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http://acasignups.net/16/10/01/update-minnesota-approved-avg-2017-rate-hikes-566and-one-other-twist Death Spiral?

The Drew @ about 1 year ago

Comments (77)

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if only Trump had paid his taxes

AMi @ about 1 year ago

Villa Park, IL, USA

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or the clintons?

President Not Sure @ about 1 year ago

Wright City, MO, USA

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My husband self insured this year. It's crazy. He's paying over $900/month.

Dr. Evil @ about 1 year ago

Lakeland, MN 55043, USA

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that sucks

AMi @ about 1 year ago

Villa Park, IL, USA

0eda15e8a4a685a0722949782c90e863

I'm so happy insurance is more affordable now

AMi @ about 1 year ago

Villa Park, IL, USA

26e82c69bac3abe48cfce8aae262fda8

You know what's fcked up? That this isn't an issue at all in the election. Hillary has barely mentioned it, Trump doesn't much mention it either actually and if he does he'll give a Trump response of course.

The Drew @ about 1 year ago

Midtown, New York, NY

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That adverse selection problem that was predicted that Skål said we'll "see" about, obviously that's kicked in big time. Is Obamacare unraveling by itself? I remember making a comment along the lines of

The Drew @ about 1 year ago

Midtown, New York, NY

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"Fcked up Rube Goldberg machine with the parts flying off." The problems seemed to have gotten papered over during the risk adjustment period.

The Drew @ about 1 year ago

Midtown, New York, NY

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I think it's ludicrous to think we can just junk the law at this point since it's far too embedded in our system, but some major changes need to be made.

The Drew @ about 1 year ago

Midtown, New York, NY

26e82c69bac3abe48cfce8aae262fda8

Bill Clinton has even weighed in recently and admitted things are fúcked.

The Drew @ about 1 year ago

Midtown, New York, NY

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Also props to that Gaba dude for continuing his blog.

The Drew @ about 1 year ago

Midtown, New York, NY

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It's a bit more complicated than that. The actuaries thought that more employers would have stopped offering coverage, shifting those (healthier, working) people to the exchange.

Tjaden Froyda @ about 1 year ago

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That didn't happen, which was actually a surprise. As a result, this magnified the adverse selection problem. At the same time, the federal reinsurance funds have expired - a small footnote in Gaba's blog entry.

Tjaden Froyda @ about 1 year ago

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I'm curious to see how Vermont's all-payer system is going to be implemented and what happens with Colorado care. The great thing about America is that we have 50 laboratories.

Tjaden Froyda @ about 1 year ago

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employer coverage trends: http://kff.org/private-insurance/issue-brief/trends-in-employer-sponsored-insurance-offer-and-coverage-rates-1999-2014/ flat since implementation.

Tjaden Froyda @ about 1 year ago

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(figure 5)

Tjaden Froyda @ about 1 year ago

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Vermont's healthcare was a total failure so if Colorado is sane they won't even touch it.

CD1 @ about 1 year ago

Ames, IA, USA

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Vermont's was a political failure. Despite saving money overall, they didn't have the guts to replace premiums with taxes. They're trying again with the all-payer plan.

Tjaden Froyda @ about 1 year ago

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MR PINK https://youtu.be/WOl7DmsfhKU

Mr. Pink @ about 1 year ago

Strongsville, OH, USA

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So Skål, do you think we are in a death spiral situation, MN in particular?

The Drew @ about 1 year ago

Midtown, New York, NY

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And what the hell does your name mean

Mr. Pink @ about 1 year ago

North Royalton, OH 44133, USA

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@Pink - sound it out. @Drew - the individual market plans in MN are definitely struggling. Death spiral? We'll see. Insurance is expensive and they underpriced based on the risk pool.

Tjaden Froyda @ about 1 year ago

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I've always thought that ACA left healthcare in no man's land. Single payer would have been better if we had a government mostly void of corruption.... unfortunately that's a big IF

AMi @ about 1 year ago

Villa Park, IL, USA

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It's not really a no-man's land. ACA is only incremental change.

Tjaden Froyda @ about 1 year ago

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sure feels like it's neither here nor there

AMi @ about 1 year ago

Villa Park, IL, USA

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We need a single payer system. Unfortunately the ACA is the worst appease-and-compromise bill ever and that possibility was squashed early on. But we could do single payer now.

Dr. Evil @ about 1 year ago

Lakeland, MN 55043, USA

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I doubt it, doc. . aca, will provide fodder for the "opposing" party. . "ACA and VA, look at what happens when government gets involved," . And it won't matter which party proposes it. .

H2O @ about 1 year ago

Spotsylvania Courthouse, VA 22553, USA

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Single payer will be tough to get just because of the politics of shifting paying for coverage from premiums to taxes, even if cheaper. I do like the all payer approach Maryland has taken and hope it works well for VT

Tjaden Froyda @ about 1 year ago

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Lots of talk of various things to replace O'Care.... I guess we all realize it's falling apart?

The Drew @ about 1 year ago

Midtown, New York, NY

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People who didn't think it went far enough, like me, have been. Others want to keep trying incremental fixes. And the there always has been the repeal crowd.

Tjaden Froyda @ about 1 year ago

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*then there

Tjaden Froyda @ about 1 year ago

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I think we all realize there are certain parts that have worked well, and others that need fixing. This week's NEJM has some perspective on the future of it from both sides of the aisle.

Tjaden Froyda @ about 1 year ago

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My favorite line in NEJM on it was two weeks ago at the top of HRC's piece: "The editors invited the Democratic and Republican presidential nominees, Hillary Clinton and Donald Trump, to answer the following question

Tjaden Froyda @ about 1 year ago

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What specific changes in policy do you support to improve access to care, improve quality of care, and control health care costs for our nation? Secretary Clinton responded. Mr. Trump did not respond"

Tjaden Froyda @ about 1 year ago

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It's hard to fit everything in one short response when your plans are so huuuge and great and the best.

The Drew @ about 1 year ago

Midtown, New York, NY

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How do we avoid the single payer system becoming a massive and inefficient bureaucracy? Who will be made accountable?

AMi @ about 1 year ago

Mississauga, ON, Canada

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How do we ensure the money goes into quality medical labor and research.... and not some low contribution government employee in Washington?

AMi @ about 1 year ago

Mississauga, ON, Canada

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@AMI - transparency.

Tjaden Froyda @ about 1 year ago

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Research funding exists outside of the payer model.

Tjaden Froyda @ about 1 year ago

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Are you talking Obama transparency, or bird killing window transparency?

AMi @ about 1 year ago

Mississauga, ON L4W 1S9, Canada

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leave the new viking's stadium out of this.

Tjaden Froyda @ about 1 year ago

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lol

AMi @ about 1 year ago

Mississauga, ON L4W 1S9, Canada

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if you put everyone on medicare you dont even need medicaid anymore (maybe the VA too), removing a redundant bureaucracy would mitigate that.

[412035] @ about 1 year ago

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good point

AMi @ about 1 year ago

Villa Park, IL, USA

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I thought that when they first passed the ACA: why not basically remove the age requirement for Medicare. We'd pay in taxes not premiums...But all money is the same shade of green after all.

Dr. Evil @ about 1 year ago

Lakeland, MN 55043, USA

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ACA was written with significant input from health insurers. We couldn't get the public option, there's no way in hell we'd have gotten that.

Tjaden Froyda @ about 1 year ago

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WWE Rikishi related removing a redundant bureaucracy would let it get bad removing everything in your case you would like it. removing a redundant rectocele litigation

Mr. Pink @ about 1 year ago

Strongsville, OH, USA

6c48fb73634fa41fe7915a7faf370ee7

that is really hard to say! eliminate redundant bureaucracy it would let it go really don't like this you would like it. Alien interaction with living it up

Mr. Pink @ about 1 year ago

Strongsville, OH, USA

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Medicare would need some tweaking to make that work, but it is a path. HRC's current plans to expand Medicare enrollment to age 50-65 is a start along that path of incremental change.

Tjaden Froyda @ about 1 year ago

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That'd have some interesting effects on the private market though, but I don't see that being discussed anywhere.

Tjaden Froyda @ about 1 year ago

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redundancy accuracy would let it go at that removing a redundant bureaucracy eliminate cats

Mr. Pink @ about 1 year ago

Strongsville, OH, USA

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Standard government coverage for all Private sector upgrades in partnership with medical institutions available

AMi @ about 1 year ago

Villa Park, IL, USA

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Your government issued ID is all you need for your standard coverage The private sector upgrade would act as a "Gold Club" card that allows more flexibility on scheduling and non critical services. No private sector insurance

AMi @ about 1 year ago

Villa Park, IL, USA

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Uh oh MN Governor... http://minnesota.cbslocal.com/2016/10/12/gov-dayton-affordable-care-act/

The Drew @ about 1 year ago

Yorkville, New York, NY

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Well it's hard to deny the facts regardless of how people love to try. I said years ago that the law is not sustainable, it isn't.

AMi @ about 1 year ago

Villa Park, IL, USA

7feb020fb3d3aa6cf2752031cf61da89

AMI, did you really say "Government issued ID"? . you do know that's impossible for minorities to obtain .

H2O @ about 1 year ago

Spotsylvania Courthouse, VA 22553, USA

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I suppose there would have to be an even more basic tier of care for those unable to provide an id

AMi @ about 1 year ago

Villa Park, IL, USA

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With captain disaster at the GOP helm, Dems will have a chance to push fixes that repubs have been resisting for the last few years.

Tjaden Froyda @ about 1 year ago

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I'm not sure the Dems have much of an idea how to "fix it", do we just throw more money at it or what.

The Drew @ about 1 year ago

Midtown, New York, NY

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I am encouraged by plans to lower the age of Medicare enrollment. That is a good idea, no? I don't know what they're going to do in MN though. The problem is very bad, very right now.

Dr. Evil @ about 1 year ago

Lakeland, MN 55043, USA

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Maybe. It depends on which simulation model you believe. Such an idea could be quite costly for taxpayers based on the current age distributions.

Tjaden Froyda @ about 1 year ago

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https://upload.wikimedia.org/wikipedia/commons/thumb/a/a7/USpop2010.svg/350px-USpop2010.svg.png Sure, it'd drive down premiums by removing the older, higher risk folks from that pool...but mostly just cost shifting.

Tjaden Froyda @ about 1 year ago

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The way medicare is currently run where it can't consider cost in coverage decisions (but private insurers can) nor can it negotiate for part D prices, current cost controls in the private market are removed.

Tjaden Froyda @ about 1 year ago

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Yes, the MN exchange is in bad shape. Mostly because a large chunk of the high risk pool from the old MCHA got dumped into a small risk pool (in terms of overall numbers in the individual market).

Tjaden Froyda @ about 1 year ago

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But I thought the only states that'd have trouble would be the evil red ones with evil red governors not wholeheartedly implementing the glorious Obamacare.

The Drew @ about 1 year ago

Midtown, New York, NY

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It's a bad law, it's a crazy rabid monster that desperately needs to brought out back and shot.

AMi @ about 1 year ago

Villa Park, IL, USA

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If the argument is that they could pass it and then fix it in the near future, I ask how they could possibly hope to achieve that having zero bipartisan support. The only way that'd work is if it could maintain itself on autopilot long enough.

The Drew @ about 1 year ago

Midtown, New York, NY

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@Drew: those states have problems too - most of the same ones that existed before the law. New problems are sexier.

Tjaden Froyda @ about 1 year ago

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@AMI - it's a very complex law for a very complex system. IMO, it's the system needs to be taken out back and shot.

Tjaden Froyda @ about 1 year ago

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Good point, the law is simply the infected limb, the system is the body

AMi @ about 1 year ago

Villa Park, IL, USA

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Then again, maybe Trump will be the ticket like Skål said? Although I don't hear much on the *how* of fixing, mostly just late-term recognition that shít is kinda fcked up.

The Drew @ about 1 year ago

Midtown, New York, NY

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The how has been there for some time, the discussions have been taking place in medical and health policy circles.

Tjaden Froyda @ about 1 year ago

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the rest of us don't encompass enough of the huge pile of details to really understand what exactly would help. Things sound reasonable, but with so many moving parts its nearly impossible to avoid unintended consequences.

Dr. Evil @ about 1 year ago

Lakeland, MN 55043, USA

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And have any actual politicians picked up on those discussions, Skål?

The Drew @ about 1 year ago

Midtown, New York, NY

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Yes.

Tjaden Froyda @ about 1 year ago

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*it lives*

The Drew @ about 1 year ago

Midtown, New York, NY

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Republicans have admitted as much. Time to start making some needed fixes.

Tjaden Froyda @ about 1 year ago

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