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I'm going to take each of your responses individually.First, regarding 'fact that insurance companies will no longer be able to drop people's insurance due to illness'. If you have insurance, your carrier CAN NOT rescind or drop coverage due to development of a health condition. NO MATTER WHAT.But, in practice, this is untrue. The reason will not be because you developed an illness. But, the insurance company will put a lot of effort into coming up with "reasons" to rescind your care. These reasons often are "an undisclosed preexisting medical condition." In other words, they'll find some slight disease that you had in the past and forgot to tell them about and use that as an excuse to drop your insurance. This is an inherently biased practice because they, of course, would never investigate a healty person who pays his premiums. They'll simply let him continue to pay until he gets sick and they can go through his records to find where he forgot to dot an "i".Not really. Insurance carriers typically have a two year period, during which they are allowed to rescind coverage for fraud or non-disclosure, the stuff you are talking about. That's not a bad thing, because insurance fraud is a very real problem in our country. Something you haven't mentioned with regards to the high cost of insurance. It's called an incontestability clause. Wiki it. After that period, your insurance carrier can't rescind coverage, even if it finds fraud. So you are not right when you say that insurance companies will look for reasons to deny coverage. If you have a major claim within the first two years, then of course the insurance carrier will investigate, since that's precisely when the most insurance fraud happens. If you are arguing that insurance carriers are denying for the wrong reasons, there are people like cane for that. It doesn't need to be legislated. I don't sell insurance from carriers that don't have solid reputations, and my clients don't have the problems you're describing. Why would an insurance carrier look for insurance fraud in a case where someone has already been 'paying into the system' for a time previous? Do you realize that one time claims from people who have insurance for less than three months is a huge portion of claims paid every year?

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I don't think it's the #1 problem, but it's a huge, huge problem.The question is, how do we go forward and build a better system?As is standard, you take the high-flying ideological position, whereby

No disrespect. And I don't have all the answers, nor do I claim to. My changes would include:- The addition of a public insurance option- The restructuring of hospitals to conform to the style of the Mayo clinic and others (which focus on results, used fix doctor salaries, encourage group discussions, and other things)- Somehow eliminating the connection between how one is treater (expensive tests) and how much one is charged. Bills should be based on results, not on what tests doctors did.- Allowing free trade of medicine and service (meaning, one can buy pills from Canada at a fraction of the price)- Encouraging medical research in universities and other not-for-profit institutions (though federal funding)- Smarter and more pragmatic drug/alcohol programs (discouraging jail time, encouraging treatment, and doing smart things like needle exchange, free condoms, etc)
Can you tell me how obamacare impacted these things you are saying that we need? I would agree that obamacare does some good things like guaranteed-issue for children etc, but it completely and totally ignores the one crisis that affects nearly every American: cost.In terms of not being able to discriminate based on preexisting conditions and the car insurance analogy, I would counter with the simple fact that cars and people are different, and there's no reason that our insurance requirements for the two should be the same. You can't argue for or against discrimination based on preexisting conditions by using another form of insurance as an analogy. Instead, you should argue on the merit of the idea. If you think insurance companies should be able to discriminate, you should say why you think so. I'm assuming that such an argument would state that the inability to discriminate would drive the insurance companies out of business. I would then counter by saying that the forced inclusion of young and healthy people into the insurance pool would allow them to say afloat. You would then counter by saying that there isn't enough disincentive to ensure that those people actually do enter the pool instead of simply biting the bullet and not getting insurance at the cost of a tax charge. I would then counter that your claim is merely speculation. etcIf everyone carried insurance, then these problems with bankruptcy go away. Surely we can agree that good citizens should pay their taxes and carry insurance for their cars, etc. Health insurance should be the same way. People shouldn't be 'forced' to buy insurance. If people want to make the personal choice to not have insurance, then they are also making the personal decision to roll the dice, hoping they won't get sick. I'm sorry, but I don't feel sorry for someone who has never had insurance because they're healthy, and all of a sudden they get sick, and want insurance to pay for it. It seems like you think otherwise.If you are agreeing on an individual mandate to go along with guarantee issue (covering everyone), then we are in agreement. However, obamacare does neither.
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I make no claims to be a Health care cost expert. I only pay 80% the bill for approx. 105 families that work for me. that being said every three years we rebid out healthcare coverage. Step one is to get base increase from our existing contact to see if we want to stay there or shop around (changing companies is a real pain in the ass). Preliminary numbers are calling for a 22 percent rate hike in premiums starting on 2010...when asked why we were told it is a direct cause and effect of the national health package. We will shop it arpound but at the minimum we are going to get 15 percent increase.Thanks Barak, Nancy, Barney and the rest. There are now 105 people that are not going to be getting raises this year end or they will be reduced quite a bit. The best part is the people will be mad at me....see health care is free so I am just being greedy.I am sure this will go a long way to help jump starting the economy...maybe I should go hire somebody...no that would be wrong. The best way is to sub work to a guy who has less then 50 and he doesn't have offer private insurance, he has lower pay scale for his workers compared to mine. That will be good for everyone, his prices are lower, my profit margin is better and the little guy gets screwed!! By the demorcats....AGAIN. LOL people are so silly.

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I make no claims to be a Health care cost expert. I only pay 80% the bill for approx. 105 families that work for me. that being said every three years we rebid out healthcare coverage. Step one is to get base increase from our existing contact to see if we want to stay there or shop around (changing companies is a real pain in the ass). Preliminary numbers are calling for a 22 percent rate hike in premiums starting on 2010...when asked why we were told it is a direct cause and effect of the national health package. We will shop it arpound but at the minimum we are going to get 15 percent increase.Thanks Barak, Nancy, Barney and the rest. There are now 105 people that are not going to be getting raises this year end or they will be reduced quite a bit. The best part is the people will be mad at me....see health care is free so I am just being greedy.I am sure this will go a long way to help jump starting the economy...maybe I should go hire somebody...no that would be wrong. The best way is to sub work to a guy who has less then 50 and he doesn't have offer private insurance, he has lower pay scale for his workers compared to mine. That will be good for everyone, his prices are lower, my profit margin is better and the little guy gets screwed!! By the demorcats....AGAIN. LOL people are so silly.
sounds like they are getting screwed by you and your greed.
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I make no claims to be a Health care cost expert. I only pay 80% the bill for approx. 105 families that work for me. that being said every three years we rebid out healthcare coverage. Step one is to get base increase from our existing contact to see if we want to stay there or shop around (changing companies is a real pain in the ass). Preliminary numbers are calling for a 22 percent rate hike in premiums starting on 2010...when asked why we were told it is a direct cause and effect of the national health package. We will shop it arpound but at the minimum we are going to get 15 percent increase.Thanks Barak, Nancy, Barney and the rest. There are now 105 people that are not going to be getting raises this year end or they will be reduced quite a bit. The best part is the people will be mad at me....see health care is free so I am just being greedy.I am sure this will go a long way to help jump starting the economy...maybe I should go hire somebody...no that would be wrong. The best way is to sub work to a guy who has less then 50 and he doesn't have offer private insurance, he has lower pay scale for his workers compared to mine. That will be good for everyone, his prices are lower, my profit margin is better and the little guy gets screwed!! By the demorcats....AGAIN. LOL people are so silly.
Not saying that it might not be true but just because they say the reason is one thing doesn't mean that it is. Pretty convenient to blame the Health Care Reform for any increases that they want in their rates.What were the percentage increases in previous years before the Reform was passed ?
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Not saying that it might not be true but just because they say the reason is one thing doesn't mean that it is. Pretty convenient to blame the Health Care Reform for any increases that they want in their rates.What were the percentage increases in previous years before the Reform was passed ?
Oh, you noticed that too? It fits his worldview though so he took it as gospel instead of wondering why the rates would be so affected before most of Obamacare's provisions even go into effect.
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sounds like they are getting screwed by you and your greed.
Yea, with the robust economy and the fact that profits have been flat from last year 09, which was down 20 percent from 08 and the fact that instead of cutting back my work force we chose to keep everyone working. roughly 20 percent or a hair higher were jobs taken at beakeven just keep the workers going...there was no gain to business what so ever. Sounds like my greed is the problem...oh and the fact that i offer to pay 80 percent...and i offer a plan that I am willing to participate in meaning is it solid...yep my greed, got it. It is odd for a smart guy who claims to be from the Ivy you have a very shallow mind.
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I make no claims to be a Health care cost expert. I only pay 80% the bill for approx. 105 families that work for me. that being said every three years we rebid out healthcare coverage. Step one is to get base increase from our existing contact to see if we want to stay there or shop around (changing companies is a real pain in the ass). Preliminary numbers are calling for a 22 percent rate hike in premiums starting on 2010...when asked why we were told it is a direct cause and effect of the national health package. We will shop it arpound but at the minimum we are going to get 15 percent increase.Thanks Barak, Nancy, Barney and the rest. There are now 105 people that are not going to be getting raises this year end or they will be reduced quite a bit. The best part is the people will be mad at me....see health care is free so I am just being greedy.I am sure this will go a long way to help jump starting the economy...maybe I should go hire somebody...no that would be wrong. The best way is to sub work to a guy who has less then 50 and he doesn't have offer private insurance, he has lower pay scale for his workers compared to mine. That will be good for everyone, his prices are lower, my profit margin is better and the little guy gets screwed!! By the demorcats....AGAIN. LOL people are so silly.
Employees often don't appreciate the contribution that employers make on their behalf with regards to healthcare. It used to be that the benefits package is what separated similar employers, now everything is less transparent. Good for you that you're offering coverage instead of bonuses, your families with medical conditions thank you.I hope you're using an agent for your insurance needs instead of working direct with your carrier. Make sure you're current agent is a member of the national association of health underwriters. If not, find a better agent through nahu.org. A good agent will save you bunches of money. One of our older clients has documented saving millions of dollars on their health coverage since 1977 by making various changes with our help. It's obscene that people try to do this themselves.
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Yea, with the robust economy and the fact that profits have been flat from last year 09, which was down 20 percent from 08 and the fact that instead of cutting back my work force we chose to keep everyone working. roughly 20 percent or a hair higher were jobs taken at beakeven just keep the workers going...there was no gain to business what so ever. Sounds like my greed is the problem...oh and the fact that i offer to pay 80 percent...and i offer a plan that I am willing to participate in meaning is it solid...yep my greed, got it. It is odd for a smart guy who claims to be from the Ivy you have a very shallow mind.
oooooh, now I am just claiming? It was a joke, buddy, lighten up ya greedy bastard.
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Not saying that it might not be true but just because they say the reason is one thing doesn't mean that it is. Pretty convenient to blame the Health Care Reform for any increases that they want in their rates.What were the percentage increases in previous years before the Reform was passed ?
they were bad, 10 or 11 percent. still the increase doubled...even after squeezing it I highly doubt i will be able to get it below 15. In past years they have often come out will opening offers of 15 to 17% and we have been able to get it down to 10-12. If you notice i said it was 22 and i thought i could get it to 15%.Bottom line is first year and we still have a 5 percent jump. In a bad market, where the costs of the healthcare package, according the CBO wasn't supposted show up until 2014. Does that give anyone a good feeling? if it does please expand on how.
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Employees often don't appreciate the contribution that employers make on their behalf with regards to healthcare. It used to be that the benefits package is what separated similar employers, now everything is less transparent. Good for you that you're offering coverage instead of bonuses, your families with medical conditions thank you.I hope you're using an agent for your insurance needs instead of working direct with your carrier. Make sure you're current agent is a member of the national association of health underwriters. If not, find a better agent through nahu.org. A good agent will save you bunches of money. One of our older clients has documented saving millions of dollars on their health coverage since 1977 by making various changes with our help. It's obscene that people try to do this themselves.
oh yea, agents are the only way to go. lucky for us there are several we are pretty happy with and feedback from users is good.
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Not saying that it might not be true but just because they say the reason is one thing doesn't mean that it is. Pretty convenient to blame the Health Care Reform for any increases that they want in their rates.What were the percentage increases in previous years before the Reform was passed ?
Group insurance trends 12-20% each year, this year it's on the higher end. Individual insurance trends slightly less at 5-15%. Some of my individual clients have seen 40-50% increases.You all can act like healthcare reform doesn't have an immediate effect on rates, but that's a foolish position to take. It's ridiculous to assume that we won't see increases in premiums as a direct result of this legislation. Before healthcare reform was passed, we were seeing the lower side of that trend.Moving forward, the only way employers will save money is by keeping 'grandfathered' plans with current benefits, instead of new plans that require very expensive benefits. Removing annual caps is fine but it raises rates, and it doesn't make sense for everyone. Right now, grandfathered vs non-grandfathered plans will be roughly the same cost, but in 2 years, non-grandfathered plans will likely be 25-50% less than healthcare reform-compliant plans. It's pretty ignorant to assume that we'll make cuts to medicare to pay for healthcare reform. Does anyone actually think that we'll make cuts there? LLY? The only way we'll pay for healthcare reform is by increasing rates. Period. I can tell you that my commissions come from the same pool of money as the carrier profits, and as a direct result of healthcare reform, my commission structure will be cut by roughly 20%. Again, as a direct result of this legislation. I have enough alternate revenue streams that it's not a huge hit to me personally, but not many people can stand a 20% hit to annual revenues. Cane would be surprised that I'm not in agreement with him that all insurance carriers are evil.
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oooooh, now I am just claiming? It was a joke, buddy, lighten up ya greedy bastard.
sorry business is important. bottom line is I can argue about our government and everythying else but that is fantasy land. it does have real results over time but day to day it is not a major player.When it comes to business i am not much of a joker. I make a damn good living and it is going up through investments rather then income, someday soon I hope it will be going up through both. I take employment serious and go out of my way to offer top notch stuff for my employees, i appologize for getting defensive.
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Now that we passed it and are seeing what's in it.Things are changing rapidly, but it's starting to appear that this whole 'grandfathering' of health insurance plans is going to be difficult for small employers to deal with. Basically, if you want to keep your current coverage ('grandfathered'), it's going to be nearly impossible to qualify for discrimination requirements, even though they might be legal currently. For example, it's very expensive to provide coverage to part time, seasonal, and high turnover employees, so we see management carve-outs, where only salaried managers and owners are eligible for coverage. Take a Dairy Queen for example (hi brv). That owner wants to reward his loyal managers and maybe full time employees, and of course his spouse and family. Currently, he can 'discriminate' between classes of employees, full/part time etc. This is a good thing. Moving forward, if that owner makes any changes to his current plan and loses 'grandfathered' status, he then must provide coverage to every single employee, even the hourly workers, even the high turnover positions, etc. It's going to be more affordable for employers to pay the fine instead of provide coverage for their employees. How does this increase coverage? LLY? This is just a small example, but something that will affect nearly every small business owner in a negative way. What are sick people going to do if they can't find group coverage?But hey, go obamacare.

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Moving forward, if that owner makes any changes to his current plan and loses 'grandfathered' status, he then must provide coverage to every single employee, even the hourly workers, even the high turnover positions, etc. It's going to be more affordable for employers to pay the fine instead of provide coverage for their employees. How does this increase coverage? LLY? This is just a small example, but something that will affect nearly every small business owner in a negative way. What are sick people going to do if they can't find group coverage?But hey, go obamacare.
Correct me if i'm wrong, but isn't the "fine" supposed to subsidize coverage to individuals who aren't getting the coverage through emplyment, thus increased coverage because it is affordable to those people now, even though they aren't getting it through their employer.BTW I am NOT a fan of Obamacare ... just asking a question.
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Correct me if i'm wrong, but isn't the "fine" supposed to subsidize coverage to individuals who aren't getting the coverage through emplyment, thus increased coverage because it is affordable to those people now, even though they aren't getting it through their employer.BTW I am NOT a fan of Obamacare ... just asking a question.
It's all good. It's difficult for me to get offended in this thread when it's so difficult to get good info. I'm even hearing different interpretations of obamacare from different carriers. It's nuts.To answer your question, theoretically, assuming that 'fine' goes directly to pay for uninsureds, it's a fine idea. Realistically though, since our current system is employer based, when that employer based coverage goes away, there is no options except a public program. The program created under obamacare, gettingUSCovered, only covers people who have been without coverage for six months or longer, it doesn't apply to the employee in our example. So, if the group plan went away and the employee is unhealthy, then they'd have to go without insurance for six months before they can qualify for the free federal program. I can think of a half dozen clients where there is a serious cancer type medical claim. I have one client who has an employee with end stage kidney failure. What is he going to do if he loses the group coverage?Pass it so we can see what's in it. Why would they put this six month limitation in the legislation if the goal was to increase coverage? Anyone?Also, people with insurance already contribute a portion of their premium to a fund that provides care to uninsured. Do you see that sick people were actually better off before obamacare?
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It's all good. It's difficult for me to get offended in this thread when it's so difficult to get good info. I'm even hearing different interpretations of obamacare from different carriers. It's nuts.To answer your question, theoretically, assuming that 'fine' goes directly to pay for uninsureds, it's a fine idea. Realistically though, since our current system is employer based, when that employer based coverage goes away, there is no options except a public program. The program created under obamacare, gettingUSCovered, only covers people who have been without coverage for six months or longer, it doesn't apply to the employee in our example. So, if the group plan went away and the employee is unhealthy, then they'd have to go without insurance for six months before they can qualify for the free federal program. I can think of a half dozen clients where there is a serious cancer type medical claim. I have one client who has an employee with end stage kidney failure. What is he going to do if he loses the group coverage?Pass it so we can see what's in it. Why would they put this six month limitation in the legislation if the goal was to increase coverage? Anyone?Also, people with insurance already contribute a portion of their premium to a fund that provides care to uninsured. Do you see that sick people were actually better off before obamacare?
Wouldn't the employee be able to be covered under COBRA for the 6 month period and then be able to get the government coverage? Or is COBRA going to be nonexistant under the new legislation?
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Correct me if i'm wrong, but isn't the "fine" supposed to subsidize coverage to individuals who aren't getting the coverage through emplyment, thus increased coverage because it is affordable to those people now, even though they aren't getting it through their employer.BTW I am NOT a fan of Obamacare ... just asking a question.
Yes, the fines are supposed to help finance the federal program, but the fines are way way too low, the will barely even pay for a month of coverage. Guess who pays the rest. And that cost is not included in the cost estimates of ObamaCare. How's that budget neutral thing look now?(And that's not to mention Jeep's explanation, which is by far the most detailed I've heard.... keep them coming.)
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Wouldn't the employee be able to be covered under COBRA for the 6 month period and then be able to get the government coverage? Or is COBRA going to be nonexistant under the new legislation?
If an employer stops providing benefits, there is no underlying medical plan for the COBRA to continue coverage. If the medical plan goes away, so does the COBRA. Each state is different, as COBRA is over 20 employees, so small employers will be affected differently. Our state has 'continuation' that mirrors cobra for smaller employers. Also, if an employee hasn't been on the plan for longer than six months (high turnover employees etc), then they don't qualify for cobra or continuation. Lucky for my clients, we already had an additional high risk pool/safety net program called cover colorado. Once again, there were already options in place for people to get coverage, obamacare just puts more barriers in place and limits the options of sick people. It's disgusting.
Yes, the fines are supposed to help finance the federal program, but the fines are way way too low, the will barely even pay for a month of coverage. Guess who pays the rest. And that cost is not included in the cost estimates of ObamaCare. How's that budget neutral thing look now?(And that's not to mention Jeep's explanation, which is by far the most detailed I've heard.... keep them coming.)
Notice how obamacare has ceased to be an talking point for democrats. A lot of dems are distancing themselves from this because of the backlash. With two elections between now and 2014, hopefully we'll see some changes to the really really bad parts of this legislation.
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For fuck's sake.Sebelius calls on health insurers to stop misinformation and unjustified rate increasesWASHINGTON, DC – U.S. Department of Health and Human Services Secretary Kathleen Sebelius wrote America’s Health Insurance Plans (AHIP), the national association of health insurers, calling on their members to stop using scare tactics and misinformation to falsely blame premium increases for 2011 on the patient protections in the Affordable Care Act. Sebelius noted that the consumer protections and out-of-pocket savings provided for in the Affordable Care Act should result in a minimal impact on premiums for most Americans. Further, she reminded health plans that states have new resources under the Affordable Care Act to crack down on unjustified premium increases.The text of Sebelius’ letter is below.Ms. Karen IgnagniPresident and Chief Executive OfficerAmerica’s Health Insurance Plans601 Pennsylvania Avenue, NWSouth Building, Suite 500Washington, DC 20004Dear Ms. Ignagni:It has come to my attention that several health insurer carriers are sending letters to their enrollees falsely blaming premium increases for 2011 on the patient protections in the Affordable Care Act. I urge you to inform your members that there will be zero tolerance for this type of misinformation and unjustified rate increases.The Affordable Care Act includes a number of provisions to provide Americans with access to health coverage that will be there when they need it. These provisions were fully supported by AHIP and its member companies. Many of the legislation’s key protections take effect for plan or policy years beginning on or after September 23, 2010. All plans must comply with provisions such as no lifetime limits, no rescissions except in cases of fraud or intentional misrepresentation of material fact, and coverage of most adult children up to age 26. New plans must comply with additional provisions, such as coverage of preventive services with no cost sharing, access to OB / GYNs without referrals, restrictions on annual limits on coverage, a prohibition on pre-existing condition exclusions of children (which applies to all group health plans), access to out-of-network emergency room services, and a strengthened appeals process. And health plans that cover early retirees could qualify for reinsurance to sustain that coverage for businesses, workers, and retirees alike.According to our analysis and those of some industry and academic experts, any potential premium impact from the new consumer protections and increased quality provisions under the Affordable Care Act will be minimal. We estimate that that the effect will be no more than one to two percent. This is consistent with estimates from the Urban Institute (1 to 2 percent) and Mercer consultants (2.3 percent) as well as some insurers’ estimates. Pennsylvania’s Highmark, for example, estimates the effect of the legislation on premiums from 1.14 to 2 percent. Moreover, the trends in health costs, independent of the legislation, have slowed. Employers’ premiums for family coverage increased by only 3 percent in 2010 – a significant drop from previous years.Any premium increases will be moderated by out-of-pocket savings resulting from the law. These savings include a reduction in the “hidden tax” on insured Americans that subsidizes care for the uninsured. By making sure insurance covers people who are most at risk, there will be less uncompensated care, and, as a result, the amount of cost shifting to those who have coverage today will be reduced by up to $1 billion in 2013. By making sure that high-risk individuals have insurance and emphasizing health care that prevents illnesses from becoming serious, long-term health problems, the law will also reduce the cost of avoidable hospitalizations. Prioritizing prevention without cost sharing could also result in significant savings: from lowering people’s out-of-pocket spending to lowering costs due to conditions like obesity, and to increasing worker productivity – today, increased sickness and lack of coverage security reduce economic output by $260 billion per year.Given the importance of the new protections and the facts about their impact on costs, I ask for your help in stopping misinformation and scare tactics about the Affordable Care Act. Moreover, I want AHIP’s members to be put on notice: the Administration, in partnership with states, will not tolerate unjustified rate hikes in the name of consumer protections.Already, my Department has provided 46 states with resources to strengthen the review and transparency of proposed premiums. Later this fall, we will issue a regulation that will require state or federal review of all potentially unreasonable rate increases filed by health insurers, with the justification for increases posted publicly for consumers and employers. We will also keep track of insurers with a record of unjustified rate increases: those plans may be excluded from health insurance Exchanges in 2014. Simply stated, we will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections.Americans want affordable and reliable health insurance, and it is our job to make it happen. We worked hard to change the system to help consumers. It is my hope we can work together to stop misinformation and misleading marketing from the start.Sincerely,Kathleen Sebelius

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For fuck's sake.Sebelius calls on health insurers to stop misinformation and unjustified rate increasesWASHINGTON, DC – U.S. Department of Health and Human Services Secretary Kathleen Sebelius wrote America’s Health Insurance Plans (AHIP), the national association of health insurers, calling on their members to stop using scare tactics and misinformation to falsely blame premium increases for 2011 on the patient protections in the Affordable Care Act. Sebelius noted that the consumer protections and out-of-pocket savings provided for in the Affordable Care Act should result in a minimal impact on premiums for most Americans. Further, she reminded health plans that states have new resources under the Affordable Care Act to crack down on unjustified premium increases.The text of Sebelius’ letter is below.Ms. Karen IgnagniPresident and Chief Executive OfficerAmerica’s Health Insurance Plans601 Pennsylvania Avenue, NWSouth Building, Suite 500Washington, DC 20004Dear Ms. Ignagni:It has come to my attention that several health insurer carriers are sending letters to their enrollees falsely blaming premium increases for 2011 on the patient protections in the Affordable Care Act. I urge you to inform your members that there will be zero tolerance for this type of misinformation and unjustified rate increases.The Affordable Care Act includes a number of provisions to provide Americans with access to health coverage that will be there when they need it. These provisions were fully supported by AHIP and its member companies. Many of the legislation’s key protections take effect for plan or policy years beginning on or after September 23, 2010. All plans must comply with provisions such as no lifetime limits, no rescissions except in cases of fraud or intentional misrepresentation of material fact, and coverage of most adult children up to age 26. New plans must comply with additional provisions, such as coverage of preventive services with no cost sharing, access to OB / GYNs without referrals, restrictions on annual limits on coverage, a prohibition on pre-existing condition exclusions of children (which applies to all group health plans), access to out-of-network emergency room services, and a strengthened appeals process. And health plans that cover early retirees could qualify for reinsurance to sustain that coverage for businesses, workers, and retirees alike.According to our analysis and those of some industry and academic experts, any potential premium impact from the new consumer protections and increased quality provisions under the Affordable Care Act will be minimal. We estimate that that the effect will be no more than one to two percent. This is consistent with estimates from the Urban Institute (1 to 2 percent) and Mercer consultants (2.3 percent) as well as some insurers’ estimates. Pennsylvania’s Highmark, for example, estimates the effect of the legislation on premiums from 1.14 to 2 percent. Moreover, the trends in health costs, independent of the legislation, have slowed. Employers’ premiums for family coverage increased by only 3 percent in 2010 – a significant drop from previous years.Any premium increases will be moderated by out-of-pocket savings resulting from the law. These savings include a reduction in the “hidden tax” on insured Americans that subsidizes care for the uninsured. By making sure insurance covers people who are most at risk, there will be less uncompensated care, and, as a result, the amount of cost shifting to those who have coverage today will be reduced by up to $1 billion in 2013. By making sure that high-risk individuals have insurance and emphasizing health care that prevents illnesses from becoming serious, long-term health problems, the law will also reduce the cost of avoidable hospitalizations. Prioritizing prevention without cost sharing could also result in significant savings: from lowering people’s out-of-pocket spending to lowering costs due to conditions like obesity, and to increasing worker productivity – today, increased sickness and lack of coverage security reduce economic output by $260 billion per year.Given the importance of the new protections and the facts about their impact on costs, I ask for your help in stopping misinformation and scare tactics about the Affordable Care Act. Moreover, I want AHIP’s members to be put on notice: the Administration, in partnership with states, will not tolerate unjustified rate hikes in the name of consumer protections.Already, my Department has provided 46 states with resources to strengthen the review and transparency of proposed premiums. Later this fall, we will issue a regulation that will require state or federal review of all potentially unreasonable rate increases filed by health insurers, with the justification for increases posted publicly for consumers and employers. We will also keep track of insurers with a record of unjustified rate increases: those plans may be excluded from health insurance Exchanges in 2014. Simply stated, we will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections.Americans want affordable and reliable health insurance, and it is our job to make it happen. We worked hard to change the system to help consumers. It is my hope we can work together to stop misinformation and misleading marketing from the start.Sincerely,Kathleen Sebelius
Jeep I was literally just coming to post this letter and get your comments...
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