Maine Health Professionals Working to Provide Affordable Insurance

In summary, my sister says that the GOP's efforts to kill the ACA are really angering the health educators she works with. They're trying to enlist poor and elderly people into one of Maine's two participating insurances, and she told me about an old man that qualified for a Silver plan for $2/month. Another old guy wanted dental insurance, and she talked him out of it telling him that routine examinations and cleanings would only cost him about $50/visit. The people on the front lines know all this stuff, and they're pissed at the GOP's plans to kill the ACA. Anything we can do to get more people insured and reduce the costs of health care should be welcomed.
  • #1
turbo
Gold Member
3,165
56
I spoke to my younger sister yesterday, and she is really upset about the GOP nay-sayers that are trying to kill the ACA. She is a health educator, and she is working with several regional health providers to enlist poor and elderly people into one of Maine's two participating insurances.

She told me about an older man that qualified for a Silver plan for $2/month. He told her that he could afford more coverage and picked a more extensive plan for $26/mo. Another old guy had pretty good dental health and wanted dental insurance. With his income and discounts it would have cost him $30/mo. My sister talked him out of it, telling him that if he went in for routine examinations and cleanings, it would only cost him about $50/visit, so he is all set.

The people on the front lines know this stuff, and they are quite pissed at the GOP's efforts to kill the program. Anything we can do to get more people insured and reduce the costs of health care should be welcome. Every uninsured person who heads to the ER when they are sick costs us all money, and if they haven't been getting regular preventive care, the costs can be a lot higher.
 
Physics news on Phys.org
  • #2
As always, the disclaimer "Your results may vary." should be applied in these cases. Remember, the plural of anecdote is not data.
 
  • #3
You call $30/mo for health insurance "working"? I call it "where's the scam?"

And that's just for that example: of course one example where someone made out well tells us virtually nothing of value about whether in a general sense the program is "working".
 
  • #4
russ_watters said:
You call $30/mo for health insurance "working"? I call it "where's the scam?"

And that's just for that example: of course one example where someone made out well tells us virtually nothing of value about whether in a general sense the program is "working".
Where did you see that?
 
  • #5
turbo said:
Where did you see that?
Sorry, $26/mo. Doesn't change my point.
 
  • #6
Would you rather that these previously uninsured/uninsurable old guys pay whatever the whatever the insurance companies demand, IF they would even extend coverage at all? I don't get it.
 
  • #7
You say that if an uninsured person shows up for treatment at an ER, it costs us all money. If an insured person with a $26/mo ACA policy shows up for treatment at a hospital, it still costs us all money. If this guy is getting a subsidized ACA premium, it's not Santa Claus or Uncle Sam making up the difference, it's you or your neighbor, one of those rapidly dwindling number of taxpayers in the US. If this guy with the ACA policy can't pay his deductible, then the hospital or doctor passes on that unreimbursed cost to the next patient or they go out of business eventually.

It's like the old joke, "We lose money on every widget we make, but we make up for it in volume!" At some point, the books have to balance.

There are a lot of problems already manifest with ACA, and more will undoubtedly appear in coming years when the employer mandate goes into effect. To deny this is unworkable as policy, especially for supporters of the ACA, since the program is already unpopular.
 
  • #8
SteamKing said:
To deny this is unworkable as policy, especially for supporters of the ACA, since the program is already unpopular.
It is unpopular with people who hate Obama. It is quite popular with people who have never had insurance coverage and can now get it. If insurance companies are required to cover people that they previously refused to cover, we can all hope to see medical costs go down at doctors' offices and hospitals. That is a plus for everyone. Let's get a grip.
 
  • #9
Turbo, it's not about "hating Obama" - and your habit of putting words in the mouths of your opponents is not particularly attractive. Some people have gained insurance. Others have lost it. It's not surprising that people in the latter category don't like it.
 
  • #10
Vanadium 50 said:
Turbo, it's not about "hating Obama" - and your habit of putting words in the mouths of your opponents is not particularly attractive. Some people have gained insurance. Others have lost it. It's not surprising that people in the latter category don't like it.
I beg to differ regarding the respect (or lack of) for Obama. Lots of people have been trying to kill the ACA for months.

As for people losing insurance, it's not all that common among the poor and the elderly who rarely had coverage anyway. It is possible that some people have lost insurance because their plans don't meet the basic requirements of the ACA, but it is quite possible that such people can pick up coverage through the ACA, likely at much-reduced premiums.
 
  • #11
Hey, turbo, I have an idea. Why don't you tell us what you think, and let other people tell us what they think, rather than you having to hold up both sides of the argument.
 
  • #12
Go for it.

If you want, I will give you my little sister's phone number so she can talk to you. She's only 59, and she is fiercely protective about her clients - especially the retired military. Maine is a very poor and elderly state, and she advocates for them every day.
 
  • #13
No one is saying she doesn't advocate for her clients. Her client with the $26/mo. premium is proof. I applaud him for finding the pot 'o gold with the help of your sister.

However well one man has fared, there may be others who, through no fault of their own, have not been as fortunate. There have been reports of several people who formerly had insurance which has now been canceled because the terms of the policy don't comply with the ACA. These people had complex medical problems which were being treated by a network of doctors and hospitals with whom the patient was satisfied. The plans offered under the ACA may not allow access to these same doctors and hospitals, the premiums may be more expensive, and the deductibles higher. What to do about their situation?
 
Last edited:
  • #14
turbo said:
Would you rather that these previously uninsured/uninsurable old guys pay whatever the whatever the insurance companies demand, IF they would even extend coverage at all? I don't get it.
I'm not sure exactly what they should pay (not the least because I don't know their exact situation), but $26 a month is absurdly unfair. Roughly, though, it is off by probably a factor of ten or more from what I'd consider fair.
SteamKing said:
There are a lot of problems already manifest with ACA, and more will undoubtedly appear in coming years when the employer mandate goes into effect. To deny this is unworkable as policy, especially for supporters of the ACA, since the program is already unpopular.
Clearly the first sentence is true. The second is a prediction that I think is likely to become true, but time will tell.
 
  • #15
turbo said:
It is quite popular with people who have never had insurance coverage and can now get it. If insurance companies are required to cover people that they previously refused to cover, we can all hope to see medical costs go down at doctors' offices and hospitals. That is a plus for everyone. Let's get a grip.
Well sure, handing people money is always a popular way to get yourself votes. But if mandating coverage was all it did, that would be a good thing, but clearly it doesn't. The value of insurance coverage is never $26 a month for anyone.

I support many forms of health insurance reform, bu I don't support additional wealth redistributions.
 
  • #16
Im not partisan in this subject, but I am suspicious about ACA.

A report I heard on the radio talked about the ratio of old and sick people signing up compared to young healthy people. They are not getting enough young and healthy people signing up and paying to subsidize the old and sick people. If these old and sick people are paying ~$30 a month, they are paying way less than they will consume. Somebody has to foot the bill, and young healthy people like me are not signing up. I'm just going to pay the tax rather than sign up.

Clearly if this is the situation it is unsustainable. Do the taxes we uninsured pay go to subsidizing the old and sick people with ridiculously low monthly costs? I don't know.
 
  • #17
ModusPwnd said:
Im not partisan in this subject, but I am suspicious about ACA.

A report I heard on the radio talked about the ratio of old and sick people signing up compared to young healthy people. They are not getting enough young and healthy people signing up and paying to subsidize the old and sick people. If these old and sick people are paying ~$30 a month, they are paying way less than they will consume. Somebody has to foot the bill, and young healthy people like me are not signing up. I'm just going to pay the tax rather than sign up.

Clearly if this is the situation it is unsustainable. Do the taxes we uninsured pay go to subsidizing the old and sick people with ridiculously low monthly costs? I don't know.

Yes, but that's the way *all* insurance works. The risk is shared among a large group of subscribers, and the larger the group, the lower each participant's cost. So having a cheap "opt out" door deflates the whole intention of this program.

Be aware, if you chose to pay the penalty rather than buy insurance: just because you pay the (very small) penalty doesn't mean you are off the hook for any medical bills you acquire. You still have to pay those, too.
 
  • #18
Yes, I know how insurance works... If only sick people are in the pool the costs per person are much higher. A large pool of sick people is not good. Thats the point I heard on the radio and was trying to convey. They need more young healthy people in the pool to subsidize the sick and the young healthy people are not joining. This gap needs to be made up and I am thinking it should be made up by the penalty, but I don't know.

Also, the penalty may be very small to you, but its not small to me! Its many days and eventually will be weeks of my wage. Ill have to reevaluate each year whether or not its worth it, but for now the tax is better option for me than the premium is.
 
Last edited:
  • #19
ModusPwnd said:
Yes, I know how insurance works... If only sick people are in the pool the costs per person are much higher. A large pool of sick people is not good. Thats the point I heard on the radio and was trying to convey. They need more young healthy people in the pool to subsidize the sick and the young healthy people are not joining. This gap needs to be made up and I am thinking it should be made up by the penalty, but I don't know.

I think that's quite reasonable. When I heard what the penalty was, my first thought was, ugh sounds like a decision made by committee.

Also, the penalty may be very small to you, but its not small to me! Its many days and eventually will be weeks of my wage. Ill have to reevaluate each year whether or not its worth it, but for now the tax is better option for me than the premium is.

Yeah I realize that sounded insensitive of me. I know how it is to be a starving student and be faced with unexpected bills.

But I also had to have a surgery once when I wasn't insured. It was the late '80s so I made it through OK - medical bills were :eek: expensive, but not yet expensive. If that happened to someone today they'd be financially ruined.
 
  • #20
The penalty is small in the first year or so, but it is scheduled to increase in later years. Whether this increase remains so has yet to be seen, given how several key provisions of the law have been waived by the President without consulting Congress.
 
  • #21
lisab said:
If that happened to someone today they'd be financially ruined.

The thing is that many people without health insurance are already "financially ruined" of sorts. They will never have a nest egg and/or they will be in debt their whole life. If you already have wealth to preserve then buying insurance can certainly be helpful. But in many peoples case insurance would only stave off debt that would never be repaid anyway. This is of course a reason the mandate was put in place. It makes more sense for a poor person to save their money and just live with the medical debt. The medical debt can get in line behind the rest of the debt.
 
  • #22
Here's a Senator who lost coverage for his cancer specialist due to Obamacare. So he's paying out of pocket.
http://www.foxnews.mobi/quickPage.html?page=22995&external=2513415.proteus.fma
 
  • #23
russ_watters said:
Here's a Senator who lost coverage for his cancer specialist due to Obamacare. So he's paying out of pocket.
http://www.foxnews.mobi/quickPage.html?page=22995&external=2513415.proteus.fma
From the article:

"I'm doing well from a health standpoint, got great docs and fortunately, even though my new coverage won't cover my specialists, I'm going to have great care and I have a great prognosis," he said.

So what's the problem? Is this what you mean by wealth redistributions?
 
  • #24
ModusPwnd said:
...

A report I heard on the radio talked about the ratio of old and sick people signing up compared to young healthy people. They are not getting enough young and healthy people signing up and paying to subsidize the old and sick people. If these old and sick people are paying ~$30 a month, they are paying way less than they will consume. Somebody has to foot the bill, and young healthy people like me are not signing up. I'm just going to pay the tax rather than sign up.

Clearly if this is the situation it is unsustainable. Do the taxes we uninsured pay go to subsidizing the old and sick people with ridiculously low monthly costs? I don't know.

lisab said:
Yes, but that's the way *all* insurance works. The risk is shared among a large group of subscribers, and the larger the group, the lower each participant's cost. So having a cheap "opt out" door deflates the whole intention of this program.

...

All insurance? Did you mean all health insurance? Life, auto, property all include risk factors. Life especially factors in age. Auto figures in accident records and so on.
 
  • #25
mheslep said:
All insurance? Did you mean all health insurance? Life, auto, property all include risk factors. Life especially factors in age. Auto figures in accident records and so on.

I'm not sure I understand your point -- just because there are risk factors doesn't mean the risk isn't shared.

One good thing about ACA is they have higher rates for smokers, which is a significant risk factor. One bad thing is, they don't have higher rates for older people that are proportional to their risk. Age is a very strong predictor of health problems...and death even.
 
  • #26
turbo said:
... Maine is a very poor and elderly state,...

Interestingly Maine had the 2nd largest increase in millionaires (0.41%) of all the states, just behind oil boom king N. Dakota, bringing Maine up now up to one millionaire for every fifteen residents. Maine ranked 32nd by median income in 2011.
 
Last edited:
  • #27
lisab said:
I'm not sure I understand your point -- just because there are risk factors doesn't mean the risk isn't shared.

One good thing about ACA is they have higher rates for smokers, which is a significant risk factor. One bad thing is, they don't have higher rates for older people that are proportional to their risk. Age is a very strong predictor of health problems...and death even.

Ok, a matter of degree then. In the ACA, risk factors are ignored and thus 'shared' (aside from smoking as you say). With other kinds of insurance, the policy holder pays substantially for risk factors (driving record-auto, age-life, etc).
 
  • #28
dlgoff said:
From the article:

So what's the problem? Is this what you mean by wealth redistributions?
I don't think that has anything to do with wealth distribution, but the problem should be obvious: he lost coverage and as a result his out of pocket costs went up.
 
  • #29
russ_watters said:
I don't think that has anything to do with wealth distribution, but the problem should be obvious: he lost coverage and as a result his out of pocket costs went up.
Yes that, despite the president's misleading promise that it would not happen because of the law, period.
 
  • #30
Note that the ACA still does allow for age-rating in the individual markets, just not enough to cover the population’s average difference in claims cost. The cap is at a 3:1 ratio (in most States, less in a few), which is probably not too far off for women, but is much less than observed for men (which is more like 6, or even 8 to 1). The ratio is probably even higher in the exchange markets than it is as a national average.

This cap results in a financial transfer from the younger members to the older members. As was mentioned, there are always transfers between members in an insurance program – that’s what they are designed to do. However, it is usually considered best when those transfers are unpredictable – by making older members pay more, the odds that they will lose or win financially are similar to the young. In the current system (with a age ratio cap), older members are more likely to come out ahead than younger members are. (This doesn’t mean they are likely to; it just means the odds are more in their favor).

However, employer group health insurance is not typically age-rated either, resulting in a similar (but usually less extreme) difference in odds and the resulting intergenerational premium transfers. The idea of some transfer between demographic groups is not new, and depending on the society’s values it is not necessarily a bad thing.
 
  • #31
To clarify (not all will need this clarification),

The ACA has, unfortunately, made the word “premium” very confusing. The person mentioned earlier in the thread does not have a $26/month premium (and I don't think Turbo called it that) – it is probably more like $400-$500. However the insurance company is getting two payments – one from the member, and the rest from the government. Or, at least they are supposed to, if the system were working properly.

This portion coming from the government will be coming from taxpayers. There are taxes in the ACA (lots of them) that were meant to partially offset this, but they are small in the scheme of things.

So for me, the word premium means "the amount the insurance company is getting" (because I've helped set rates in the past). For the rest of the US, the word premium means "amount the person is paying". In the media it isn't always clear which is being used.
 
Last edited:
  • #32
Finally,

You’re going to hear a lot about the narrow networks in ACA plans. Keep in mind that narrow, but sufficient, networks are a highly efficient way to cut costs, and they do so in a market-oriented manner. They cut costs first because limiting the network increases the insurance company’s negotiating leverage substantially. Networks that include every provider often have little real leverage, since they absolutely have to bring every provider onboard.

More importantly, not all providers are equal. There are, in any major market, a few outrageously expensive systems. These often can’t be shown to be measurably higher quality than any other. You can save a bundle just by cutting them out. This is a reasonable way to encourage healthcare efficiency in the market.

This doesn’t mean narrow networks are best (maybe you value much higher premiums for slightly or immesurably health insurance), or that they didn’t overshoot the mark (there’s a range between wide and narrow). There are some very narrow networks being offered in the ACA, and I expect some consumer pushback. However in most markets there are actually both narrow and wide networks being offered, so people still have the choice if they take the time to do their research (it appears they aren't, for the most part).

So they may not be best, but the way the ACA is being blamed in the media isn’t appropriate. They are really part of a larger trend towards healthcare efficiency that has been going on (well, off and on) for some time. HMO’s, after all, are essentially a very narrow network with a gatekeeper.
 
Last edited:
  • #33
lisab said:
Yes, but that's the way *all* insurance works. The risk is shared among a large group of subscribers, and the larger the group, the lower each participant's cost. So having a cheap "opt out" door deflates the whole intention of this program.

Be aware, if you chose to pay the penalty rather than buy insurance: just because you pay the (very small) penalty doesn't mean you are off the hook for any medical bills you acquire. You still have to pay those, too.
I think that Mheslep is trying to explain that you mix up normal insurance with redistribution schemes. With correctly priced insurance your premium is based on your risks. Under normal conditions you can't seriously game the system. If you are low risk, you receive low premium, high risk - high premium. If the margins (and transaction costs) are low its rational with even mildly risk adverse individual to enrol, regardless whether he is low or high risk. However in redistribution system you mostly neglect risk, but concentrate on ability to pay. So such system in order to work has to be compulsory, because otherwise rational individuals would either flock if are those in need or try to avoid joining if they are those who are supposed to sponsor the whole system.
 
  • #34
I think the some 1200 waivers of the ACA to various companies and organizations should also be factored into evaluations of the effectiveness of the law.
 
  • #35
mheslep said:
I think the some 1200 waivers of the ACA to various companies and organizations should also be factored into evaluations of the effectiveness of the law.

Why just the effectiveness, why not fairness also?
 
Last edited:

Similar threads

Replies
10
Views
1K
  • General Discussion
Replies
9
Views
980
Replies
9
Views
3K
Replies
65
Views
8K
Replies
9
Views
2K
  • General Discussion
Replies
9
Views
5K
Replies
25
Views
4K
  • General Discussion
5
Replies
154
Views
19K
  • Biology and Medical
2
Replies
57
Views
6K
  • General Discussion
Replies
4
Views
3K
Back
Top