Sec. 302. Exchange-eligible individuals and employers.

[ProSense]

HR 3962, the Affordable Health Care For America Act: Section‐by‐Section Analysis (PDF)

Sec. 302. Exchange‐eligible individuals and employers. Defines who is eligible for participation in the Health Insurance Exchange including employers and individuals. In year one, individuals not enrolled in other acceptable coverage as well as small employers with 25 or fewer employees are allowed into the Exchange. In year two, employers with 50 and fewer employees are allowed into the Exchange. In year three, the Commissioner is, at a minimum, required to open the Exchange to employers with 100 and fewer employees, but is permitted from this year forward to expand employer participation as appropriate, with the goal of allowing all employers access to the Exchange. Defines acceptable coverage to include enrollment in other qualified coverage and most other federal health programs.

<...>

Once an individual or an employer enrolls in coverage through the Exchange, they remain eligible for Exchange coverage even if circumstances change that would otherwise exclude them.

This is huge.

Do people realize how many individuals and employers this will impact?

More facts

[Oregone]

1. But if the employers do not choose it, the employees remain excluded

And why would the employers choose it, unless it was cheaper and more comprehensive than a private alternative?


"This is huge."

Its really much the same

[ProSense]

2. But nothing.

You assume that enrollment in a public option will not grow. While at any given time the number of umeployed is 15 million or under, throughout a year there is at least four times that number passing through the rolls. Dependents become eligible for life.

Small businesses and their employees become eligible regardless of changing circumstances, including moving to another job.

[Oregone]

3. "You assume that enrollment in a public option will not grow."

Why would it grow if it were not cheaper and/or more comprehensive?

Here is to well-wishing. Kicking and screaming, or cheerleading, it doesn't matter at this point. You will get what you will. Everyone will all need to learn to enjoy it at this point, despite apprehensions, because the bandwagon isn't stopping.

[ProSense]

4. "Why would it grow if it were not cheaper and/or more comprehensive?"

Cheaper than what? Is there going to be a public option price and then one price for private insurance?


Also doesn't a larger pool help drive down cost?

[Egnever]

6. there are actually going to be different prices

and it is the main reason that the cbo estimated that the PO would only get 2% enrolement.

Having said that the exchange itself in and of itself should force prices down as companies work harder to to capture the business in the exchange.

[Oregone]

7. "Also doesn't a larger pool help drive down cost?"

How does that pool grow if it is not cheaper than private insurers, so that it may attract people?

"Cheaper than what?"

Don't be coy. You aren't stupid enough to not know what I am referring to: the private market "competition".



Look. Its all pointless anyway now. You've laid the parade. Ive tried to spell out the pitfalls. In 10 years you will all be grinning, eating a shit sandwich or not. I hope I am wrong that a national emulation of the Massachusetts model will not result in a rise in prices, as that model did, but no one has a crystal ball. You choose to applaud politicians taking a Third Way to embark on a "uniquely American" health care experiment. There was no time for real intellectual discussion, less we all miss the departing bandwagon. You all get what you will. End of this story, and beginning of a new one (now you can only hope as you may that the new story will be better).

[ProSense]

8. "How does that pool grow if it is not cheaper than private insurers, so that it may attract people?"

Are you being obtuse? You need to read the OP again.

[Oregone]

10. Are you being coy?

You know exactly what I am referring to.

If the public option is not superior in any way, and certainly not in prices, it will forever have a sluggish amount of enrollment and never truly compete and become superior (this isn't exactly coming out of the blue here). No one will enroll in an inferior or more expensive service.

But we have diverged from the OP anyway at this point, a specialty of yours.

Again. Enjoy your shit sandwich. This is Monday-morning cheerleading at this point.

[ProSense]

11. No, you're making a lot of stupid assumptions. n/t

[Egnever]

5. what difference does it make what option gets more enroleees as long as

people are covered and costs are kept down?

[Oregone]

9. Because it won't keep costs down

Thats all well-wishing. You aren't going to significantly take a stab at prices unless an option can be devised to cut out that 30% private market overhead. If the public option is designed not to do that (due to negotiation rates and pool sizes), then you are gaining nothing. Whatever you gain by insuring everyone (maybe 8%), you will lose on the other hand by guaranteeing demand at certain price points (look at Massachusetts, the most expensive state for family premiums in the nation at 12% higher than average).

The public option was supposed to "compete against private insurers" and "keep them honest". Now it merely exists, but it will not do what it was sold as. There is no significant cost-control in this insurance reform bill.

[Egnever]

12. How can it not?

When people are allowed to choise freely between plans that are mandated to have the same coverage how can there not be pressure for the price to come down?

Also the 30% is adressed and is limited to 15%

[Oregone]

14. "When people are allowed to choise freely between plans"

You sure thatll happen for the standard worker...positive now?

This uniquely American health insurance experiment may just not go the way the keyboard predictors so obviously see it at all. The debate, if there ever was one, is over now anyway, so we will check back in 10 years or so and see how your premiums are doing. Im not sure why I give a damn anymore.

[Egnever]

21. If the House bill as it stands today was what we ended up with then yes.

Sec. 302. Exchange‐eligible individuals and employers. Defines who is eligible for participation in the Health
Insurance Exchange including employers and individuals. In year one, individuals not enrolled in other
acceptable coverage as well as small employers with 25 or fewer employees are allowed into the Exchange. In
year two, employers with 50 and fewer employees are allowed into the Exchange. In year three, the
Commissioner is, at a minimum, required to open the Exchange to employers with 100 and fewer employees,
but is permitted from this year forward to expand employer participation as appropriate, with the goal of
allowing all employers access to the Exchange.

[Oregone]

22. I guess we read different things in the same text

I see employers will be able to choose freely, and you see individuals will be able to choise freely. Oh, wherethe truth lies?

[Egnever]

23. its both

Once in the exchange the employee gets to chose their plan. but it is the employer that gets to make the initial decision to join the exchange.

The only reason I could see for the employer not to chose it though is if outside plans are less costly, but in that case then you would be saving the employee money anyway so where is the problem with that?

[Oregone]

25. "but it is the employer that gets to make the initial decision to join the exchange"

Bingo. Which was my first post in this thread.

"The only reason I could see for the employer not to chose it though is if outside plans are less costly, but in that case then you would be saving the employee money anyway so where is the problem with that?"

This is something Ive also mentioned. What is the harm in that? Well, if the exchange plans do not significantly lower costs from the outside, they are a moot addition in terms of lowering costs in the overall reform.

[ProSense]

26. Again, you're assuming that

the plan will not have more appeal than the higher cost private plans. There will be a range of coverage. Insurance companies are not going to go around offering business the lowest plan possible. (Is there something that makes you think they will?)

The exchange will be more appealing to more employers than you think.

[Egnever]

27. I dissagree

As basic coverage levels are mandated. The only way they will be able to beat the prices of the exchange is if they can provide significant cost savings. Also the premium subsidies are only available to people buying from the exchange that in and of itself will push more people into the exchange.

[SKKY]

15. I believe it read "employers" AND "individuals"...

[Oregone]

16. You may be crossing paragraphs

*with the goal of allowing all employers access to the Exchange*

The employer must choose it prior to an individual employeee having access. Only thereafter would the employee be able to keep it. But alas, you must also look at what would motivate an employer to choose it if it does not significantly compete against alternative plans.

[ProSense]

17. "The employer must choose it prior to an individual employeee having access. "

Contract workers, freelancers, self-employed, mom and pop shops, a lot of people are not making decisions about health care based on employers.

[Oregone]

18. And a lot of people do

"small businesses" becomes "mom and pop shops" to tear at my heart strings? :)

[ProSense]

19. Mom and pop shops are small businesses, but reflect really small ones as opposed to

one with 25 employees. What's your point?

[Oregone]

20. Funny edit, thats all.

We all edit though. :)

[vaberella]

13. Well I give this a plus 1 because it's good news in my book. n/t

[ProSense]

28. It is good. n/t

[Phx_Dem]

24. I think this is the smart way to do it., It gives them time to

work out the kinks. This is a new program -- it's not the existing Medicare program -- so they are bound to be glitches and kinks. Let the people who need it the most and don't have other options get coverage before millions of us pile on the "lifeboat," potentially causing minor glitches to become big problems before they have time to iron things out.

I have insurance -- which I would love to dump just on principal (the principal is that I hate the fucking insurance companies) -- but as long as the bill prohibits denying coverage to people with pre-existing conditions and denying reasonable claims, I can certainly wait a few years until they get it worked out.

[Cleita]

29. Universal health care to be successful can't be tied to employment.

Again we are in a nightmare of means testing and class discrimination.

[ProSense]

30. That is just not true

Facts.

[dugaresa]

31. i work for a company that has in excess of 10,000 employees

i doubt the insurance lobby will allow such "captive" audiences to migrate to the public option. i wish but I somehow doubt it.

[ProSense]

32. You may be surprised what business will do to save money

I doubt the insurance companies can persuade a business to spend more on health care than is necessary.

[TheKentuckian]

33. A lot will depend on how the exchange is structured. If you've got massive national pools

then it will pretty much have to work at least as compared to rates currently available to small companies. How big the risk pools are is the real key.

[HopeOverFear]

34. can't rec but can kick