CBO - new information on H.R. 3962 ...

[slipslidingaway]

The health care calculator at the Kaiser site which estimates premium costs is based on a 70% actuarial value.

http://cbo.gov/doc.cfm?index=10691

"Subsidies and Payments at Different Income Levels Under H.R. 3962

The enclosed table focuses on enrollees who purchase a “reference” plan (the premiums for
which equal the average of the three lowest-cost “basic” plans, as defined in the bill), because
federal subsidies would be tied to that average. Such a plan would have an actuarial value of
70 percent, which represents the average share of costs for covered benefits that would be paid
by the plan. Although premiums under H.R. 3962 would vary by geographic area to reflect
differences in average spending for health care and would also vary by age, the table shows the
approximate national average for that lower-cost reference plan—about $5,300 for single
policies and about $15,000 for family policies in 2016. Enrollees could purchase a more
expensive plan or more extensive coverage for an additional, unsubsidized premium—and CBO
anticipates that many enrollees would do that, so the average premiums actually paid in the
exchanges would be higher (although average cost-sharing amounts could be lower than those
shown in the table)..."


****The actuarial squeeze on low and middle income families

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6916987

"...The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families..."

[Oregone]

1. Hrmph. Facts can prove anything

Damn you with the numbers. Let the reform be an ambiguous triumph

[slipslidingaway]

2. No reason to change now, it has been ambiguous from the beginning...

"ambiguous triumph"

:thumbsup:

[slipslidingaway]

3. An example of what someone would pay under the House bill...56 year old self-employed...

person with a family.

Person/family payment as % of income - 17.6% add the $10000. cap for out of pocket expenses, which more people will reach, and it is about 27% of gross income or easily over 30% of net income.

Just playing with the numbers, used 90,000 income for a family of four.

[ProSense]

4. What exactly are you trying to prove? From the CBO link

To illustrate the effects of those features, the table shows the amounts of income that would correspond to the midpoint of each FPL band, the resulting premiums that single individuals and families of four would have to pay for a reference plan if their income equaled that midpoint, and the share of their income that would be represented by the sum of the enrollee premiums and the average cost-sharing amount at that midpoint. For instance, a single person with income of $26,500 in 2016 (225 percent of the FPL) would pay a premium of about $1,900 (after getting a premium subsidy of 64 percent) and could expect to pay another $900 in cost sharing (net of federal subsidies); thus, the average payment by such a person for the premium and cost sharing combined is projected to be $2,800, or about 11 percent of income. A family of four with income of about $54,000 (also 225 percent of the FPL in 2016) could expect to pay about the same share of its income for premiums and cost sharing. (Because use of health care in a given year varies widely, many people would pay less in cost sharing than the average, but some would pay more—subject to the limits on out-of-pocket costs that are specified in the bill.)

This is exactly what has been reported.

[slipslidingaway]

7. No subsidies for a more extensive plan and a lower actuarial value...

than most employer based plans...means more out of pocket expenses.

[ej510]

5. In other words it's a pile of shit.

[slipslidingaway]

6. I think it may be less than many are expecting, I've seen posts where...

people state that using the calculator they will be saving money, but I'm not sure they are comparing apples to apples.

For people who have a chronic condition they could wind up meeting the max on out of pocket expenses most years and need to add that number to the premium number.

http://healthreform.kff.org/SubsidyCalculator.aspx

[dflprincess]

8. So, not only does the bill help the insurance companies

it will help the credit card companies as well because many people will still have to use credit to cover medical expenses. There may be few medical bankruptcies, but there will still plenty of them - and more than there are in Switzerland, France or Germany.

The bill also allows premiums and out of pocket maximums ("cost-sharing") to increase annually, whether your income does or not.

[slipslidingaway]

9. I had not connected the CC aspect but you are right, people will be paying...

premiums and have insurance in case something catastrophic happens to them.

Many people are not going to be able to afford the constant co-pays and will wait before going to the doctor.

:(

Our insurance is still very good, but not as good as before, and the extra hundred, two hundred do add up over time.