Early data on ACA enrollees

by on January 17, 2014 at 8:37 pm in Current Affairs, Law, Medicine | Permalink

Christopher Weaver and Anna Wilde Matthews report:

Early signals suggest the majority of the 2.2 million people who sought to enroll in private insurance through new marketplaces through Dec. 28 were previously covered elsewhere, raising questions about how swiftly this part of the health overhaul will be able to make a significant dent in the number of uninsured.

Insurers, brokers and consultants estimate at least two-thirds of those consumers previously bought their own coverage or were enrolled in employer-backed plans.

The data, based on surveys of enrollees, are preliminary. But insurers say the tally of newly insured consumers is falling short of their expectations, a worrying trend for an industry looking to the law to expand the ranks of its customers.

I would emphasize that we still don’t really know quite what is going on here.  But the view that everything is now in the clear simply is not warranted by the available evidence.

Hat tip goes to Megan McArdle.

Ray Lopez January 17, 2014 at 8:41 pm

Good point. I really don’t know what is happening in my health care plan either, as I got some sort of one-time charge added…reminds me I have to call them, what time is it in the USA now? Ah, only 6:41 pm yesterday…haha.

Ray Lopez January 17, 2014 at 10:40 pm

OMG! I was told this is not a one-time charge but due to something called the Affordable Care Act (Orwellian speak!)–I got my premium almost tripled to $450 a month! Obummer-care. Wow. The problems of out of control US healthcare reach out and touch me half way around the world in the Philippines… where you can get an entire physical, including blood exam, for about $30 USD.

Jan January 18, 2014 at 6:53 am

I don’t understand why you have a US health plan if you live overseas. Philippines: come for the malls, stay for the cheap health care–and special blood exams! Joke lang…but seriously, why don’t you get a local insurance product? Are those unavailable to you as an expat?

Ray Lopez January 18, 2014 at 10:46 am

Because I travel a lot back and forth to the USA. But when I need healthcare here I just pay out of my own pocket, it’s so cheap. I have found a loophole in Obamacare: you can pay a small $95 penalty if you ‘opt out’ of Obamacare, which I will do, and though the fine increases over the 2nd and 3rd years, it’s worthwhile for me to opt out.

Frank Somatra January 18, 2014 at 1:00 pm

It’s $95 or 1% of your income, whichever is greater.

JWatts January 19, 2014 at 11:05 pm

And that’s only 1% for the 2015, it goes up to 2.5% by 2016. As Jan suggested, you’re better off bailing out of the US healthcare insurance system entirely.

Dingbat January 17, 2014 at 8:48 pm

Wait. It’s a problem that people who were covered are getting coverage? I thought it was a problem that people who couldn’t get insured were getting coverage.

dearieme January 18, 2014 at 6:28 am

Are they getting coverage? “who sought to enrol” sounds pretty ambiguous to me.

Thomas Sewell January 18, 2014 at 11:14 am

I suppose it’s obvious to those more involved in the projections that if most of the 2.2 million people enrolling were already covered before, than what you’re doing is replacing the coverage of a subset of those whose coverage was canceled because of the act. So not only have you now canceled more people’s coverage than have enrolled via the exchanges, but you haven’t covered very many people who didn’t have coverage before, which was a major “official” purpose of the act.

In short, as I’ve been saying for years, the ACA is resulting in less health insurance coverage than before, not more. It’s also more expensive coverage and it’s driving costs up, not down. I suppose now we can add after seeing the plans on the exchange that it’s also worse coverage in terms of higher deductibles.

Marie January 18, 2014 at 12:49 pm

Yes, I think this is largely right.

We had two plans we paid in full for and that we cannot continue using as a direct result of the ACA reforms.

The people who are working hard to navigate the new system are the ones who already were navigating the old one. The ones who didn’t bother with health insurance questions before are likely not bothering with ACA questions now, they’ll deal with it when the IRS fines them.

It’s a transfer.

Marie January 18, 2014 at 12:51 pm

Oh, and as an aside, despite beginning the process last September our family still has not been able to receive all the answers it needs to enroll in the new exchanges.

So, yes, try to enroll is not the same as enroll, if you are applying for a subsidized plan you have to be denied Medicaid first and that means a bureaucratic process through offices suddenly swamped with applications.

Careless January 18, 2014 at 1:24 pm

Spending lots of money to change the insurance people already had while increasing the number of uninsured is a hell of a way to start a “universal healthcare coverage system”

JWatts January 19, 2014 at 11:10 pm

On the other hand, it’s added a whole lot of jobs as navigators to people who were almost certainly heavy Democratic voters in the last election.

Lonely Libertarian January 17, 2014 at 9:15 pm

All these economists and I have yet to see one demand curve – not one!

If a policy costs a 30 year old male $100 a month before Obamacare and 20% enrolled then what % would enroll if the lowest cost option available to him (covers a lot more crap, with 0 value to him) cost $140.

In five years we will see a lot of analysis that points out how absurd it was to disrupt a mediocre health care system ostensibly to cover more people with a Rube Goldberg contraption that increased costs and the number of uninsured – a true lose-lose situation.

Bill January 17, 2014 at 9:32 pm

Re: “I would emphasize that we still don’t really know quite what is going on here.”

….and that’s why we post on a subject if we don’t really know what’s going on.

Andre January 17, 2014 at 10:28 pm

Because Obama proposed it, so whatever is going it must be bad.

Mogden January 18, 2014 at 12:51 am

Given that he is an irredeemable statist, that is a safe bet.

TMC January 18, 2014 at 3:20 pm

Does not need to be bad. It’s more of a choice.

ckb January 19, 2014 at 1:02 pm

Well, we’ve gone from “this is not going to work” to “the view that we are in the clear is not warranted” at MR. I don’t know if ACA is a success or not, but I do know a rear-guard action when I see one. Someone should tell Tyler about “mood affiliation bias” someday, too…

CPV January 17, 2014 at 9:39 pm

Wonkblog was doing good reporting on ACA until someone “got to them”. Pretty sad to see.

Jan January 17, 2014 at 9:44 pm
ziel January 18, 2014 at 11:51 am

You’re not a big one for reading between the lines, are you? “Things aren’t necessarily way out of whack with our expectations” – that’s one helluva ringing endorsement.

Jan January 18, 2014 at 1:05 pm

Did you check the context of your quote? He is contrasting progress toward the White House enrollment projections versus the insurance company’s own expectations. To date, WH projections are not necessarily being met, but the numbers are “not out of whack” with Wellpoint’s projections. I mean, by all means, keep reading between the lines. We’ve got two more months of open enrollment, so not sure this really means anything at this point.

“Given the general demographics that CMS released yesterday, I’m not alarmed,” Bertolini says. “They’re better than I thought they would have been.”
This is, incidentally, an idea that other insurance executives brought up this week: They don’t really care what goal the White House set for young adults. What matters to them — and what will determine if rates need to increase next year — is who they expected to sign up.
“Things aren’t necessarily way out of whack with our expectations,” Wellpoint’s chief financial officer Wayne DeVeydt said at a separate presentation. “It’s not about whether or not you’re getting a sicker book. It’s whether you priced for it.”

TMC January 18, 2014 at 3:21 pm

Not sure how that helps, Jan.

Jan January 18, 2014 at 5:20 pm

The only reason that executive had to say that the enrollment numbers are not out of whack with their projections is because the #s actually _are_ out of whack with the WH projections. He is just clarifying that, hey, our projections are not the same as the administration’s. If the insurers were all staying silent, now that would give one reason to think this thing isn’t going well for them.

Marie January 18, 2014 at 12:52 pm

I’m not sure my interests align with Aetna’s CEO’s interests! ;)

Jan January 18, 2014 at 1:06 pm

But if they go under, you’re without insurance! You need some alignment of interests, right?

Marie January 18, 2014 at 2:10 pm

Oh, no, if they all went under at once, I’d be dancing the Snoopy dance.
I don’t care if I have insurance, I care if I have health care, and I care if my assets get taken.
Insurance as a concept is very replaceable, and by private market methods.

Stan January 18, 2014 at 3:43 pm

“Insurance as a concept is very replaceable, and by private market methods.”

What are they? What private market method would prevent financial disaster if I were uninsured and was diagnosed with cancer?

Marie January 18, 2014 at 4:27 pm

No individual choice would be protective right now because our national choice to embed ourselves so deeply in the insurance industry makes private choices fairly impossible. Yes, absolutely, right now, any uninsured person with assets who gets cancer loses his assets.

I should have been more clear, I do believe insurance is very replaceable, I just don’t think it’s easily replaceable at this point. The parasite is too deeply dug in. I just wanted to be clear I wasn’t calling for single payer.

Jan January 18, 2014 at 5:06 pm

Usually insurance is how people make sure they have health care and protect their assets. Given that health care can end up costing anyone a bucketload of money at pretty much any time, private markets can only protect one from financial disaster by letting people pay to pool risk. That’s what insurance is. Now, there’s also social insurance, but you wouldn’t like that. So, at that point you’re left with other types of supports, like care donated through church communities, etc., which is really just another way to pool risk.

Marie January 18, 2014 at 5:35 pm

I’m thinking a little more broadly than that, Jan. Our current system of paying for health care (from sniffles to cancer) using employee-based private insurance for about half the country and government funds (welfare, government worker benefits, Medicaid, military) for the other half is less than 60 years old. That’s 60 out of 5000 years of human civilization. It’s hardly the be all and end all of risk pooling.

The major reason why people need insurance is cost — costs are absurd. And costs are absurd because of 60 years of growing use of insurance (and government) as our method of dealing with costs. But, of course, no one person can put his shovel down as long as everyone else keeps digging.

Marie January 18, 2014 at 5:39 pm

Sorry, meant Medicare, not Medicaid (that falls under welfare, already on the list).

Jan January 19, 2014 at 10:49 am

I totally agree that costs are the reason people need insurance, welfare, etc. If average health care expenses were $500 a year and a diagnosis of cancer ran someone $2000 for the full course of treatment, then most of the population could handle that through planning and savings.

A substantial payment is often needed for access to modern standard of care and health innovations. While health insurance has mostly been thing of the last 60 years, that is also the same period when most of the achievements of modern medicine were reached. There are research and development costs that have nothing to do with how we structure payments through insurance companies or otherwise regulate health care. Yeah, some countries have done a much better job of controlling costs and still maintaining access to innovative therapies than we have. But those countries have not achieved this by taking more of a private market approach. Quite the opposite.

Marie January 19, 2014 at 2:19 pm

I disagree.

Yes, better products mean more value, and so the great health care products and services we have today mean the price we pay will be higher. Not this much higher.

This conversation on the price of health reminds me a great deal of the old turn of the century assertions, contested by Hayak to Belloc, that certain technological advances required a certain kind of management. For example, Belloc contends that the Industrial Revolution didn’t require consolidation of the means of production — nations could have taken advantage of the advances in a widely distributed manner — but power was already consolidated and so the new tools fell into the hands of those already powerful, who then become more powerful and directed progress towards centralization. So with Hayak, I just read (no expert, newbie), he notes how often people claim technological progress requires central planning, as if it’s intuitively so, even though a moment’s thought shows that the more sophisticated and technologically intricate markets become the more impossible it becomes for a small central authority to understand and direct it all.

So with health care, as it becomes more rich and extensive and varied and valuable, there’s this weird call for it to be controlled by some small group of people — either government or a small group of corporations. As if each individual making his or her own choices about the market available is an inferior method to central planning. But our move to centrally control health care costs and availability (through government regulation directly or encouraging insurance control) has created this monster that we now feel we need to address with — guess what — more centralized government control and monopoly concentration.

No, there’s no reason a night at the hospital should cost $1000. If we had kept a system where everyone paid directly for their costs, it never would have reached $1000, because there’s no point in billing people an amount no reasonable human would pay. All the other stuff — the cost of R & D, patent law, lawsuits, costs for the indigent, all that has bumped costs up more. But the foundation of the cost rise is our choice to divorce medical pricing from individual market decisions.

Of course, I have no sourcing for that, so I completely understand you taking my opinion for exactly what it’s worth.

I’ve become very passionate about this over the last five years, as I’ve been able to ‘see behind the veil” on health care billing and realized how deceived and self-deceived Americans have been for a very long time.

prior_approval January 17, 2014 at 11:36 pm

‘a worrying trend for an industry looking to the law to expand the ranks of its customers’

And some people wonder why America has the most expensive health care system on the planet.

Pretty much everywhere else, the concern is that people are getting medical care. In America? That insurance can expand its customer base.

Dan Weber January 18, 2014 at 9:54 am

Too bad that the goal of the legislation was to expand the customer base as much as possible, huh?

prior_approval January 18, 2014 at 12:36 pm

Silly me – I thought it was to provide health care in a way that timidly begins a process of reform. Much to the discomfort of those currently profiting from the world’s most expensive health care system, most notably including insurance companies.

But then, I live in a country where health insurers – Krankenkassen – trace their past to that notable socialist Bismarck, back in the later part of the 19th century.

Careless January 18, 2014 at 1:27 pm

Politician’s syllogism is a joke, PA, not a way to run the government.

Anonymouse January 18, 2014 at 12:13 am

I can also say that the insurance companies are finding the ACA enrollees much harder and more expensive than expected to service due to all of the glitches with the website/system and people making mistakes and/or not understanding the law, their plans, or both. It’s a huge, expensive mess for the insurers.

Jan January 18, 2014 at 6:56 am

Yet the insurers who are talking are actually pretty high on the progress so far, and the law. Yeah there are some issues, but those issues are one-time problems.

Megan McArdle January 18, 2014 at 8:07 am

CEOs at investor conferences do not say “Hey, this massive new change is terrible.” I once listened to a biotech guy who had sold off all his patents and had nothing in the pipeline even remotely near approval talk about their “future plans” as if the company had some sort of future beyond imminent bankruptcy.

Jan January 18, 2014 at 8:26 am

Fair point, but if you read the interviews with the executives there are actual compelling reasons they are viewing things positively that don’t just sound like corporate bs.

I just question the alarmism when we have limited information, and before open enrollment is even close to over. It sounds a lot like the “disaster” with the website that was sure to lead to the program’s failure.

lonely Libertarian January 18, 2014 at 10:39 am

OR there could be a sort of perverse relief – what the worst case for the insurers would have been was a LOT of very sick people who had not been able to get insurance before signing up. If all that is happening is we are “reenrolling” those who were canceled [and substantially higher rates] and we now have margin/profit certainty I think I as a CEO would be pretty happy too.

As I noted earlier – we have put a lot of people through a lot of real pain – and will be taking a lot of money out of there pockets for VERY LITTLE real gain thus far. Billions of dollars spent with little or no reduction in the number of uninsured IS the definition of a failed program.

If we wake up on December 31 of 2016 and we have reduced the number of uninsured by anything LESS than 10 Million we would have been far better off to just find a way to pay there medical costs out of the general fund than put the nation through all of this crap. AND the next President will be facing a real challenge in trying to “fix” something that might at that point be beyond fixable.

Jan January 18, 2014 at 11:11 am

What do you think the Medicaid expansion is?

Aaron January 18, 2014 at 1:35 am

Megan McArdle, the most reliable aggregator for health care news and views: http://nymag.com/daily/intelligencer/2014/01/death-of-the-death-of-obamacare.html

Jan January 18, 2014 at 6:50 am

From the article: “My favorite moment from the debate, and I’m obviously biased, occurred when McArdle denied that she philosophically opposes national health insurance, prompting me to quote the headline of this 2009 McArdle column, ‘Why I Oppose National Health Care.’ “

Dan Weber January 18, 2014 at 10:06 am

Insurance isn’t health care.

Jan January 18, 2014 at 11:21 am

In the article McArdle talks about a “government takeover of insurance.” Maybe her opposition is strictly limited to government provision of health care and she fully supports single payer or a public option, if that’s what you’re saying.

prior_approval January 18, 2014 at 12:30 pm

‘Insurance isn’t health care.’

Nope – but how health care is paid for is part of a health care system. And the American system is the world’s most expensive, in part because many Americans, apparently, don’t understand that insurance companies do not provide halth care.

yo January 18, 2014 at 3:53 am

Why do you ruminate so much on a random US government program which affects less than 1% of the population in your home country? I’m an international reader and getting quite tired of the uninteresting ACA posts here lately.

Lee A. Arnold January 18, 2014 at 10:41 am

I think that Tyler is hoping to gently push the libertarians into a serious study of the requirements and responsibilities of workable institutions, so they will stop all this nutty, knee-jerk anti-government stuff. I think he is doing this because he sees that the U.S. is tottering on the brink of clownish disaster. I applaud him in his efforts, but it may be an uphill battle.

prior_approval January 18, 2014 at 12:26 pm

Or, based on an interview in Die Zeit from about 4 months ago, Prof. Cowen is simply reinforcing the prediction he made there that ACA will fail.

Lee A. Arnold January 19, 2014 at 3:37 pm

Please put a link to the section in English where Tyler Cowen tells Germany that its healthcare system won’t work. I would like to read that next.

Careless January 18, 2014 at 1:30 pm

It affects almost everyone. It affects Medicaid, Medicare, individual pooled people, group pooled people, uninsured people.

Careless January 18, 2014 at 1:32 pm

There are what, four countries in the world with GDPs larger than our healthcare spending? Including us

A Berman January 18, 2014 at 6:19 am

Au Contraire, I think we *do* know what is going on. One of the two major United States political parties tied themselves to a fiasco of such magnitude that it will have strong negative effects on America and on the Democratic party itself for the foreseeable future. It’s just difficult and embarrassing for Americans to accept what actually has happened over the last few years.

Of course, we can say that not just about the ACA, but about Barack Obama in general.

Handle January 18, 2014 at 7:35 am

But I thought Cass Sunstein at OMB was going to make government transparent?

Scholar’s / Wonk’s Dream: Website with real-time, queryable database (sanitized of personal information) of government-program website data. Traffic, number of attempts, number of enrollees, characteristics of indiciduals, etc. Maybe even add some FRED-like graphing and analytical tools with Tableau. Not just a few Measures of Performance and Effectiveness, but Full, Customizable, Surveillance Epidemiology.

Discourse will be better when the data is the narrative.

Komori January 18, 2014 at 12:26 pm

Ah, transparency. It’s the kind of word politicians love. Just like momentarily. If you say you’re going to deal with a problem “momentarily”, do you mean soon, or quickly? In this case, they’ve made the government so transparent no one can even see what’s going on…

Careless January 18, 2014 at 7:03 pm

The Sunlight Before Signing policy didn’t even last to the first bill he signed.

Jane the Actuary January 18, 2014 at 8:49 am

The reality is that the “early data” allows us to speculate, and to fill up blog posts, but doesn’t give us meaningful answers. Let’s see what the numbers look like after March 31st (http://janetheactuary.blogspot.com/2013/12/open-enrollment-ends-march-31st.html ) . I do find the process of targeting advertising to young men, “buy an overpriced product to subsidize others,” disturbing, but who knows how many such young men know that their premiums are subsidizing others?

prior_approval January 18, 2014 at 12:08 pm

Well, except all those young men who did not get into a car wreck or otherwise require medical care, for example.

And do we count young men with families as subsidizing their children’s health care?

This is just strange, from the perspective of just about anyone living anywhere else in the industrial world. There the basic idea is that medical care is provided to those who need it, and the costs are paid through a system that distributes the burden equitably – using any number of different modelsa. However, absolutely no country with cheaper, though essentially universal, health care systems has any desire to implement anything resembling whatever it is the Americans are doing.

Though interestingly, in Germany, those who pay for health care through the Krankenkassen are actually subsidizing child health care, for all children who are covered by the Krankenkassen. Nobody finds this a problem, it seems. Mainly because all of us used to be children, and children are the future which society chooses to invest in.

I believe the Germans even have a word for it – ‘Zivilisation.’ The French, who follow the same principles, albeit with different details, also have a word – ‘civilisation.’

Thomas January 18, 2014 at 12:49 pm

“There the basic idea is that medical care is provided to those who need it, and the costs are paid through a system that distributes the burden equitably”

“equitably”

There are some who suggest that “equitable” distribution of insurance premiums is one which mirrors distribution of expected consumption. There are others who use words like “equitably” as a euphemism for “my preferred system”.

prior_approval January 19, 2014 at 12:26 am

‘use words like “equitably” as a euphemism for “my preferred system”’

So, from using the words that immediately follow the quote – ‘using any number of different models’ – any idea which of easily 10 different models I prefer? Especially since some models, like Germany’s, would require American society to be something it isn’t.

Equitably in this case means that there is no political movement in any of the countries with significantly cheaper and essentially universal health care systems to change their own system to be more ‘equitable.’ Generally, because the system is seen to be that way already.

Tarrou January 18, 2014 at 10:04 am

Wait, do you mean to tell me that the people most likely to buy health insurance after the ACA were the ones who were most likely to buy it before the ACA? The mind boggles.

Marie January 18, 2014 at 12:57 pm

Exactly, wish I’d seen this before I commented.

dearieme January 18, 2014 at 11:35 am

Ever since I bought my first one, my use of a mobile phone has been heavily subsidised by other users, mainly young women I dare say. And I’m all for it. It’s a cause of celebration.

Jazmine January 18, 2014 at 1:58 pm

I definitely agree with what you said here. There’s some good financial advice at http://www.youtube.com/MoolalaMethod too if anyone wants to watch videos about this kind of stuff too. Always good to be educated on how to best handle our money!

Tom G. January 18, 2014 at 4:40 pm

“I would emphasize that we still don’t really know quite what is going on here” seems a bit disingenuous. I would say Tyler’s coverage is almost entirely negative (even on areas like the slowdown in health costs) so I think he either
1) Does believe he knows what going and that is that the ACA will fail
2) Believes his readers mostly operate in a world full of overly optimistic coverage that he must balance
I would suggest his comment sections indicate that 2 is not likely to be true.

Lonely Libertarian January 19, 2014 at 9:08 am

One of the unintended consequences of the ACA is that it could actually make a perverse form of self-insurance more practical. Assuming one is in good health and able to manage one’s way through relatively minor illness or accidents [which will cost much less if paid for in cash], the rational person would put a sum equal to at least the premium one would be paying in a savings account and continue to do so until an accident or event requiring health care occurs. Best case the event occurs during one of the open enrollment periods and then he/she could sign up and begin paying for – and using a health care plan. Worst case he/she will have to cover any health care out of accumulated savings for 9 months – until the start of an open enrollment. With any luck several years will pass with little or no health care costs – meanwhile the savings balance will be growing – depending on the amount of the monthly deposit the balance could be growing at $30K or more every five years. Once the total available hits $50K or more some portion of the funds could be diverted into paying off a mortgage and eliminating credit card balances. Given the price of most policies available and the OPC and deductibles this “defer until needed” approach is rational – and yes the “responsible” citizen can and should pay the appropriate penalty each year out of the saved funds making it legal and in full compliance with the law.

Marie January 19, 2014 at 10:02 am

Agreed, with a few caveats.

1. Paying out of pocket actually will cost you more, per incident. This is one reason why it has made sense until now to have a high deductible plan, because you get full coverage for catastrophic events but you also get the negotiated rate for the costs that you pay out of pocket — the rate might be half what the retail rate is.

It’s true if you take it several billing cycles in or let it go to collections you can negotiate medical bills down — sometime well down — but that’s not really a normal purchasing strategy.

I note this because I believe the move to insurance-ize every medical need is part of what got us here, and this is part of why that happened, because there was a strong disincentive to use pay as you go for anything at all.

2. Your plan will work even better if the saver buys discreet insurance plans — for example, for about $50 a month you can buy an accident insurance plan that will compensate you for any accident (not sickness) related medical costs up to $100,000. This cuts the risk of depleting savings down somewhat, also.

3. Unfortunately, the kind of savings you are talking about may not save a person from bankruptcy in the interim between an event and open enrollment in many cases. I know a family that went from a routine $10,000 delivery to a $250,000 bill in two weeks — not because there were any serious complications, just because her twins required oxygen. Anyone pursuing this strategy does need to take into account the very real possibility of losing all his assets and starting again. Certainly may be worth the risk if your assets are moderate anyway or you have no dependents to worry about.

lonely Libertarian January 20, 2014 at 10:49 am

Marie,

We were actually self insured for about 5 years prior to becoming eligible for Medicare. During that time we had a number of minor – and one major event – the major event was billed to us at a total of just over $40,000. We told each of the firms billing us two things. 1. We would be paying cash 2. We were prepared to pay immediately and asked them for their revised bill. We ended up paying just over $18,000. For planned events – like when I decided to go to dentures and have my teeth removed we were able to prepay for both the clinic and the anesthesia and save over 60% on each. Even things like doctor office visits were discounted once I told the cashier we would be paying cash.

And yes – there are ways to make things “safer” – accident insurance is one – life insurance policies are available that allow access to payouts before death to cover a major illness or accident.

I suspect we will be seeing a lot of “advice” books and web sites to help folks navigate Obamacare alternatives – some are out there already – google “self-pay patient” and “cash medical care”.

Marie January 20, 2014 at 10:57 am

That’s interesting. We had high deductible, but in a couple interactions I was given the impression that this kind of “pre”negotiating on medical bills got the facilities in trouble with their insurance providers — it was o.k. to negotiate late in the game, but not early in the game, because if they negotiated (say) a 30% off rate for Aetna on a procedure they had to make it 30% of a retail rate they usually charged. Orthodontist and dental seemed to fall outside of that since there was less insurance involvement.

Very glad to see that. A little reason in the system, that’s terrific.

Chuck January 23, 2014 at 1:16 pm

My brother in law isn’t going to get coverage because, like many low income people in our society, he doesn’t think much about the future and he isn’t a self-starter and he finds the whole system complicated and intimidating. And not buying it won’t cost him much.

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