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Honored Social Butterfly

Your Thoughts on Medicare Negotiating the Price of Drugs as a Health care cost containment method

An old (but new again) piece of legislation has been re-introduced in the House of Representatives on allowing Medicare to negotiate the price of medication - at least some of them.
 
The President supports Medicare negotiating the price of drugs to bring down the cost of drugs - although there maybe some unintended consequences -
 
Would you support allowing Medicare to negotiate the price of medication - at least some of them?
 
What if your particular (expensive) drug is not included - would you switch to another one that is included or pay a higher price for the same one?
 
Would you be OK with taking a generic instead of a brand name drug if available?
Would you be OK with taking a generic of a type that gives the best price to Medicare and which may change from one generic manufacturer to another periodically depending upon who gives the lowest price to Medicare?
 
This is now in discussion at the (House) legislative level so I am just wondering what the actual medication users think about such a proposal.
 
It's Always Something . . . . Roseanna Roseannadanna
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the federal government is a not for profit organization unlike the pharmacuticle companies. goverment is involved in our daily lives and if they can get prices lower that helps the consumer. look at the prices of some of that medicine out there its ridiculas to have to pay thousands of dollars of income for these drugs and it only coves 30 day.  i am not a big government fan but in this case its ok                          

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Social Butterfly

.

To those that believe our government shouldn’t be involved in our healthcare, are you sure you never depended on the U.S. federal governments expertise in public healthcare?

 

We’d still have small pox, polio and an out-of-control Covid19 pandemic in our neighborhoods if the federal government hadn’t gotten involve in health care.

 

And about Obamacare, I wish Obama was a socialist then we would have gotten real socialized health care, but instead only in the US can an insurance middle man stand between you and your health care professional and be allowed to profit exceedingly.

 

Since others have mentioned their favorite Ronald Reagan quote, here’s mine.

“I never drink coffee at lunch. I find it keeps me awake for the afternoon.” Ronald Reagan

Honored Social Butterfly

Never been able to understand as to how come a nation that has over 300 M people think that it can be governed by dealing with the differences that every Stated wands and needs. It makes me think of a nation that has 50 different nations  and they all try to work together.
Medicare is a Federal program. therefore it needs to function as a Federal program. If each and every Stated wants to have their own rule and regulations it will become a mess. for all.

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Honored Social Butterfly

@Roxanna35 

Medicare is a federal program but when private industry is involved - be that some type of providers or insurance companies - there is only so much they can do to get them to participate.  States have more latitude in getting these private companies to participate in certain ways.

 

Like:  Not all states and localities have Medicare Advantage plans because it is not feasible - the area may not have enough providers or even senior population that want to be apart of that part of Medicare.  OR states may want to extend coverage of Medigap coverage [ private coverage] to more of the disabled population under Medicare or not.  

 

Healthcare for the most part is local and is provided by private entities, as opposed to government owned & operated, like the VA Healthcare System.  That is why states play a very important part.  States also know the needs of their own populations better -

 

I think more can and should be done at the state level.  I think this will become more apparent when and IF some type of national plan is ever seriously considered.  

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 wrote:

@Roxanna35 

Medicare is a federal program but when private industry is involved - be that some type of providers or insurance companies - there is only so much they can do to get them to participate.  States have more latitude in getting these private companies to participate in certain ways.

 

Like:  Not all states and localities have Medicare Advantage plans because it is not feasible - the area may not have enough providers or even senior population that want to be apart of that part of Medicare.  OR states may want to extend coverage of Medigap coverage [ private coverage] to more of the disabled population under Medicare or not.  

 

Healthcare for the most part is local and is provided by private entities, as opposed to government owned & operated, like the VA Healthcare System.  That is why states play a very important part.  States also know the needs of their own populations better -

 

I think more can and should be done at the state level.  I think this will become more apparent when and IF some type of national plan is ever seriously considered.  

 

 

 


Lets go be the numbers.

1. It is feasible to have Medicare Advantage in every area of the country. Fact is we had that when the program was first started. I was in one. The Carrier provided just what Medicare did. Nothing more nothing less. Claims were submitted to the Carrier for payment. Providers did not have to accept this type of Advantage plan and people were turned down. Hot spots where this happended were in N. FL, and GA. The Carrier was paid 15% more by Medicare for providing this coverage.  Medicare some time ago ended these type of plans and said Carriers had to add programs to the basic Medicare ones. Many Carriers dropped out.

The real reason we do not have Advantage programs in every area is the Carriers can not make a profit.

2. Health Care is provided to all mainly  by local private or govt. supported private entities, and States should know what is needed better than any party.

Many States provide money to cover some of the costs by these entities, and provide oversight of them.

3. Health Care is a National issue and can only be solved at the National level on a broad basis with States allowed to add or subtract things not needed in their State, and this is something the Feds must agree to so it is a State and Fed. Partnership. We have seen this with the virus. We need a base National plan as a Starting point.

4. The Carriers are in this to make a profit as big as they can. If they can not make a profit they drop out or get one of the parties to support changes to existing laws so that happens.  Part D Drug in Medicare is an example of that by the Drug Mfg.

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@john258 

1.  It is feasible to have Medicare Advantage in every area of the country.

RESPONSE:  The number of counties with no Medicare Advantage plans for 2021 is 82, similar to 2020. As in prior years, there are no Medicare Advantage plans offered in Alaska. Additionally, no Medicare Advantage plans are available in territories other than Puerto Rico.

KFF: Medicare Advantage 2021 Spotlight 

The real reason we do not have Advantage programs in every area is the Carriers can not make a profit.

In a way, that is true but it originates because the insurers have little way of developing their networks in areas where [all types] of providers are scarce.

2. . . . States should know what is needed better than any party.

Many States provide money to cover some of the costs by these entities, and provide oversight of them.

That is why I said "

States also know the needs of their own populations better -

 

I think more can and should be done at the state level.  I think this will become more apparent when and IF some type of national plan is ever seriously considered.  "

States are also the ones that provide charters to hospitals to either open new ones or expand their bed capacity with reason.  To control health care cost, as other countries do, this sort of managed medical infrastructure is carried into other areas of supply like where & how many imaging facilities are placed. It does us no good to have them all piled into one area and none in another - same with other types of medical infrastructure - and these can only be controlled at the state level unless a system like the NHS is developed but I don't think we would ever go that far.

4.  Part D Drug in Medicare is an example of that by the Drug Mfg.  

Part D was designed the way it was because seniors wanted access to the widest range of drugs.  Negotiating drug prices also means that we are gonna negotiate which drugs are covered - there is NO negotiation strategy that can support the number of drugs that seniors have access to today under the Part D program - if we go this route, only some drugs will be on this negotiated formulary.  I am not saying that is bad - just a reality.

 

It's Always Something . . . . Roseanna Roseannadanna
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Gail.

By the numbers again.:

1. You are correct there are now parts of the country that have no advantage programs. The area I live in is one of them. The reason is that no Carrier wants to have one in that area because they can not make money. PERIOD.

There was Advantage plans in my area when the program started and I explained it to you. That program was in every State, and county in the USA. The Carrier made money by the extra 15% paid to it by Medicare. Medicare ended that and the Carrier ended the plan everywhere.

 

Carriers can develop networks in just about everywhere in the country they want to have one. There are networks developed by outside groups which sell access to the network to Carriers. How do I know that. I was involved in using those networks in programs I had a hand in developing. I am in such a network now for Dental Insurance which is used by a large Carrier.

2. Glad we basically agree on the States. There are States which do some of this now. One Eastern State some years ago got in to the heart transplant area. When it was new just about every Hospital was trying to have one. The State stepped in and ended any new Hospital having such a unit with out State approval. The State then only allowed what was needed.

4. Part D was created by the drug mfg. and crafted to end the problem of Seniors being forced into bankruptcy by having to take a high cost drug off long periods of time. Medicare picked up the cost after a certain level. They threw in the starter coverage to supply something for all so they would get support of most members. The far right Rep signed on to that idea and saw it as a starter to turn Medicare back to Carriers. What they actually did was lay the groundwork for total drug coverage, and you see this as the coverage gap is shortened each year.

You can include all drugs in the program you set prices for, so  you leave none out, and you can be sure drug mfg. want all their drugs in. I have no problem in requiring that generic be used where there is one unless the DR. has a reason to use Brand name.  Have you ever been to a drug mfg operation? If not visit one. Have them explain the red book to you and how it used to work. Go look at the production line on over the counter drugs and see the pills going into different bottles on the line and then learn the difference in prices the bottles of the same pills will be sold for. This area has been controlled pricing for years.

 

 

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I know that you know about these things more than the general public. so what is your position ?  Mine is as follows. we al know that we pay in the US for medicines more than the rest of the world. so if Medicare can alleviate any of this more power to them. Personally, yes I think is a good idea. and I already accept generics in most of my prescription. If there was one that was not included I would have to make the decision depending of my need as to whether I would pay or whether I would  get a generic if that generic was as efficient as the brand one then yes I would take that generic.

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@Roxanna35 wrote:

I know that you know about these things more than the general public. so what is your position ?  Mine is as follows. we al know that we pay in the US for medicines more than the rest of the world. so if Medicare can alleviate any of this more power to them. Personally, yes I think is a good idea. and I already accept generics in most of my prescription. If there was one that was not included I would have to make the decision depending of my need as to whether I would pay or whether I would  get a generic if that generic was as efficient as the brand one then yes I would take that generic.


The  answer to your question is easy. Yes the prices would come down if Medicare could bargain with the drug Cos. on prices. That is why the drug Cos. had it made unlawful for Medicare to do that. You will hear a lot from some on the free market and all the usual cries when their ability to control what you and I do that can reduce what they make in profit. There is no free market in health care and has not been for years. The States control most of what the Insurance Carriers do. Everything from what they must cover, to rates, reserves, and definitions. This came about due to the Carriers misuse of what they were doing. If you ask a number of Carriers to rate a policy based on loss ratio all would give you the same rate as they all use the same base table.

 I always say never listen or follow anyone who says the free market will fix this. It has proved it will not, and has not in the last 100 years.

Honored Social Butterfly

@Roxanna35 

I feel pretty much like @somarco does.  If the government would stay out of it ( not just this but other stuff too, like the cost of higher ed.), private institutions - be that a pharmaceutical company, a college or even a doctor, hospital or other medical business - then those who want to sell something would have to compete for just our dollars and between themselves.  That, in and of itself, would make the price of [whatever] more reasonable for our dollars.  There is only a finite number of rich people who could afford something with price being of no concern.  

 

Government creates a lot of this problem with the way they approve medications and even therapies, surgeries, treatments, etc. even down to the way they allow the creating pharmaceutical manufacturer to manipulate their patent protections.  Governments roll should be only to evaluate the efficacy (including price) of any medication and then if approved as the good-better-best, set limits on how long they can continue to hold its formula captive without a MAJOR re-invent.  They also should not be able to hold such medication ransom for other uses - IOW, a med should be approved, rated by its efficacy (including price), for only the patented use - outside of that patented use, either they or another drug company / manufacturer has the ability to seek approval in the same way for other uses - treatment for AMD involving Avastin, Lucentis or Eylea is a great example.

 

We do need government to determine the efficacy of all drugs - they should always include price in this measurer of approval.  Further more, they should rate it for approval (including price) as to whether or not it is good-better-best of the current market treatments.  Meaning they rate it (including price) not only that it works but that it works better than whatever is now on the market in comparison (including price and quality of life).

 

As the Commonwealth Fund links in my post show, there will be some draw backs to this current plan.  That's why it is still in the works -

When government says, it is gonna save money - many times, it is not talking about a persons' money - they are talking about the money that government spends which does affect people's pocketbook - IF they pay taxes.

 

So downfalls in the current plan as written are:

  • scope would be limited to the most expensive, most widely used meds in the beginning and most likely just a few.
  • might cut down on manufacturers development of new drugs somewhat
  • will reduce the size of the Medicaid drug rebates, increasing the price for government (feds share with the states)

There are a lot of IF's in your answers - and that is always the problem - the unknown, unintended consequences and how those changes would affect real people.

 

It's Always Something . . . . Roseanna Roseannadanna
Honored Social Butterfly

Gail, I believe that you want perfection in politics and government? LOL LOL

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@GailL1 the most feared words in the English language are, "I am from the government and I am here to help you".

 

Almost every time the DC critters try to help they make it worse and more expensive. Promises to "fix" or "save" Medicare and SS in particular translates into "DC will pay/contribute less and the beneficiaries will pay more".

 

Part D was supposed to make Rx more affordable but instead caused prices to rise. Consumers lost access to most of the PAP's once they enrolled in a PDP.

 

Medicare beneficiaries, for the most part, are better off without Part D than with it. That is a general observation and, as always, there are exceptions. Most of my clients, including those with a PDP, pay cash and use GoodRx vs their drug plan for all but brand names.

 

In some cases they may qualify for a PAP even with Part D but many of the PAP's won't give you a discount card if you have a Medicare drug plan.


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Drug companies should not be allowed to extend their patents for minor changes to a brand drug such as a tablet versus a capsule, one pill a day instead of two, a blue color instead of green, or even some changes to molecules of a drug are questionable as whether they are safer or more effective.

.

All drug companies are doing is unfairly preventing another company from manufacturing a cheaper generic version of the drug.

.

And yes, I think Health and Human services should be permitted to negotiate Medicare prescription drug prices.

.

Congress needs to pass the Elijah E. Cummings Lower Drug Cost Now Act that will help older Americans afford their medications.

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@ReTiReD51 

Yes, it is the Elijah Cummings Bill that has been introduced HR 3 but they seem to be tweaking it slightly because of some of the unintended consequences brought out by some studies/research last year.

Commonwealth Fund - 04/29/2020 - The Elijah E. Cummings Lower Drug Costs Now Act: How It Would Work,... 

 

It still depends on what we all (including other nations) can live with - it is not the "fix-all" for everybody.  That's why I asked the questions that I did in my initial post.

 

It is a very complicated topic - U.S. drug pricing and patents.

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 most of the folks in DC lack real world experience. All they know is collecting a paycheck from the taxpayers as long as they promise lot's of free stuff.

 

Almost every time they try to bring companies "in line" and make them behave the consequences are enormous.

 

Obamacare is a good example. The promise was to prevent the insurance carriers from "discriminating against those with health problems", make health care and health insurance more affordable and accessible to everyone by creating more competition and letting the market dictate pricing.

 

What a joke.

 

What we got instead was over 90% of the carriers in the individual health insurance bailed within the first 2 years after the law was implemented. Most never even stuck around for the 2014 inauguration year.

 

Premiums nearly doubled almost overnight and are still rising. PPO plans, once the norm, gave way to HMO's with smaller networks and LESS access to care, not more as promised. Deductibles and OOP limits increased from $1500 - $2500 pre-2014 to the current $7,000 levels.

 

"Junk" plans that were not true major med were supposed to be eliminated. Now we have more than before.

 

The promise to "tax the rich" to pay for these pipe dreams never works out as planned. The 1991 luxury tax was supposed to create a windfall for the Treasury. What it did was collapse the luxury boating industry and almost sink the private aircraft industry as the wealthy found ways around the tax.

 

The luxury tax was a complete failure and was repealed 2 years later due to the crushing impact on jobs.

 

The DC crowd always assumes behaviors are static, that everyone and every company will simply roll over and comply with new rules, taxes, etc.

 

Instead, the companies take their jobs elsewhere, ship their products out of the country and the wealthy pay advisors a lot of money to find ways to legally avoid compliance.

 

So pardon me if I don't jump on the wagon and expect lower Rx prices. History says this will fail like most other government great ideas.

 

 


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Lets look at what we got from the ACA. Carriers were forced to have a loss ratio of 80%, and that will go higher. They used to be come concerned at 60% loss ratio. Everyone was required to have coverage so base table rates could be used, and that also gave us coverage for all as the pre ex was ended. Kids were allowed to stay on parents policy till age 26 reducing need for high cost Indv. coverage. There was to be a public option offered, but that was killed by Joe L. who would not vote for the bill. They offered a non profit approach by state and gave the start ups a grant for funding. After a short period of time the grant was changed to a loan forcing most of theses new carriers out of business to to State Insurance laws on reserves since now it was a loan or liability. (The Carriers, and agents were behind this along with the far right.) There was expanded Medicaid which was changed to an opt out at the State level. Joe L work again. The ACA was working to cut costs, and increase number insured till Trump gutted it by executive orders.

 

Yes at first a lot of Carriers got out since they could not make the large profit, and most woke up and came back in. There were no pipe dreams but the first step to what would become a medicare for all approach to pay for our medical coverage for all system we have had for years. HMO and networks were invented to cut costs mainly by the Carriers and all started to use them because they could make more money the ACA  had little to do with this area. Just look at the Dental Insurance area and just about every Carrier uses them.

The DC Crowd is a lot smarter than the people who opposed the ACA since they now work under the new rules. The Insurance Agents have been the biggest losers since the commissions are much smaller.

Where does this end. When we have a medicare for all under 65. That will give us Medicaid and Medicare supplying coverage for all and hopefully from a trust fund which can take money from the sources that cause a lot of our illness.

 

Bronze Conversationalist

@john258 interesting observations but a few miss the mark IMO.

 

I have worked the health insurance market for a long time. The only time I have seen 60% MLR is for ancillary business (dental, cancer, HI, etc). I have never seen 60% for primary payers. More common (pre-Obamacare) was in the 78 to 85% range.

 

All the MLR rules did was make the cost of administering these plans more expensive . . . and that cost is passed along to the end user . . . along with the incredible cost of eliminating underwriting and pre-ex.

 

Mandating coverage accomplished almost nothing. There are still millions who go bare or rely on overpriced indemnity plans and health care sharing (which are not insurance). Both of those approaches have a lot of holes. In addition, the sharing plans are not regulated by the DOI since they are not insurance.

 

MEWA's were essentially banned except for TH plans and some association plans. Now MEWA's for individuals are coming back and some of them have already crashed and burned.

 

Other insanely stupid ideas by those who crafted Obamacare include the "public option" (which is really Medicaid for all) , and the health care co-ops which soaked up a lot of taxpayer money. Most of the $$$ went to the folks who started the co-ops (many were Obama cronies) and the 30+ co-ops that did make it out of the starting gate were all gone in 3 years or less.

 

Obamacare was a pipe dream designed to draw in votes  . . . "relying on the stupidity of the American voter" (thank you Jonathon Gruber for pulling back the curtain). The real purpose of Obamacare was a Trojan Horse to disguise the Medicaid expansion (another taxpayer boondoggle).

 

Affordable Care never materialized and never will. Most aspects of Obamacare not only increased premiums but also significantly added to the cost of health CARE.

 

at first a lot of Carriers got out since they could not make the large profit, and most woke up and came back in.

 

I don't know where your world exists but I haven't seen that happen in any state.

 

I know agents in just about every state (all 57 of them . . .) and they all tell the same tale. Pre-2014 they had 20, 30 carriers or more now they are reduced to usually 3 or less.

 

PPO plans were once prevalent  now they are nowhere to be found, replaced by HMO's.

 

You say "insurance agents were the biggest losers" and again, I disagree. Weak agents who were peddlers left the market in droves or moved to non-compliant plans (including STM).

 

Some, like me, moved to the senior (Medicare) market and never looked back.

 

The REAL losers in the Obamacare game were the consumers.

 

Fewer choices, if you like your plan too bad it's gone, if you like your doctor get over it, if you want advice and help in picking out a plan go to hc.gov or the carrier.

 

Medicare for all will become Medicaid for all with limited access to care.

 

"Trust funds" in DC are really promissory notes (IOU's) that are nothing more than a slush fund for politico's to raid when they run out of real money.


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If only the current administration would have followed up on President Trump's getting drug mfgs to lower the price of insulin and lowering the cost of medicine  in general to what mfgs charge other countries (lower price) for the same medicine we in the U.S. have to pay more for.

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If you think Trump wanted to lower Drug prices I would say dream on. Congress needs to pass laws and the Trump Reb are blocking them doing that.

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Per CMS.gov  May 26,2020:

"Today, under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year. "

 

Is this still in effect, or did the current administration cancel this - or let it drop?  

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Yes @JoeT64, these [Insulin] Med D or MADP plans are still in effect - you just have to look for them and right now is a good time to do so since it is open enrollment.  They are specific plans and I think they are called "Savings Model" plans.

Medicare.gov - Insulin Coverage

from the link:

Insulin savings through the Part D Senior Savings Model

Starting January 1, 2021, you may be able to get Medicare drug coverage that offers broad access to many types of insulin for no more than $35 for a month's supply. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets you choose among drug plans that offer insulin at a predictable and affordable cost.

more at the above link ~

 

There are a few more Trump proposals that Biden is still considering or working on too - Here is a couple of links on them from back in July 2021.

KHN 07/19/2021 - Biden’s July Executive Order Includes Drug Pricing Provisions. But Will They Do Eno...

On Drug Importation:  During the Trump administration, a rule was finalized allowing states to seek the FDA’s permission to import drugs. Several states then passed laws to that end, but Florida is the only state to have formally applied to the FDA. The agency has yet to make a decision on the request.

 

Bloomberg Law 07/09/2021 - Biden Order Revisits Trump Answers on Drug Prices, Competition 

 

Since both of these things required other action before beginning, I do not know where they currently stand but I believe the Biden Administration is still pursuing their practicality and savings.  The state of FL, maybe others, do have an importation process in place.

 

 

It's Always Something . . . . Roseanna Roseannadanna
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MLR was being seriously considered for elimination prior to January 2020

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@somarco wrote:

@john258 interesting observations but a few miss the mark IMO.

 

I have worked the health insurance market for a long time. The only time I have seen 60% MLR is for ancillary business (dental, cancer, HI, etc). I have never seen 60% for primary payers. More common (pre-Obamacare) was in the 78 to 85% range.

 

All the MLR rules did was make the cost of administering these plans more expensive . . . and that cost is passed along to the end user . . . along with the incredible cost of eliminating underwriting and pre-ex.

 

Mandating coverage accomplished almost nothing. There are still millions who go bare or rely on overpriced indemnity plans and health care sharing (which are not insurance). Both of those approaches have a lot of holes. In addition, the sharing plans are not regulated by the DOI since they are not insurance.

 

MEWA's were essentially banned except for TH plans and some association plans. Now MEWA's for individuals are coming back and some of them have already crashed and burned.

 

Other insanely stupid ideas by those who crafted Obamacare include the "public option" (which is really Medicaid for all) , and the health care co-ops which soaked up a lot of taxpayer money. Most of the $$$ went to the folks who started the co-ops (many were Obama cronies) and the 30+ co-ops that did make it out of the starting gate were all gone in 3 years or less.

 

Obamacare was a pipe dream designed to draw in votes  . . . "relying on the stupidity of the American voter" (thank you Jonathon Gruber for pulling back the curtain). The real purpose of Obamacare was a Trojan Horse to disguise the Medicaid expansion (another taxpayer boondoggle).

 

Affordable Care never materialized and never will. Most aspects of Obamacare not only increased premiums but also significantly added to the cost of health CARE.

 

at first a lot of Carriers got out since they could not make the large profit, and most woke up and came back in.

 

I don't know where your world exists but I haven't seen that happen in any state.

 

I know agents in just about every state (all 57 of them . . .) and they all tell the same tale. Pre-2014 they had 20, 30 carriers or more now they are reduced to usually 3 or less.

 

PPO plans were once prevalent  now they are nowhere to be found, replaced by HMO's.

 

You say "insurance agents were the biggest losers" and again, I disagree. Weak agents who were peddlers left the market in droves or moved to non-compliant plans (including STM).

 

Some, like me, moved to the senior (Medicare) market and never looked back.

 

The REAL losers in the Obamacare game were the consumers.

 

Fewer choices, if you like your plan too bad it's gone, if you like your doctor get over it, if you want advice and help in picking out a plan go to hc.gov or the carrier.

 

Medicare for all will become Medicaid for all with limited access to care.

 

"Trust funds" in DC are really promissory notes (IOU's) that are nothing more than a slush fund for politico's to raid when they run out of real money.


Like you I spent years in this area with Carriers. We were told the profit  they wanted to make on this line was 18%, and then add Admin costs, Agents Commission, Prem. taxes, plus a few other items and you hit 60% loss ratio needed. Yes added in was interest on reserves, and some large policies were written at close to cost since money flowed in from other business with them.

I am sure you understand the pre ex clause and why it was put in policies. The way you end the prex is if everyone has coverage and the ACA did that. You might not like how it did that but what is in the ACA is the only way they could get the law passed. It was a base law and will be changed till we have Medicare for all under 65.

I live in the real world. We saw Carriers get out and when the number covered grew they got back in. Not all use local agents now. You know that the Commission rate is not what it use to be with the Carrier having to pay out in claims .80 of every $ in.

Yes many agents moved to the Senior Market as the advantage plans were an attempt by the far right to end Medicare. That has changed and we now see the 15% excess payment to Carriers for providing what basic medicare benefits ending. That means less Commission for agents.

The cost of health care has decreased in States that followed all of parts of the ACA and extended the Medicaid part. In States that did not they have problems. The cost increases you speak of are in those States and from what Trump did by ex order to the law. That will now change and we see it with the new enrollment period in place.

Like it or not   Health Coverage for all has been provided by the USA for the last 100 years. Just go to the ER, and you will get it. That part is the most expensive and least effective part of the system and the ACA in time will end that area. Health Care is a National Problem and will only be solved by National Govt. programs. In time you will see a Medicare for under 65 added to the current Medicare, and Medicaid programs which if the trust fund approach is used will reduce the full health care costs in our total system. Agents will be a thing of the past (reduce cost), and Carriers will play to a totally different role yet to be defined but their cost to the system will be reduced.

What you say about the current trust fund is some what true, but the govt saves money by borrowing from those funds rather than using the open market with higher rates.

No the ACA was a winner for consumers and that is why Trump was never able to kill it. It is a looser for the Carriers and Agents.

Your comments about  loosing your Dr. and choices is right from the Carriers, and agents play book. Never was true, and never will be true. Fact is just the opposite. Anyone who lost a Dr. when the ACA came in was the result of their Carrier or Dr. Ever hear of Carriers going to a panel of providers for their insured. In one large Eastern City there was a Hospital who took over another Hospital and told all of the great new benefits the take over hospital employees would get when they were one. That day came and the take over hospital employees had no people to supply coverage as they were out side the network of their new hospital insurance covered. Yes they fixed that.

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@john258  We were told the profit  they wanted to make on this line was 18%, and then add Admin costs, Agents Commission, Prem. taxes, plus a few other items and you hit 60% loss ratio needed.

 

Unless you actually saw the financials, information required by law, to be reported to the DOI, SEC and stockholders, what you were told was nowhere near the truth.

 

SEC filings are audited and a matter of public record. If you are a stockholder you get a copy of the annual report.

 

I worked with and for over a dozen carriers during the years. Not a single one had anywhere near an 18% profit margin.

 

Traditional health insurance, individual major med & EGH, normally hovered around 4%.

 

Admin (retention costs) around 3%, reserves in the 15% to 18% range. That puts the net loss ratio in the 74 to 78% range.

 

Other lines of coverage including life insurance, annuities, cancer and HI plans, etc. have separate accounting and are all factored in the mix. The profit margin and reserve requirements can vary significantly by line.

 

If you have audited financials that show otherwise I would love to see a link so I can be enlightened.


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Have  news for you. People were help to that profit goal in their evaluation. By the way I did see the financials.  If all you saw was 4% overall you must have worked for Medicare as no Carrier was setting 4% as its profit. We now see large Carriers form holding Cos. and move money into them where they really make their money as what they can do is unregulated by the States. We saw that during the Bush downturn. One large Insurance Holding Co. was set to go under as it played with the Wall Street crowd a lot, yet not one of its Insurance Cos. Subs was in trouble. That shows all how the game is really played. If a Carrier was a a loss ratio of 78% they were looking to cancel the line or policy shortly. That is when the agent used to advise the Co. who the large claim people were, and if they were gone their insurance would be great.

Once again we see a lot of reading without understanding the full picture. Less use of the Carrier line, and better use of what is really happening in total is what will fix the problems. By the way I spent time in accounting, and we got the calls from on high to increase or decrease the IBNR at the end of some months they did not have to worry about audits or State. Carriers make a lot of money honestly doing things for their customers which they both make money and that can be credited to a customer in the total evaluation, and what they do is good for all including the general public.

To much reading and to little understanding of the  total area leads to problems. The Congresswomen showed us all that.

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