Aetna Inc pulled out of Maryland’s health insurance exchange being created under President Barack Obama’s healthcare reform law after the state pressed it to lower its proposed rates by up to 29 percent. …

In an August 1 letter sent to the Maryland Department of Insurance, Aetna said the state’s requirement for rate reductions off its proposed prices would lead it to operate at a loss. The rate reductions include products from Aetna and Coventry Health Care, which it bought this spring.

“Unfortunately, we believe the modifications to the rates filed by Aetna and Coventry would not allow us to collect enough premiums to cover the cost of the plans, including the medical network and service expectations of our customers,” Aetna said in the letter to insurance commissioner Therese Goldsmith.

According to online documents, Aetna had requested an average monthly premium of $394 a month for one of its plans and the agency had approved an average rate of $281 per month.

 whembly wrote:
Can we stop this nonsense that it'll be cheaper for everyone?

Obamacare will increase premiums by 122% in eight states.

The average price for the lowest-cost ObamaCare "bronze" plan in eight states is 122% higher than the cheapest plan currently available in those states, according to an IBD analysis of rate filings and a recent Government Accountability Office report.

 sebster wrote:

 whembly wrote:
Can we stop this nonsense that it'll be cheaper for everyone?

Obamacare will increase premiums by 122% in eight states.

The average price for the lowest-cost ObamaCare "bronze" plan in eight states is 122% higher than the cheapest plan currently available in those states, according to an IBD analysis of rate filings and a recent Government Accountability Office report.

We've been over this so many times. Comparing the cheapest plans under ACA and the cheapest plans pre-ACA is not comparing the same things. The ACA has raised the minimum standards for what a healthcare plan can allow, which means you're complaining that it costs you $2,000 to buy a car, but last year it only cost you $900 to buy a rusted out piece of crap that was missing an engine and only had three wheels.

And no, ACA isn't going to be cheaper for everyone. But that is a nonsense standard to require of any new proposal. Instead, the system should be, across the whole, an improvement for most. Which the ACA is.

 Easy E wrote:
I can't wait until next election when the Republicans run an anti-Obamacare strategy.... again.

 whembly wrote:
Bad analogy... Seb, it's waaaaay more complex than simple economics. Take of the rose colored glasses and step way.

Can we new call Obama a liar then? He said Premiums Will Decrease 3000% So You Should Get A Raise:

 sebster wrote:
Which means you don't reject a policy because someone oversold it.

 Easy E wrote:
Sure, I'm sure the base will eat it up and get fired oup to vote. Just like always. There are very few "new" people the Republicans can attract with the same rhetoric.

 whembly wrote:
Why not?

The policy... the ACA itself is still a gak sandwich. It's doubling down on the SAME fething SYSTEM that completely ignores to root cause why all of this started.

It's about holding our elected officials accountable.

 Grey Templar wrote:
Except its not better than what we had before. Its some stuff thats better, and then a bunch of stuff thats worse.

Plus it was sold to us under false pretenses..

 Grey Templar wrote:
Iraq wasn't sold under false pretenses. We thought he had WMDs, we didn't know for sure. Turned out he didn't, big deal. We also thought the Iraq army would put up more of a fight.

 Breotan wrote:

 Grey Templar wrote:
Iraq wasn't sold under false pretenses. We thought he had WMDs, we didn't know for sure. Turned out he didn't, big deal. We also thought the Iraq army would put up more of a fight.

WMD's was just one of the reasons we went in. Also, both the Republicans AND the Democrats voted to authorize our military action in Iraq. That's right, the Democrats voted for it, too.

 Grey Templar wrote:
The ACA is NOT a Mercedes. Its more like a 20 year old station wagon that needs a new engine and tranny when you were promised a Mercedes in perfect condition.

 d-usa wrote:
If republicans would really care about fixing things, they would fully fund and implement the ACA so that everyone can see how horrible it really is and then replace it with something better.

But they just want to protect the old business model.

 Grey Templar wrote:
If it was all that it was claimed to be, the Unions wouldn't be trying to jump ship.

And they don't need to fund it and implement it. They just need to voice their opposition to it, so that when the **** hits the fan people will see they were right about it.

 Grey Templar wrote:
Except you can't really treat a law by its parts. You have the whole package.

 Breotan wrote:
Also, both the Republicans AND the Democrats voted to authorize our military action in Iraq. That's right, the Democrats voted for it, too.

d-usa wrote:If the Republicans would give even the slightest token effort towards replacing the ACA with something better, then I might actually listen to the noise they keep on making.

Instead we get "our system was really crap and the new one is less crap. But it's still crap so we don't want it. So we will go back to the old crap that was worse, because that is how you fix things!"

 azazel the cat wrote:

d-usa wrote:If the Republicans would give even the slightest token effort towards replacing the ACA with something better, then I might actually listen to the noise they keep on making.

Instead we get "our system was really crap and the new one is less crap. But it's still crap so we don't want it. So we will go back to the old crap that was worse, because that is how you fix things!"

Yeah, but that's conservatism in a nutshell.

 Easy E wrote:
Newsflash: employers were dropping full-time people before ACA and would have continued to drop them without ACA.

 Easy E wrote:
Newsflash: employers were dropping full-time people before ACA and would have continued to drop them without ACA.

 whembly wrote:

 Easy E wrote:
Newsflash: employers were dropping full-time people before ACA and would have continued to drop them without ACA.

Citation please.

 djones520 wrote:
And what has the ACA done to make anything better?

 d-usa wrote:
What's next, the ACA didn't stop Bengazi?

 sebster wrote:

 whembly wrote:

 Easy E wrote:
Newsflash: employers were dropping full-time people before ACA and would have continued to drop them without ACA.

Citation please.

Automatically Appended Next Post:

 djones520 wrote:
And what has the ACA done to make anything better?

Seriously? You can now get coverage when you've got a pre-existing condition. How are you not aware of this, after all this time?

 d-usa wrote:
So you are arguing against the ACA because it has not lowered under-employment? Or reversed the pre-ACA trend of under-employment?

What's next, the ACA didn't stop Bengazi?

 dogma wrote:
Because, at the end of the day, you cannot please everyone and so you must make your decisions at least palatable to those who are not immediately in favor of them.

Cities and towns across the country are pushing municipal unions to accept cheaper health benefits in anticipation of a component of the Affordable Care Act that will tax expensive plans starting in 2018.

The so-called Cadillac tax was inserted into the Affordable Care Act at the advice of economists who argued that expensive health insurance with the employee bearing little cost made people insensitive to the cost of care. In public employment, though, where benefits are arrived at through bargaining with powerful unions, switching to cheaper plans will not be easy.

Cities including New York and Boston, and school districts from Westchester County, N.Y., to Orange County, Calif., are warning unions that if they cannot figure out how to rein in health care costs now, the price when the tax goes into effect will be steep, threatening raises and even jobs.

“Every municipality with a generous health care plan is doing the math on this,” said J. D. Piro, a health care lawyer at a human resources consultancy, Aon Hewitt.

But some prominent liberals express frustration at seeing the tax used against unions in negotiations.

“I think it was misguided all along,” Robert B. Reich, the former labor secretary, said in an e-mail. When the law was being written, he said, he worried that the tax was “a blunt instrument that could too easily become a bargaining chit for cutting back benefits of workers.”

“Apparently, that’s what it’s become,” Mr. Reich, who is a professor of public policy at the University of California, Berkeley, said.

Under the tax, plans that cost above a certain threshold in 2018 — $10,200 annually for individual plans and $27,500 for family plans, with slightly higher cutoffs for retirees and those in high-risk professions like law enforcement — will be taxed at 40 percent of their costs in excess of the limit. (The thresholds will rise with inflation after 2018.)

State and local governments across the country tend to offer more expensive health plans than private businesses do, and workers often accept smaller wage increases to retain their benefits. Because of this, state and local government employees are expected to be disproportionately represented among those whose plans will be subject to the tax.

New York City expects its two most popular employee health plans to reach taxable Cadillac levels by 2018 or shortly after. This year, the city projects that it will pay a total of $7,128 for individuals and $18,249 for families in its most popular plan, including the costs the city pays into union welfare funds to cover prescription drug benefits. That is above the national average for employer-sponsored health care coverage, which last year was $5,615 for single coverage and $15,745 for family coverage, according to a 2012 Kaiser Family Foundation survey.

The total health care cost for the city’s nearly 300,000 municipal employees, pre-Medicare-age retirees and their dependents is expected to approach $8 billion by 2018.

In a letter in April to the head of a labor coalition, Caswell F. Holloway IV, deputy mayor for operations, said the Cadillac tax would cost New York City $22 million in 2018, increasing to $549 million in 2022. (This year, the total city budget, excluding federal and state aid, is just over $50 billion.)

“We know that, on the current trajectory, we’re going to be hit with that tax and it would increase very steeply,” Mr. Holloway said.

So the administration of Mayor Michael R. Bloomberg, in its final months in office, is asking municipal unions to agree to seek new bids for the city’s health insurance business, hoping to lower premiums. It has already achieved one small victory, getting the city’s current primary insurer to freeze premiums for one year if it keeps the city’s business, the mayor said on Friday.

But lower-cost plans are likely to involve greater out-of-pocket costs and more limited networks of doctors, and so far, the response from labor has been cool.

Ninety-five percent of city employees and 93 percent of retirees are in the two largest plans, which require employees to pay nothing toward their premiums. According to the Kaiser Family Foundation survey, the average contribution by public employees throughout the country is 12 percent for individual plans and 23 percent for family plans.

Harry Nespoli, the chairman of the Municipal Labor Committee, the labor coalition that negotiates with the city on health care, said that he was concerned about the tax, but also that the burden of any cuts would fall largely on workers at the bottom of the pay scale.

Mr. Nespoli said his staff was looking over the request for proposals that the city had written, but he said he was skeptical that the process of seeking new health insurance could be completed before the next administration.

“We’re not going to turn around and do a $7 billion contract that affects our members for the next 10 years out without looking at it very carefully,” he said.

Most of Boston’s 20,000 employees are currently in plans that by 2018 would exceed the tax threshold. The city and its unions are preparing a request for proposals for new insurance coverage.

“The tax is going to be a hit, and, if you’re not expecting it, it’s going to be very shocking,” said Meredith Weenick, the chief financial officer for Boston.

Jim Finley, the executive director of the Connecticut Conference of Municipalities, said he thought it would be hard for Connecticut towns and cities to get their unions to agree to cheaper health care benefits to avoid the tax.

“In the end, it’s the taxpayer that’s going to bear that burden,” Mr. Finley said.

In Orange County, Calif., the Newport Mesa Unified School District warned employees during contract negotiations that if the district’s health care costs continued rising at the current rate, the district could face a $2.3 million burden from the tax in 2018.

The teachers’ union ultimately agreed to accept greater out-of-pocket costs to reduce the increase in its premium this year to 3 percent from 6 percent, but union leaders said they resented the district’s using the threat of the tax as a negotiating tactic.

Municipal unions opposed the inclusion of the tax in the health care law, and it was partly their efforts that succeeded in delaying its effective date until 2018.

Steven Kreisberg, the director of collective bargaining and health care policy at the American Federation of State, County, and Municipal Employees, said the term Cadillac tax was misleading, because it “connotes a certain aspect of luxury in these health plans that is just factually incorrect.”

The announcement last month that the Obama administration would delay by a year the mandate that larger employers offer coverage to their workers does not affect the timing of the excise tax, although it may provide encouragement to those who hope that the assessment will be delayed or scrapped altogether.

“Some skeptics, and I’m not one of them, say that that’s why the tax was put into effect in 2018 — that it’s far enough away that people can consider whether or not they really want it to go into effect,” Mr. Piro, the health care lawyer, said.

Jonathan Gruber, an economist at the Massachusetts Institute of Technology who was a paid consultant to the Obama administration on health care policy, said forcing state and local governments to rein in health care costs was exactly what the tax was intended to do.

“This is intended to shift compensation away from excessively generous health insurance toward wages,” he said.

In New York, if the Bloomberg administration does not succeed in getting new health insurance before the end of the year, the problem will fall in the lap of the next mayor.

Mr. Holloway said the Bloomberg administration, like many city governments, had long been concerned about the rising cost of health care and its impact on the budget.

But the 2018 tax “adds a sense of real urgency to getting a handle on this,” he said.

“We’ve got to start thinking about this now,” he continued. “Why is it that my plan is so expensive per person? What are the ways that we could get that under control?”

Quick disclaimer.

I am a fierce champion of single payer. I am on the board of California OneCare, one of the most active single payer organizations in California. But right now, we are several heartbeats away from the opening of the health insurance exchanges. So let's take a real world look at what we might expect.

Take a deep breath and continue reading.

The task facing the administration is Herculean, quite literally changing the psyche of the American people. American have long accepted that in this country healthcare is a privilege reserved to the affluent and those still with employer provided insurance. We're now being told, throw away those beliefs the future is here, and the future belongs to those who buy for-profit private insurance.

We've segued from each man/woman for herself, to we're all in this together.

The biggest and most critical hurdle is to sell the young 18-34 year old cohort on the need for them to enroll. Without this group of Americans, which the Administration estimates is around 2.7 million strong, the exchanges will implode due to a phenomenon called adverse selection.

Enroll America

Despite my grave reservations and deep concern about the implementation of Obamacare, I would urge anyone who can lend a hand, to go to the web site of Enroll America and do whatever you can, to help get young people happily enrolled. Without their participation, We. Are. Toast.

As Robert Pear wrote yesterday in the New York Times,"For Obamacare to Work, Everyone Must Be In". And the sine qua non of the ACA are the young invincibles who must be persuaded to enroll.

So struggling Americans, still reeling from the 2008 crisis, are being asked/required to accept the for-profit insurance industry, and pay staggering premiums and deductibles, just to get a foot in the door to the most expensive, but far from the best healthcare system in the world. We are being told that the barbaric belief system which continues to be embraced by tens of millions, that healthcare is only for those who can pay, is all wrong, and a new day has arrived.

Up until now, healthcare in the United States has been a privilege. Some would argue, and I would agree, that even with the new day we are all awaiting, healthcare will remain a privilege and as many of us have long feared, many/most of us who will comply with the law, will have insurance in name only.

What do we mean by insurance in name only?

The situation in New York State is instructive, and helps explain what it means to be insured, but in reality to be dangerously underinsured.

A few weeks ago, headlines trumpeted that New York would see premiums drop by up to 50%. This was misleading. New York had among the highest premiums in the nation because we are a pure community rating, guaranteed issue state--one of six or seven community rating states in the country.

This meant that insurers had to sell insurance to anyone who could pay for it. Pre-existing conditions did not taint New York State. Young and old, all paid the same. So, guess what happened? Young people dropped out, and the pool shrunk to just people who really needed to be insured--the sick, those with chronic conditions. New York could brag about offering health insurance to everyone--with one caveat, if you could pay among the highest rates in the country! I would be dead or would have filed for medical bankruptcy, if I weren't a resident of NY State.

Obamacare is supposed to ameliorate this problem of adverse selection by mandating that everyone buy, so the older and sicker will in effect be subsidized by the young and healthy.

But returning to the reality on the ground, what kind of check will I and other New Yorkers be writing every month, and what will we get for it?

Here is a chart of the generic plans being offered on the NY Health Benefits Exchange.

Here is the approved New york State rate chart.

If you focus on the Silver Plan, you'll find that the deductible is $2000 with a maximum out of pocket cap of $5000.

But in order to access these magnanimous benefits, if you select, say Oxford, and live in the New York City vicinity, as I do, you'll pay a monthly premium of $555.48 X 12 = $6,665.76, then you've got the $2000 deductible which brings your immediate costs to $8665.76.

Then you've got, co-pays and co-insurance on top of this. You've got to incur an additional $3000 after the deductible to hit your out-of-pocket cap.

What we're really seeing play out is an overhaul of the insurance model codified by the Affordable Care Act. It will be all but impossible (except for the mega rich), to buy insurance offering what is called first dollar coverage. This means we will all be required to pay steep premiums and deductibles but may not have the financial resources to actually access healthcare.

As I like to say, you don't have to believe me, but you should trust theJournal of General Internal Medicine which made exactly this point.

“Obamacare is making underinsurance the new normal,” said Woolhandler. “It will reduce the number of uninsured from 50 million to 30 million, but the new coverage is full of holes. Americans deserve the kind of first-dollar, comprehensive coverage that Canadians already have. But that’s only affordable under a single-payer system that cuts out the private insurance middlemen.”

Yes, thanks to the ACA, there are a couple of preventative screenings included in these huge costs, but overall, what we have going on here is a huge shifting of costs onto the backs of the insured.
As we all know, there is zero price transparency in the US healthcare system, so God help you if you plan on calling around to get the best price for a bypass before signing up.

And when you pay for that bypass, you'd do yourself a favor by considering getting it in a country with far better outcomes, at a fraction of the cost than in the United States.
http://s53.photobucket.com/user/nyceve/media/blog_health_rankings_usa_oecd.jpg.html
I am reminded on days like today, that President Obama campaigned on the idea that people like me would see something like a $2500 reduction in health insurance costs.

What was I thinking?