Impeding changes to our Health Care system

[Happy Monkey]

What a bizarre complaint. The evidence that the legislation won't let you keep your plan is that if your insurance or your employer make your plan worse for you, they don't get to pretend it's still the old, grandfathered plan?

Is the fact that "increas[ing] the percentage of costs patients must pay out of pocket", "significantly decreas[ing] the percentage that employers contribute to premiums", or "significantly increas[ing] deductibles or co-payments" was "standard practice in the industry" part of what people like about their health care plan?

[classicman]

Just facts.

Obama: You can keep the plan you have.
Reality: Actually no you can't.

[Happy Monkey]

It's not "just facts".

Do you think that "Obama: You can keep the plan you have." meant that he would force insurers and employers to never change their plans?

Old plans are grandfathered in. You can keep them to the extent that you could ever keep your plan, before or after this legislation - based on the contract between your employer and insurer. This legislation did not change that.

But it did discourage the continuing worsening of the new contracts, by saying that if you want to increase employees' costs, you have to give up your grandfathering status. So some employees may be able to keep the plan they like longer than they would have been able to before.

[classicman]

Originally Posted by Happy Monkey

It's not "just facts".

Do you think that "Obama: You can keep the plan you have." meant that he would force insurers and employers to never change their plans?

Nope, not at all. I would fully expect them to change as they had in the past.

Old plans are grandfathered in. You can keep them to the extent that you could ever keep your plan, before or after this legislation - based on the contract between your employer and insurer. This legislation did not change that.

Completely false. Read again for comprehension. That is the main reason why I posted the link.

But it did discourage the continuing worsening of the new contracts, by saying that if you want to increase employees' costs, you have to give up your grandfathering status. So some employees may be able to keep the plan they like longer than they would have been able to before.

Uh, no thats not how I read that at all. Unfortunately we really do not know how this is going to play out, but it is beginning to look like things will change based upon what most reasonable people would consider to be technicalities.

[Happy Monkey]

Originally Posted by classicman

Completely false. Read again for comprehension. That is the main reason why I posted the link.

Perhaps you didn't read my post for comprehension. You can keep what you have, as long as your employer and insurer let you. Which is the same as it ever was.

The change is that now, if they want to make the plan worse for you, they have to lose their grandfathered status.

Look at the list of things that end the status:

• Plans that increase the percentage of costs patients must pay out of pocket.
• plans that significantly decrease the percentage that employers contribute to premiums or those that significantly increase deductibles or co-payments.
• An employer that switches health-insurance providers also loses its grandfathered status.

If my company did that, I would not consider myself to still have the plan I liked. If my company decided not to do these, in order to avoid the new regulations, I would consider myself to have kept the plan longer than I would otherwise have been able to.

The insurance companies can no longer follow the plan they like - continually raise prices and decrease benefits without following the new regulations.

[SamIam]

Originally Posted by classicman

Completely false. Read again for comprehension. That is the main reason why I posted the link.

Hey, Classic, I think you need to look more closely at your own link. It reads:

Plans that increase the percentage of costs patients must pay out of pocket - known as co-insurance - lose their grandfathered status. The same is true for plans that significantly decrease the percentage that employers contribute to premiums or those that significantly increase deductibles or co-payments. An employer that switches health-insurance providers also loses its grandfathered status.

(emphasis my own)

In other words, if an employer wants to increase the amount that employees pay for health care, he can't. What's wrong with that? Do you want to pay even more for health coverage? Most people will be glad that their current plans are grandfathered in.

[TheMercenary]

HM, the problem is that the people who are insured are going to eat the majority of the costs associated with Obamacare. And there was never any intent to protect the currently insured in that bill. It has only been after the fact that the lawmakers are now jumping through hoops to try to modify that effect. I am sure it is of no concern for those who have little to no healthcare insurance now. To the rest of us it is a huge concern.

[classicman]

* Plans that increase the percentage of costs patients must pay out of pocket.
* plans that significantly decrease the percentage that employers contribute to premiums or those that significantly increase deductibles or co-payments.

How much? Costs increase all the time. For everything, not just health insurance. So if a plan requires the insured to pay a $15 co-pay for prescriptions instead of a $10 co-pay .... OUT.
Additionally if the premiums rise by (what percentage?) is the plan no longer grandfathered. That may or may not be a good thing. I think its situationally dependent. This again is an issue that may or may not be a good thing. If an employer goes to a plan that better suits the needs of the employees from one which doesn't - too bad, OUT.

* An employer that switches health-insurance providers also loses its grandfathered status.

ETA
So a doctor retires and "the plan" selects a new one to replace him ... OUT.
If a plan wants to ADD doctors to INCREASE the options for the insureds .. OUT.

Its simply not as cut and dried as you want it to be.

Which is why I bolded -

Originally Posted by Time article

Still, while many employer-based plans will be snared in the regulatory net of the Patient Protection and Affordable Care Act, many of those with this coverage could actually stand to benefit.
It will be years before it's clear...

[Happy Monkey]

Originally Posted by classicman

How much? Costs increase all the time. For everything, not just health insurance.

Percentage. Costs can increase, but the percentage of those costs that the employees pay can't. There might be some issue as to what a significant deductible or co-pay increase consists of, but once that's defined the plans will be able to decide whether to follow the new regulations, or raise the co-pay by a bit less.

So a doctor retires and "the plan" selects a new one to replace him ... OUT.
If a plan wants to ADD doctors to INCREASE the options for the insureds .. OUT.

Incorrect. Insurance provider. Not doctor. If your employer moves from Aetna to UnitedHealthcare, they obviously can't call it the same plan. Again, it is your employer changing the plan from the one you like.

[classicman]

Originally Posted by Happy Monkey

Percentage. Costs can increase, but the percentage of those costs that the employees pay can't. There might be some issue as to what a significant deductible or co-pay increase consists of, but once that's defined the plans will be able to decide whether to follow the new regulations, or raise the co-pay by a bit less.

Got it. ... once that is defined.


I read it this way at first and then changed my mind.

Incorrect. Insurance provider. Not doctor. If your employer moves from Aetna to United Healthcare, they obviously can't call it the same plan. Again, it is your employer changing the plan from the one you like.

... to perhaps a better one or similar one for less cost or a worse one. It doesn't matter. There are too many unknowns. And insurance costs may change from plan A to plan B so that in one case copay for prescription increases while at the same time the co-pay for a doctors visit decreases. How does that work out? No one knows - - - - - yet.

[TheMercenary]

The only thing controlled in the Bill is percentage differences between the upper and lower tiers. There are no cost controls. The insurance companies were given a gift.

[TheMercenary]

Sam, do you think that any insurance company can survive by not changing rates in the future? I mean to say that as long as costs go up, every single insurance company in the country will have to eventually change, therefore the idea that "you can keep the plan you have" is based on the false premise that some plans will never have to change over the next 20 years. I don't buy it and I don't believe that those who wrote the bill believed it either.

[Happy Monkey]

Originally Posted by TheMercenary

Sam, do you think that any insurance company can survive by not changing rates in the future? I mean to say that as long as costs go up, every single insurance company in the country will have to eventually change,

Percent.

If costs rise 10%, the insurance company can raise their rates 10%. But not 20%.

[TheMercenary]

Originally Posted by Happy Monkey

Percent.

If costs rise 10%, the insurance company can raise their rates 10%. But not 20%.

How does an insurance company measure that cost?

[SamIam]

Originally Posted by TheMercenary

Sam, do you think that any insurance company can survive by not changing rates in the future? I mean to say that as long as costs go up, every single insurance company in the country will have to eventually change, therefore the idea that "you can keep the plan you have" is based on the false premise that some plans will never have to change over the next 20 years. I don't buy it and I don't believe that those who wrote the bill believed it either.

Well - let's face it - its not as if insurance companies just raise their rates to reflect their increased costs. They have raised their rates because they can get away with it.

Again, from Classic's link:

Plus, it's not as though the employer-based insurance market is reliable and stable in its current form. Most employees don't have any control over the structure of their health insurance. As a result, coverage has been steadily eroding in the past decade, with premium costs for workers increasing 131% from 1999 to 2009, even as the actuarial value of those plans, on average, decreased.

I shed no tears for the insurance companies.