

Well it is if you want to put everyone on equally crappy insurance, but since most people do not want that it isn't a problem
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"Most people" aren't asked what level of coverage they want. That's the problem. Put them in a market, let them vote with their wallets.

If someone wants a $19K platinum plan, more power to them. If they'd prefer to get that value in wages and put some of those toward a less extravagant plan, that's fine too. Making a $19K plan the default and hiding the cost in forgone wage increases and sporadically disclosed premium contributions is silly. It also dampens any incentive payers have to contain costs.
 
Greenbeard said:
"Most people" aren't asked what level of coverage they want. That's the problem. Put them in a market, let them vote with their wallets.

If someone wants a $19K platinum plan, more power to them. If they'd prefer to get that value in wages and put some of those toward a less extravagant plan, that's fine too. Making a $19K plan the default and hiding the cost in forgone wage increases and sporadically disclosed premium contributions is silly. It also dampens any incentive payers have to contain costs.
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Well then the state should stop mandating platinum level coverage and increase the HSA limit and insurers should encourage more use of cash to pay bills. Your purported problems are created by the government, not solved by them
 
EMNofSeattle said:
Well then the state should stop mandating platinum level coverage and increase the HSA limit and insurers should encourage more use of cash to pay bills. Your purported problems are created by the government, not solved by them
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Employer-sponsored insurance is indeed a problem caused by the government. It encourages overly generous coverage that most people would probably decline in a market scenario.

What are you even disagreeing with at this point?
 
Greenbeard said:
Some historical perspective on association health plans and the perils associated with them.

States have already tried Trump’s health care order. It went badly.



Given the rules in place now, the entire purpose of the EO does indeed seem to be to repeat the mistakes of the past by creating different sets of rules for different plans:
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There are already a different set of rules
Corporations do not have to purchase ObamaCare compliant plans, and you people have never had a problem with it apparently.

Giving small bussineses the same access to waivers and the benefits of large risk pools ? Now that you have a problem with.
 
Moderate Right said:
I'll take that as your admission that Obamacare has gone badly.
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It has very big faults, and has not delivered as promised. The answer is not to throw the baby out with the bathwater though.
 
rocket88 said:
It has very big faults, and has not delivered as promised. The answer is not to throw the baby out with the bathwater though.
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The answer is to come up with a true bipartisan plan, and that means repealing Obamacare and replacing it with a real bipartisan plan. Obamacare was partisan. The Republican plans were partisan. Trump is ripe for this now with Republicans failing to repeal and replace. But, Democrats refuse to do anything bipartisan. It is either their way or the highway. Their definition of bipartisan is for some Republicans to cross over and do things their way. Bipartisan means a mix of both Republican ideas and Democrat ideas.
 
Moderate Right said:
The answer is to come up with a true bipartisan plan, and that means repealing Obamacare and replacing it with a real bipartisan plan. Obamacare was partisan. The Republican plans were partisan. Trump is ripe for this now with Republicans failing to repeal and replace. But, Democrats refuse to do anything bipartisan. It is either their way or the highway. Their definition of bipartisan is for some Republicans to cross over and do things their way. Bipartisan means a mix of both Republican ideas and Democrat ideas.
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Bipartisan is ideal, but I don't think Republicans are very interested in it either.
 
Moderate Right said:
The answer is to come up with a true bipartisan plan, and that means repealing Obamacare and replacing it with a real bipartisan plan. Obamacare was partisan. The Republican plans were partisan. Trump is ripe for this now with Republicans failing to repeal and replace. But, Democrats refuse to do anything bipartisan. It is either their way or the highway. Their definition of bipartisan is for some Republicans to cross over and do things their way. Bipartisan means a mix of both Republican ideas and Democrat ideas.
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democrats get a lot of credit for recognizing what eff ups the republicans are.
 
rocket88 said:
Bipartisan is ideal, but I don't think Republicans are very interested in it either.
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Trump is open to it and moderate Republicans are open to it. Together, with Democrats, they could pull it off and leave the Freedom Caucus and Tea Party in the dust. But, Democrats are too much into being the resistance and demanding that healthcare be done their way or the highway. I watched Chris Wallace interview Nancy Pelosi regarding healthcare and I have also seen Chuck Schumer be asked several times what Republican proposals they would accept as part of a bipartisan healthcare plan and neither one of them could list even one thing.
 
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