If the Senate health insurance bill passes how much will premiums, co-pays and deductibles be and

[Better Believe It]

what benefits we will get for the money the insurance industry sucks out of us?

Please give examples such as single person, two spouses, family of four, etc.,

Thanks for your help.

[Cronus Protagonist]

1. Easy!

Q1: Benefits will diminish over time
Q2: Premiums and copays will increase over time

There you go. Glad to help.

[Better Believe It]

2. Thank you.

[cali]

4. lol. like that isn't happening right now, dear?

[laughingliberal]

56. We were kind of hoping for some improvement for our money. nt

[tridim]

5. Thanks for playing, but in reality the opposite is true.

It's the whole point of HCR.

[Oregone]

12. By what specific mechanism(s) in the legislation?

[Cronus Protagonist]

14. Really? It's the WHOLE POINT?

It's interesting how low people will stoop.

1/ The costs are NOT capped, and cost increases are controlled a little, but allowed and are indeed expected.
2/ That which is covered is not mandated, only your payment to the insurance profits is mandated.

If you disagree, post a link to elucidate your claims and I'll be glad to be educated.

[tridim]

15. Yes, it's the whole point. Affordable, reliable, regulated HC coverage for everyone.

Pay attention.

[Cronus Protagonist]

18. Will you help me come up with the extra $1200 I need to keep from being fined?

Didn't think so.

[laughingliberal]

57. Now, now. If you just keep repeating affordable, reliable...etc, and

clap really, really loud we can save tinkerbell!

[Cronus Protagonist]

72. Yeah, what happend to "affordable for everyone"?

Apparently, they haven't talked with me about that.

[laughingliberal]

79. Now, you're getting all grabby. nt

[Ms. Toad]

3. Try here:

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

Edited to add:

Here is the link that will give you a less easy to decipher breakdown of the costs beyond premiums: http://www.kff.org/healthreform/upload/housesenatebill_final.pdf (scroll down to the cost-sharing section)

[berni_mccoy]

7. Reduction of $7k for my family from our current plan.

[Ms. Toad]

8. $8000 less for us as a family.

Once my daughter is out on her own, it will be close to a $14,400 reduction for her - alone. The only thing she is eligible for now as a single adult costs $14,400 - but she has no income (and will be unlikely to be able to hold down a full time job because of health issues).

[Tailormyst]

21. As an adult with no income doesn't she qualify for any state medical?

[Ms. Toad]

50. She would need to be declared disabled.

In our state, there is no general health care for indigent adults.

As long as we can keep her in school full time, we will try to go that route and keep her on my insurance. Beyond that, we will probably get close to bankrupt before we head for disability. She needs specialized care she is unlikely to be able to get through disability provided coverage, since she has an orphan disease that only a few doctors know enough to treat. She is currently traveling 500 miles several times a year for treatment.

So - yes, she probably qualifies, but as long as we have the means to get her access to insurance we will spend our last dime doing so. Her survival may well depend on it - but I would prefer to have her able to get insurance on her own and not spend our last dime :D

[Tailormyst]

54. Ouch- I am so sorry you are going through this

Although I dislike the healthcare bill immensely, I do hope whatever is passed helps your family.

[Ms. Toad]

58. As long as there is

guarantee issue, premium parity, and coverage of pre-existing conditions it will. Subsidies would be wonderful - but at this point, I'd even just settle for the first three (which is a change - I've always considered all 4 no-brainers, but I didn't expect to be fighting both the left and the right since there was pretty much broad agreement on all four from early on.

Unfortunately, I'm afraid it is about to be tanked with the help of well intentioned people on our side who are legitimately afraid of out of control insurance companies, but who can't be bothered to read the bill see the limits on profits and cost sharing that are actually in the bill.

[Better Believe It]

20. Will the benefits remain the same or can the insurance company change them and/or increase their

premiums, co-pays and deductibles under the Senate plan?

[Better Believe It]

10. I'm not a CPA. How much will premiums, co-pays and deductibles be for different

benefit packages? And what will be included in those benefit packages, be they employer sponsored or privately bought.

Let's figure that out first than we can see what if any financial help we might get from the government.

[Ms. Toad]

60. So your theory is to tank the bill,

rather than to try to sort it out?

Sorry. It's been too hard a battle to get this far. The bill includes the things I consider essential: mandatory issue, premium parity, coverage of pre-existing conditions, and subsidies. It also has caps on out of pocket expenses, and sets out basic limits on coverage that must be provided (which were not among the things I considered mandatory).

At this stage, with the bills poised to go down in flaming defeat, I don't really care about the nuances among the individual plan variations. The benefits that are included in every bill/proposal will make insurance accessible to large numbers of people who currently have no access at all. I suggest that if the nuances of the individul plans are important to you, and you can't figure it out yourself, that you hire a CPA to analyze it for you. I've pointed you to a premium calculator, and to a summary of the highlights of the bill. I would hope you would take the time to sort out what is in the bill (or not in the bill) that is important to you before agitating for its defeat based on what you are afraid might or might not be in it.

[Cronus Protagonist]

16. Increase of $1200 for me

And I probably don't need to say this, but I don't have a spare $1200 lying around to send to my friendly insurance agent, who probably owns a home, a car and several suits, none of which I own myself.

[Change Happens]

34. HUGE positive for my family: Way cheaper price and better quality coverage overall!!!

Please God, make this bill pass...

[KittyWampus]

64. I qualify for Medicaid

[leftstreet]

6. According to our esteemed politicians: "AFFORDABLE"

Whatever the fuck that means

[Ms. Toad]

9. Try the calculator and see.

Plug in some numbers and see what it means. You may or may not think what comes out is affordable - but it is a lot more predictable than "whatever the fuck that means"

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

[depakid]

13. The calulator doesn't say how much the Treasury is pumping into premium subsidies

in other words, diverting into fat cat's pockets.

The actual price for health care is far higher for many people- it's just that everyone else pays for it ina a most inefficient way.

[Ms. Toad]

39. Take the unsubsidized premium

(which you can find by putting in a very large income) and deducting the subsidized premium. That will tell you the amount of the subsidy for the individual policy in question.

As to the actual price for heath care - actually, it is far higher for a few people, and far lower for a few people. The premium is based, essentially, on the average cost of health care plus a profit. (It's figured based on the annual cost per person - but if everyone is in it for a lifetime that just means you are looking at a lifetime as a year by year slice - just a different view of the same numbers). Generally, you pay more than you cost when you are younger, and you pay less than you cost when you are older. The change under the bills is that most of us don't bother to buy health insurance when we are young and healthy - but we still think we should have the benefit of average health care costs when we get older. A second change is that the "fat cats" are required to rebate (or cap) excessive profits - if the cost of care is less than 80-85% of the premiums either the cap kicks in (the house bill) or rebates are required (the senate bill).

As to "far higher for most people" - there are outliers - like my daughter. At 19, she costs around $60,000 a year. She is one of the few who will always be a heath care leach. There are others on the other end of the spectrum - like my father. He's had rotator cuff surgery, and gall bladder surgery, was in a car accident that broke a few ribs (and was paid for by the at-fault-driver) and was recently evaluated for prostate cancer. He takes the occasional sleeping pill - but otherwise has reached nearly 80 costing the health care system almost nothing.

Under the current proposals, the government is subsidizing people who otherwise could not afford it up to the average cost of care - which includes averaging in people like my daughter and my father (plus a 15-20% profit). I would prefer the profit go to a public single payer option, but what we have is a decent start that will help a lot of people.

[Cleobulus]

24. for me no change, except I would have to buy my employers crappy insurance...

its just under the 9.8% income limit, so no subsidies either.

[OneTenthofOnePercent]

70. wrong reply. n/t

[Lydia Leftcoast]

37. Oh cool, my premiums will double!

and there's nothing in the Calculator about copays and deductibles.

[Ms. Toad]

40. go to the second link I provided

It isn't as clear, but it does provide limits.

Do your premiums double - or is the premium just double your share of employer provided insurance?

If you're young and healthy and purchasing insurance on the open market, it could easily double - the tradeoff is that when you're old and decrepit your premiums will be perhaps 25% of what they would otherwise be under the current system.

If I were to purchase insurance on the open market (rather than through my employer), my premiums would be around $50,000 a year (because of age and pre-existing conditions) - under the Obama proposal they would be a little over $6000 - an even better deal than I thought it would be (I hadn't looked until just now).

[Lydia Leftcoast]

46. I'm self-employed, and I'm over 50

Nope, those were the premiums WITH the "assistance."

I think there may be some massive civil disobedience if a lot of 50+ types are forced to buy expensive insurance when they're worried about their jobs.

[Ms. Toad]

55. If you're self-employed, over 50

with premiums lower than the bills provide you don't know how lucky you are.

Same boat (except not self-insured). Insurance available through my employer is over $20,000 a year. On the open market (if there are open spaces on the waiting list)I could get it for around $50,000. Otherwise, I'm out of luck. The bills/proposal would make it available for a tad over $6000.

I expect the civil disobedience of 50+ types will be very limited - a tad over $500 a month is a real bargain for the full premium for most of us in that age range).

[Lydia Leftcoast]

76. It's not a bargain if it has deductibles

In some months, I have trouble affording what I have now, and the deductibles are just killers.

[Ms. Toad]

77. Since you're only paying a quarter of the premium.

(just going on memory - didn't go back up-thread to check so I may have the portion wrong) my guess is the deductibles would be considerably lower. There are statutory caps on cost sharing.

About the only thing you can get (that I know) of at our age for that price is catastrophic coverage (with deductibles in the thousands of dollars - and typically a very high copay until about you reach about double the deductible.). I used to have to rely on catastrophic coverage. One plan had a $1000 deductible, and another had $5000. I think one required a 20% co-pay until I hit double the deductible, and the other required a 50% co-pay. Both were dirt cheap, though, and since I was relatively healthy they were worth it.

If I had a chronic illness, I'd jump at the chance for higher premiums and lower deductibles.

[Lydia Leftcoast]

89. I am furious that we have to pay deductibles AT ALL

No other country has them.

We didn't use to have them.

It's simply a money-making scheme for the insurance companies. They receive thousands of dollars a year from me and have never paid out a cent.

Such a deal--for them!

The fact that neither bill bans deductibles tells me that the Senate and the House are thoroughly in the pocket of the insurance companies.

Business has been bad in the past few months (although it has picked up). Thanks to "the best medical care system in the world," I am stuck with medical bills that I can't afford for my recent broken elbow. I actually considered not getting my elbow looked at, because I knew that the doctor visits would throw my budget out of whack.

These bills institutionalize the worst practices of the insurance companies, and Americans are so used to being badly treated that they're willing to SETTLE for being screwed over only slightly less.

[Ms. Toad]

91. I agree, deductibles suck.

That said, our history of passing any kind of health care reform sucks, as well. There's only been one significant reform in the time I've been tracking it - about 30 years. This is, at least, significant insurance reform. I would prefer health care reform. I would prefer single payer. I would also prefer we stop acting like the police force for the world, advocates for regime change, stop torturing people, and a lot of other things.

All things considered, if we can at least get insurance reform, that will be a step in the right direction.

Have you looked into setting up a HSA? That might at least even out some of those unexpected deductible expenses.

[Lydia Leftcoast]

92. I did look into an HSA from the three companies that operate here: rotten deal

I'd have to pay the same premium as for a regular individual policy PLUS put at least $200 a month aside to make it work. Oh, and I'd have to reapply, even if I used the same insurance company.

Since I have occasionally been hard pressed to pay the premiums in the past year, adding another $200 a month is not feasible.

A lot of the people who blithely suggest HSAs haven't really looked into them.

[girl gone mad]

80. ugh..

mine would nearly double. please wake us up from this nightmare.

[booley]

84. wow, I am not officially against this bill

According to the calculator, I will have to come up with $3297

I don't have that. I am barely holding on now. I will never have three thousand dollars I can spare. And I dont' qualify for any of the subsidies.

And why are we giving money to private insurers who are part of the problem again? Isn't that like fighting drug addiction by hiring columbian drug cartels?

[Lydia Leftcoast]

90. See, this is the type of thing that will hurt the Dems

I know people who are fervently hoping for the passage of this bill but actually don't know much about it.

I think they will be shocked and angry when they learn the full implications.

As a free-lancer, I just may move to one of those Third World countries that accepts retirees if I'm suddenly required to pay double my monthly premiums with no reduction in deductibles. Some of them actually have universal health care.

[Bryn]

11. I remember when I had a full coverage with insurance co.

that was excellent. It cost me only 3.00 or so per week at where I used to work. Now this is what I call "AFFORABLE".

I think many people nowdays are excited about having to pay $7,000 instead of $15,000 per year.

NOT AFFORDABLE to me.

Sorry I can't answer your question here yet. I am on Medicare via SSDI that costs me $1,152.00 per year. It's pretty good so far.

[Romulox]

17. If demand goes up (in fact gov't enforced) then prices will necessarily go up, too.

Given a the relative inelasticity of supply.

It's just basic economics.

[flamingdem]

19. This is excellent, I now see that I will save 5,000 on Obama's plan, cool nt

[Better Believe It]

23. And your insurance company can't legally change their premiums, co-pays, deductibles and benefits?

I didn't realize they needed the approval of the federal government to jack up your rates and cut your benefits under the Senate plan.

Please provide some credible links proving that assertion.

[slipslidingaway]

32. Is that for the silver plan that pays roughly 70% of expenses? n/t

[flamingdem]

22. PLEASE RECOMMEND THIS THREAD FOR THE CALCULATOR !!!!!!!!!!!!!!

Some creeps are on here in the last minute 3 unrecs. What's the matter? Afraid that DU'ers will see they'll save THOUSANDS per year!?

[Better Believe It]

25. Where's the calculator on insurance rates, co-pays, deductibles?

:)

[gkhouston]

26. And where's the link for Claim Denial Bingo? n/t

[Ms. Toad]

43. Rates:

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

Copays, deductibles - too many variations for a simple calculator, but summaries can be found at p 6 and 13 here: http://www.kff.org/healthreform/upload/housesenatebill_final.pdf

[Cleobulus]

27. I won't save a damn dime, unfortunately, the Insurance my employer offers is unaffordable...

as it is, not to mention the deducts and premiums simply suck, yet I'd be forced to buy that, with absolutely no subsidies.

[flamingdem]

28. So you vote to fuck it up for millions of others who would benefit? nt

[Cleobulus]

29. Who says those millions won't be in the same boat as me? I make 10 bucks an hour...

at my job, its not like I'm rich.

[gkhouston]

31. Hey, WE get to vote? FABULOUS!!! Where do I register my vote for a public option? n/t

[slipslidingaway]

30. That calculator is based on a 70% actuarial value plan ...

just so people are aware, if you want a higher actuarial plan people have to pay the full difference

"Subsidized people can enroll in more expensive plans, but must pay the full difference in the premium..."


Personally this is what the calculator tells me.

"Note: In general, full-time employees with employer coverage available that meets specified requirements are not eligible for premium subsidies..."

[Better Believe It]

44. 70% ??? That's not much of a health care plan at all!

People would have to pay 30% of their healthcare bills! Well, that can bankrupt people real quick with a major illness or accident.

[slipslidingaway]

49. People will be surprised - Links here, actuarial squeeze on low and middle income families

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6916987&mesg_id=6916987

"...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..."

[laughingliberal]

65. Yeah, funny how they don't talk much about that. nt

[quiet.american]

53. Subsidies pay b/w 70%-94% of premiums, there are out-of-pocket caps, etc. nt

[aroach]

48. No subsidies if employer health insurance is available?

We don't participate in my husband's employer sponsored insurance because it would cost more than our mortgage does. Seeing as how we live paycheck to paycheck as it is and no one has been to a doctor in years (including two young children), there is no way we can suddenly afford to get insurance through his employer and we won't be eligible for subsidies just because it does exist. Lovely.

Sounds like we will be worse off than we already are with now a fine to pay every year. Doing without health care isn't enough for them. Now we get to pay for the privilege of doing without.

[slipslidingaway]

51. That is what is stated at the Kaiser link...

"Note: Subsidies are only available for people purchasing coverage on their own in the Exchange (not through an employer)..."

Also this ...

"The proposal also makes available a catastrophic policy for young adults and those exempted from the requirement to obtain insurance that is less comprehensive and has a lower premium than other coverage. It is not reflected in the calculator."

The catastrophic policy will still mean there is no access to care, just payments to insurance companies.

:(

[girl gone mad]

82. lots of people in that boat.

:(

[quiet.american]

41. If you're talking about the Kaiser calculator, it is completely inaccurate.

Even though it's been updated, it's still basing subsidy amounts on age, when subsidies are only based on one's income relative to percentage of the Federal Poverty Level, *and* one's citizenship status. For example, using the House version of the bill, I put in that I was at 350% of the poverty level and the calculator returned that I'd be paying 96% of the premium. The highest percentage of those at that income level would be 28% of the premium:

http://edlabor.house.gov/documents/111/pdf/publications/AHCAA-DETAILEDSUMMARY-102909.pdf
(scroll down to page 3 for the table).

I'll post down-thread the table that can be found in the President's Proposal that lays out subsidy amounts and what percentage of income one can be charged for premiums.

http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/affordability

[girl gone mad]

81. Um.. I'd be losing thousands.

But, whatever. You got yours, so..

[Better Believe It]

33. That so-called "calculator" is pretty much useless. It doesn't answer any of my questions.

It doesn't indicate how much insurance premiums will cost for different kinds of coverage nor what the co-pays and deductibles might be!

So my fundamental questions remain unanswered!

Does anyone know how much the health insurance premiums will be for different kinds of coverage, what the co-pays and deductibles will be and what the benefit packages will look like?

Beyond guessing, can anyone really say?

We understand that some people will get help from the federal government to pay the high cost of premiums but we don't know what benefits will be included in those packages. Any "savings" you may see due to government help can easily be wiped out by the insurance companies! All they have to do is increase your co-pays, deductibles and/or cut benefits! And that kind of change you can count on!

On top of that we also know that if you have pretty good health insurance the government will be able to tax your insurance in 2018!

[Cleobulus]

35. The only answer I have is when subsidies kick in, only when premiums hit...

9.8% or 12% of income(Senate and House bill differences respectively), and doesn't even address subsidies for deducts and copays.

[Change Happens]

36. Get information from the calc. then use your head to figure out the difference...nt

[Better Believe It]

38. And the calculator is only for a single person and a family of four!

And it's only designed to suggest what federal subsidies might be available.

It doesn't give us any information on what health insurance premiums will cost along with co-pays/deductibles for different benefit packages.

That being the case, is it fair to assume that health insurance rates will go up and benefits will go down if the health insurance industry bill is passed?

[Ms. Toad]

45. Profits are capped

(or rebates required) if less than 80-85% of the premium taken in is paid out for care. (The percentage and mechanism vary depending on which bill or proposal).

As to co-pays/deductibles - the cost sharing is also capped, but there are lots of variations. Summaries are at page 6 and 13 here: http://www.kff.org/healthreform/upload/housesenatebill_final.pdf

Typically insurance is based on limited variations - Single-Family or Single-Couple-Family being the two most common. Whoever designed the calculator apparently chose the Single-Family scheme. At least it gives you the outsides. I haven't run into any plans that charge per child beyond the second child.

[laughingliberal]

59. The MLR in the Senate bill is 85%. This is the precise level above which the industry lobbied agains

IOW, they fought strenuously to keep it from being any higher than that. The reason is that this is the level at which they can best manipulate the numbers.

[Ms. Toad]

62. Sure - they can manipulate the number far better at 85%

than at 50%. Give me a break.

They get 17.7-25% profit. ($15 profit for $85 in coverage or $20 profit for $80 coverage, depending on the plan type). The moaning and groaning recently has been that there are no limits. That is false, pure and simple. There are limits are in the bills. So now the complaint is that they will manipulate the numbers.

Insurance, being insurance, will manipulate the numbers no matter where the caps are set. The point is that there are caps in the bills - if we leave things as is (i.e. pass no bill) there will continue to be no caps. Hmm...which would I prefer....to continue with uncapped profits or at least have a cap. Personally, I prefer having a cap.

[laughingliberal]

63. One proposal was to set it at 90% but then the OMB director put the cabash on that

saying it would amount to nationalization of the system. The industry knew there would be a cap. They lobbied to get it down to 85%.

Believe what you want. I've studied it and studied it and read the opinions of all the experts and there will never be 85% of the revenue actually going to provide care.

The bill is not all that and a box of chocolates but the supporters aren't going to see the truth til it's too late and we're living the nightmare.

[Ms. Toad]

67. The big point youare missing

is that there is NO cap now, and the bills/proposal impose a cap.

In addition, the bills/proposal require premium parity, mandatory issue, and coverage of pre-existing conditions.

It is far from perfect - but it is significantly better than what we are currently living with (and, if we don't pass insurance reform now, will be living with for at least the next decade. It has been about a dozen years since the last (relatively insignificant) health care reform - and the previous one was more than a decade before that.

I have no illusions it will be a panacea - but it will be significantly better than the nightmare we are currently living which imposes NO caps on profits, allows the insurance companies to pick and choose who to cover, and which pre-existing conditions to cover, and how much to charge if they lower themselves to offer a policy to someone with a pre-existing condition.

[laughingliberal]

69. I'm not missing anything

I'm well aware there is no cap now. I'm also aware the cap is meaningless with no federal agencies anyone knows of with the expertise to audit the insurance companies's books and detect the manipulation.

It is not significantly better than the nightmare we are currently living. I know all the talking points. I'm well aware of what people have been told the benefits of this bill will be. I'm also well aware all those benefits disappear in a cloud of smoke when you break it all down and insert the weasel words that were inserted to provide a way around all those wonderful regulations you have been told will be there to protect you.

[Ms. Toad]

74. So allowing then to continue unchecked

is better than at least putting statutory (not regulatory) limitations and obligations on them? That makes no sense. At least with a statute, there is something to enforce.

Providing access to insurance, on the terms set out in the statute is not a talking point, it is life or death to those people who currently have pre-existing conditions and no access to insurance at all because all the insurance company has to do is to say "no" and there is absolutely no legal recourse. Requiring the insurance companies to charge the same amount regardless of pre-existing condition is not a talking point. Currently insurance companies can legally charge whatever they feel like - no one has any recourse. The statute at least provides a recourse.

I'll take laws that at least set out limits and obligations any day over the status quo - in which there are no limits or obligations. Enforceability is another issue - but there is no hope of enforcing a law that doesn't exist.

[laughingliberal]

75. It makes perfect sense when you understand it is all window dressing

Here's a post from earlier today where I laid out my position. I can respect there are people who disagree. I'm concerned that many who really, really need the help (and I get it your family fits there as does mine) who are going to be very disappointed to find they won't get the help or protection they thought they would. And some might. But I think we should be in the streets raising a ruckus every day to get this bill changed before it's signed into law and everyone forgets us.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=7878090

[Ms. Toad]

87. As long as raising a ruckus for change

doesn't result in being left with the status quo, I can agree with that.

[girl gone mad]

83. Coverage of pre-existing conditions is not going to happen.

As long as there is an opt out through smaller fines, it can't happen. Insurance companies will continue to deny people with PEC as they do now, through fraud provisions and excessive rates, deductibles and co-pays.

[Ms. Toad]

88. There is no opt out for insurance companies for pre-existing conditions.

The fines are for individuals who choose not to acquire insurance - insurance companies that offer insurance after the magic date (which is too far in the future) are REQUIRED to cover pre-existing conditions in all new policies, and are required to offer policies to everyone who falls into an eligible class (classes are based on whether you currently have insurance, and beyond that how large your employer is).

[slipslidingaway]

66. According to Wendell Potter the MLR was 95% back in the 90's...

:shrug:

http://www.pbs.org/moyers/journal/07102009/transcript2.html

"WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves..."

[laughingliberal]

68. Thanks for posting that. I've actually heard him speak on this a few times

I also saw him asked by one interviewer if there was any agency or individual within the federal government with the knowledge and skill to open up these companies' books and verify the MLR is being adhered to and he said none he knew of. The interviewer asked, "You mean not even the FBI or any of the other law enforcement agencies?" He replied, "No, I don't think so. Maybe Jay Rockerfeller's team would come closer than some but I don't really think there's anyone who can monitor or enforce it."

[slipslidingaway]

73. You're welcome, if there are very few people who actually know where

to look and see if they are cheating then the assurance of an 85% MLR is meaningless.

Appears we are adding more money to the administrative column instead of adding more money for actual care.

[Ms. Toad]

42. Follow the second link in my post upthread.

( http://www.kff.org/healthreform/upload/housesenatebill_final.pdf ) Scroll down to cost sharing and benefit tiers - around page 6 & 13.

The bills/proposal provides some caps, although the summary is not as clear as the calculator because there are lots more variations. The summary does at least provide outside limits. You'd need to plow through the language of the bills/proposal to get a clearer idea - but, the bottom line is that the statute prevents cost sharing (co-pays, deductibles) just being increased to make up for lower premiums.

As to the kinds of coverage - again - the benefit tiers are described around page 13 of the summary.

[stray cat]

47. My benefits don't change

[cutlassmama]

61. Mine either, however, for those without insurance it will be a good plan.

[booley]

85. Not if we can't afford it

I make too much for a subsidy (being self employed) but not enough to pay the costs I will be forced to.

[quiet.american]

52. House, Senate and President's Proposal subsidies, etc.

Maximum Percentage of Income Paid for Premiums



Percent of Costs Paid for By Insurance Plan


http://www.whitehouse.gov/health-care-meeting/proposal


If I make $44,000/yr, the *maximum* I can be charged as a percentage of income for premiums is either 1) 5.5% (House) or 6.3% (Senate & President's numbers). The Year 1 number is 3.0% in the House proposal, 4.6% in the Senate proposal, and 4.0% in the President's proposal. The number then increases each year up to its maximum. I've done the math on this for myself using the premium and subsidy tables (as I understand it, subsidies apply only to those who don't have employer-sponsored insurance and are shopping the exchange(s), unless the employer-sponsored insurance premiums exceed the maximum amount of percentage that can be paid in income), but if there are any math whizzes here, I'd love to compare numbers; the per month premium I came up with for this income level is so ridiculously low, before I post it, I'd like to see if I'm on the right track with how I came to the number.

As for benefits, one can download a pdf of the bills and look through the table of contents, then "Ctrl+F" on whatever keyword you're interested in to get informed *or* Google Hr 3590, HR 3962 summaries for at-a-glance info.

HR 3590
http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf

President's Proposal
http://www.whitehouse.gov/health-care-meeting/proposal

HR 3962
http://docs.house.gov/rules/health/111_ahcaa.pdf

[OneTenthofOnePercent]

71. Well, my rates would rise 17% with no subsidy. Lame.

Also, I'm not sure if the coverage would change.
Right now we have 100% preventative, %100 of certain 'scripts (usually generic), and $20 copays.

[GreenArrow]

78. I wonder how you factor in those costs of those things

when you combine them with things like:

The increased cost of transportation.

The increased cost of food.

The increased cost of fuel.

The increased cost of basic consumer items, such as clothing.

The increased cost of things like college tuition.

Rent or mortgage.

Increased utility rates.

Basically, the increased cost of living.

When does the turnip run dry?

[galileoreloaded]

86. Like I have posted before, I have $75 per person to spend for insurance.

I think I will just keep my income under the cap, and stay on Medicaid rather than have a corrupt system make criminals out of my small family. I mean, I suppose I could do more, but I would have to figure out a massive jump in pay to cover the difference being off the Medicaid, so I think for now I will just stay put. We are surviving fine, and our health care is paid for 100%.

I might sell fruit for the extra cash or something. You know, it IS interesting how there is this whole cash infrastructure set up for illegal immigrants, and how remarkably easy it is to pay cash. Kiosks for your power and water bill, etc.

Oh well, maybe someday things can get better or change, and I at least, have nothing but time.