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» The Ornery American Forum » General Comments » Obamacare Predictions for May 2015 (Page 46)

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Author Topic: Obamacare Predictions for May 2015
Rafi
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Close.
quote:
A traditional “death spiral” occurs when many healthy people drop health insurance coverage, leaving a risk pool that is smaller and sicker than before. Insurers are forced to raise premiums to continue paying promised benefits to their sick customers. But this premium hike causes remaining healthy customers to drop coverage as well, because they don’t feel it is worth it to pay sky-high premiums for coverage they rarely, if ever, use.
In Hawaii's case, the pool has remained too small and they are considering special fees to offset the costs but the demographics are that the people signing up are too poor to pay them. Since they can't raise the premiums via special fees, the state exchange is collapsing - a death spiral at the end of the spiral, it's dead. I understand your need to deny it, I really do, but it is what it is.
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kmbboots
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Survey of Non-Group Health Insurance Enrollees, Wave 2
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Pyrtolin
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quote:
In Hawaii's case, the pool has remained too small and they are considering special fees to offset the costs but the demographics are that the people signing up are too poor to pay them.
You're conflating two different things. The problem isn't the pool size so far as insurance goes. The problem is the fact that the state isn't taking in enough revenue from the system to pay for the servers, programmers, call center employees, etc.. that it needs to maintain the front end for the market. There's no insurance death spiral, just a flawed attempt to try to do cost recovery on the redundant state infrastructure that they could have for free by listing on the federally managed website instead.
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Grant
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quote:
Originally posted by Grant:
OH fine!

My prediction for Obamacare, May 2015:

The law is still in effect. Republicans are still complaining about it constantly like shrill harpies. The Democratic spin machine is still defending it like good little counselors for their naked emperor. It is more unpopular then ever to citizens.

I concede defeat on my prediction that Obamacare would be more popular than ever for citizens. According to the statistical polling witch doctors over at RealClearPolitics, Obamacare reached a peak unpopularity on Dec 8, 2013, and the percentage of those favoring the law is very near it's previous peak in July of 2012.
http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html
No points.

Are the Republicans still complaining about it? Yes, but not as shrilly as they have previously, with so much more to occupy themselves with in Sen. Clinton. Half a point.

Is the Democratic spin machine still defending it? Yes, but not as much as previously since the level of attacks have died down. They have their hands full defending George Stephanapagus and the Clinton Foundation. Half a point.

I will take 1 point out of a possible 3, for a 33% accuracy rate. How do I match up?

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yossarian22c
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quote:
Originally posted by yossarian22c:
quote:
Rand has been polling 3,300 Americans monthly about their insurance choices since last fall. Researchers found that the share of adults ages 18 to 64 without health insurance has declined from 20.9% last fall to 16.6% as of March 22.
With 317,000,000 Americans I'll predict 13,000,000 plus or minus 2,000,000 newly insured Americans. And that is only counting the number who got insurance this year (i.e. it excludes the 23-26 crowd who was already covered on their parents insurance.) It also is excluding the large number who signed up yesterday. I am very comfortable with 11,000,000 as the lower bound for insured people as a result of the law.
quote:
As of March 2015 HHS reported a total of 16.4 [million] covered due to the ACA between the Marketplace, Medicaid expansion, young adults staying on their parents plan, and other coverage provisions. According to Gallup that translates to an uninsured rate of 11.9% down from a high of 18% in 2013.
quote:
11.7 million are estimated to have enrolled in the Marketplaces during 2015 open enrollment (Nov 2014 to Feb 2015). This includes 4.5 million who re-enrolled from 2014.
web page

I get a pass. But predicting new enrollment based on the current data wasn't stepping out on a limb either.

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yossarian22c
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Grant had a good idea, instead of having Greg do the leg work. Why don't people look at their own predictions and grade themselves.
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Greg Davidson
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I love this idea. I do have mark-ups of the 700 pages I printed out and have been waiting for a respite from work (plus taking care of my wife who just has a triple spinal fusion in her neck). I will be working several days of this 'Memorial Day weekend but t I have some hours assigned to write up some on the things I noticed doing this analysis.
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D.W.
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quote:
quote:
--------------------------------------------------------------------------------
So in reality Obama just took the whole problem of uninsured going to the ER and getting free care that he was fake-complaining about and expanded it to be much worse by allowing people to wait to get sick then sign up for health insurance.

Then again it probably wasn't an accident. My guess is this is a very deliberate calculation designed to break the private insurance industry completely and try to push us to single payer, as the ACA's authors have publicly suggested.
--------------------------------------------------------------------------------

With how the implementation and penalty delays have been implemented I believe that is where we are trending. I'm not prepared to say this was the intent yet. I still hold idealism and political cowardice as likely as deliberate sabotage to the current industry.

(2nd portion mine) I was overly pessimistic. I had expected more people to just take the penalty than are doing so until they felt they needed “insurance” meaning they expected their yearly out of pocket medical needs to exceed the cost of insurance.
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Greg Davidson
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Assessing predictions – Part 1 (Summary)
There’s so much in the ~1900 comments (~700 8” x 11” pages) over 18 months that I will post pieces of my response as I finish them. In this first installment, I want to comment on my overall experience reading all of our comments and the rules I will use to judge them; later I will cover my specific predictions as well as those of others including electoral impact, enrollment #’s, loss of insurance, nonpayment of premiums, growth of part-time work, website hacking, and several other discrete predictions that some of us made.

Summary comment

My experience reading through this after a year or more gave me some distance from the arguments, in a good way. I was better able to appreciate the arguments of my opponents, and I was better able to separate out their unique voices and perspectives. Sometimes their arguments seemed more reasonable than they did when I originally read them, and even if I was not persuaded, in some cases I was better able to see the sophistication and nuance in how they made their arguments. In particular, I’ll note that a number of Seriati’s comments improved for me upon re-reading, particularly the discussion May 16-19th of 2014 and the discussion on July 9th-14th. And I can also see my shortcomings better, and so in the interest of full disclosure since I will be making assessments on all of us, let me identify where Seriati correctly chastised me for comments that I had made, which led me to the following apology

quote:
Seriati: Seriously Greg, can you knock off the personal attacks on people's morality? We disagree with you that this is a net benefit, that it helps more than it harms, but to my knowledge no one is wishing bad things to those for whom it has provided help, or denying that it didn't help some people some where
________________________________________
Greg: I have thought about it, and this is a valid point. While I have absolutely no respect for the integrity of the analysis that opponents of Obamacare usually present, if I did agree with your view of facts, I would have a similar position to you. And I don't remember you saying that if Obamacare did provide net health benefits by getting millions of people access to health care, save lives, and reduce the rate of health care cost increases, you would still be against it. Therefore, our dispute is strictly over the facts, not over values. I am sorry to have made this error.

This improved perspective when reading end-to-end revealed to me that there are aspects about the timing and cadence of an on-line discussion board that impedes a meeting of the minds.

Rules:

I used the following definition for “prediction” – one of us members of the Ornery community had to assert that something was going to happen by May 2015. I did not count predictions made by others, or predictions for beyond this month (since we can’t assess them yet).

I didn’t hold people accountable for predictions that where they later caveated them or made them contingent on other events (for example, on 3/28/2014 noel c. was quite clear in saying he disagreed that Obamacare would be the law of the land in May 2015, but he went on to cite several pieces of potential legislation and provide the caveat “If this bundle of legislation passes, the UCA has been sent to the morgue“ – I gave the benefit of the doubt and did not include this as a prediction).

There were some predictions I could not assess. RedVW had a great, long, and specific list, but I don’t have the data to judge many of these (for example, infant mortality increase or deductibles increase 2% on average). When studies come in, I am all for making the assessment, but I could not do so as of today.

There were arguments over what really was Obamacare – some argued that Medicaid doesn’t count, others argued that increased funding in Obamacare for a project that had already demonstrated positive results didn’t count because it was an existing project, and it might have been expanded without Obamacare. For purposes of this discussion, I will keep Obamacare defined as the legislation passed in the Affordable Care Act, and the subsequent administrative actions taken in accordance with that legislation (as well as established precedent for administrative discretion in executing legislation)

I did have to take a position on how we know what we know. Some argued that we can’t make assertions about the effects of Obamacare because that requires a counter-factual comparison with what would have happened without Obamacare. If you go all the way down this path, you can never make any claims about any economic or political policy, because there are no pure laboratory experiments in the real world. For purpose of this exercise, I leaned in favor of the most straightforward interpretation of predictions and causality. For example, I was wrong and several others were right in predicted strong Republican gains in the 2014 election. They predicted this would be due to Obamacare, and while I’d like to argue about the influence of the unusually high level of public concern with Ebola (and ISIS) in November 2014, in accordance with my rules here I’ll accept Obamacare as the most straightforward explanation and acknowledge that I was wrong on that prediction.

I will try to have one of these completed each day (tomorrow I hope to start with death spirals)

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Seneca
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So how do Obama's constant unilateral delays of this law impact the predictions?
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Greg Davidson
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Seneca, if you made a prediction and provided a caveat that it was based on no delay in an implementation feature, then that is taken fully into account in assessing the prediction (and there were a number of instances where that occurred for some of us). But there were even more predictions made where that was not a factor.
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Seneca
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Why should people have made caveats that their predictions depended on Obama not illegally and unilaterally editing the law after its passage? Why was it our job to predict he would do that? Why should anyone have accounted for that?

[ May 26, 2015, 10:43 AM: Message edited by: Seneca ]

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Pete at Home
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evel kenievel proposes to jup the grand canyon on may 10.

group a predicts the may 10 jump will kill him.

on May 10, kenievel postpones his jump to may 15.

on mmay 11, group b mocks group a for mistakenly predicting disaster.

not an entirely fair analogy, but a start.

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Pyrtolin
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quote:
Originally posted by Pete at Home:
evel kenievel proposes to jup the grand canyon on may 10.

group a predicts the may 10 jump will kill him.

on May 10, kenievel postpones his jump to may 15.

on mmay 11, group b mocks group a for mistakenly predicting disaster.

not an entirely fair analogy, but a start.

Rather, on May 16, after he successfully makes the jump, people point out that group B was wrong, and group B claimed that they couldn't possibly have predicted the postponement (completely ignoring the fine print on the announcement noting that the jump could be postponed within reasonable limits if circumstances required it), so they shouldn't be held to their initial prediction because it was post-fact adjusted to be about the specific date rather than the overall execution of the stunt.
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Greg Davidson
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Seneca, I will lay out the predictions as you made them and we will all judge. For example, when you wrote that "many millions will lose their healthcare, lose their doctor and struggle to hit the reset button, start over and in some cases not sufficiently replace it in time or ever" (2/14/2014), we can look into quantitative data on how many lost their healthcare and doctor etc.

I am going to emphasize the most straightforward explanations, whether that makes my own predictions look better or worse (I included an example in part 1 where it rendered my prediction "wrong").

If you want to suggest a complex interpretation of the data to justify any predictions that you have made, you will be free to do so.

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Greg Davidson
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Part 2 - Policy Cancellations

Episode #5 – Policy cancellations


Predictions
quote:
And many millions will lose their healthcare, lose their doctor and struggle to hit the reset button, start over and in some cases not sufficiently replace it in time or ever. (Seneca 2/14/2014)
quote:
nearly 2/3 of insured Americans are losing their insurance, their care providers, and are seeing a curtailment of provider access and options (RedVW on a laptop 12/3/2013)
quote:
I will predict that the current estimate will be accurate and that, under the current “law”, more than 50 million will lose their insurance. However, the law can change at any moment and polling data prior to the 2014 elections may drive significant change if the polling data proves inconvenient for Barry and the democrats do my confidence in that prediction is about 50/50. (G3 12/4)
Here is the results of the most rigorous study I could find on this question ( survey methodology details) which anchors on a large, representative sample of the population identifying whether they got letters from their insurer saying that their policy was cancelled (before they got their policies for 2014, and again for 2015). The results in summary: most of the cancellations were in the "nongroup" market (that is, not employer provided insurance or EPI). 2.6 million people in the nongroup market received such letters in late 2013 (that's 20% of that population, which is high, but it is also worth noting that the average annual turnover in insurance policies in that population before the ACA was 42%). The small-group population had negligible cancellations in late 2013. In late 2014, the nongroup population had 0.4 million cancellations and the small-group had 0.5 million cancellations for a total of 0.9 million cancellations. The large-group population had negligible cancellations in each year

These data are inconsistent with prediction of 2/3rds of Americans, or 50 million people, or even "many" millions losing their insurance. I don't have data on the number of instances where losing this coverage actually resulted in the dire doctor shortages that were predicted. G3 correctly noted that policy may change, and so states were offered the opportunity to continue noncompliant plans in the individual and small-group markets - its arguably that can have a big enough effect to account for the prediction 50 million cancellations, but if he wishes to renew that prediction for 2017 when the waiver period ends, we can document that new prediction.

quote:
one in five (18.6 percent) of those with nongroup health insurance (i.e., directly purchased coverage in the individual market) report that their plan would no longer be offered to them in 2014 because it did not comply with the ACA’s new coverage requirements. We estimate that these findings translated to approximately 2.6 million people reporting policy cancellations caused by noncompliance in 2013

our findings imply that roughly 0.4 million people in the nongroup market reported that their plan was canceled for 2015 due to noncompliance with the ACA

our findings imply that roughly 0.5 million people with ESI reported that their plan was canceled for 2015 because of noncompliance with the ACA’s mandates

The nongroup market has historically been characterized by high volatility: an analysis of pre-ACA nongroup coverage patterns from 2008–11 shows that only 42 percent of nongroup enrollees retained their coverage after 12 months (Sommers 2014).

[URL= http://hrms.urban.org/quicktakes/Health-Insurance-Policy-Cancellations-Were-Uncommon-in-2014.html]link[/URL]
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Seriati
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One caveat on that Greg I'd ask if you considered. Both the individual mandate, and the employer mandate were delayed. The employer portion in particular impacts an extremely large amount of policies in the US. Given the amount of cancellations that occurred in the individual market, its seem very likely to me that if these had not been delayed the cancellation rates would have been much higher. In particular, I suspect that the Administration learned from the debacle and has adjusted how they are implementing (or not) the employer mandate to mimimize bad optics on this.

I don't believe it will reach 50 million, probably never would have. Certainly, isn't and won't lead to loss of insurance without replacement (though no guarantee the new insurance will be comparable on price and quality to the old).

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Greg Davidson
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A fair point, Seriati. And in my next installments we'll look at costs as well as a comparison of consumer satisfaction levels between people who got insurance via the Obamacare exchanges and those who continued to get insurance through their employers.

One question in my mind is whether any of those who predicted the very adverse policy cancellation impacts described above would care to extend that prediction to a later point in time when the delays expire. If not, there is one of two possibilities: (1) they were wrong in the extent of the original prediction, or (2) the delay was actually an effective method of facilitating the transition, reducing the threat of harm to the population by providing more time to accommodate the new policy.

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Rafi
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To the point of 50 million losing insurance, it depends on what you mean. I suspect you are defining it as people who end up with no insurance whatsoever - the most narrow and advantageous definition for Obamacare supporters since it is now illegal to be in that state. The Obama adminsitration, which provided the number, appears to have been defining it as forced out of the insurance they had and into new "improved" policies that are "better" for them. How many people were indeed forced out of the policy they had?
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Pyrtolin
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MAybe you should actually read what was posted, since that's exactly what was addressed above, including pointing out that the number of people "forced" out of plans was actually half of the normal yearly turnover (people "forced" out of plans because their companies cancelled/replaced them) rate prior to the ACA
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Rafi
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ouch, little sensitive there. We aren't actually at the point where any of this has truly been addressed yet. Once we see if the Supreme Court rules that laws mean what is written or can mean anything at all is when we'll see the true scope of this
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scifibum
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" I suspect you are defining it as people who end up with no insurance whatsoever..."

No, he defined it as people whose specific plans were cancelled, even if those people picked up new insurance right away. The most inclusive definition of "lost their insurance".

Never mind the question of how their new coverage compared to their old coverage.

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Seriati
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And see I read what Greg said as 1 in 5 of those whose policies were required to comply with Obamacare had their policies "officially" cancelled (which sounds like a decrease overall year to year, but that may be less meaningful that it sounds given the pressure applied to insurance companies - if it holds long term though it would be different). Since the vast majority of the country is on employer provided healthcare and the compliance of those policies were delayed, we don't know what the "official" cancellation rate would have been.

In any event, if anyone predicted doom and gloom full on cancellation without any alternative that seems to be a bad prediction (of course there's a penalty to being uninsured so not sure how sensible that prediction was on a go forward basis, unless you were predicting complete collapse of the entire system).

Basically the first 2 predictions seem to be busted (at least at this measuring point), while the third's specific caveats apply.

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Greg Davidson
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quote:
I read what Greg said as 1 in 5 of those whose policies were required to comply with Obamacare had their policies "officially" cancelled
A slight caveat - all insurance policies were required to comply with Obamacare, and it is only in the smallest category of plans (the so-called "nongroup" plans) that the 1 in 5 cancellations occurred.
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Greg Davidson
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Healthcare Cost - Part 4

quote:
annual rate of healthcare cost growth will continue close to 50 year lows (Greg Davidson 11/28/2013)
quote:
Also, as of this last week, everyone, even the administration, is expecting healthcare costs to skyrocket next year. (Seneca 4/1/2014)
quote:
Costs on average have increased for individuals by at least 50% using the lowest estimate available (RedVW on a laptop 12/3/2013)
quote:

“it's likely that overall ACA will continue to put upward pressure on healthcare spending” Charles in Charge (11/30/2013)

quote:
But more nonsensically, I can't believe you're still spouting the idea that this law is decreasing the deficit. It's nonsense and a demonstrated deception. And no need to go dig up figures that you think support you, I've seen them already, and if you did your homework you'd already know that they correlate much more strongly to people forgoing medical care because they couldn't afford their portion of the cost than to any reduction in real costs.(Seriati 2/23/2015)
quote:
even the administration is admitting that next year's price spike will be gigantic after the honeymoon period of bribing and buying the insurance companies wears off.( Seneca 4/30/2014)

My prediction at the top could have several interpretations, and not every data source goes back 50 years, but those I could find from 2015 point to a lower rate of cost growth experienced since the ACA was passed (including in the span between November 2013 and May 2015 as compared to the time before the ACA).

With respect to total health care costs for individuals, there’s one study from May 2015 that uses a methodology based on total health care purchases by consumers:
quote:
“Last year’s 5.4% growth rate was the lowest in the history of the MMI and stands out compared with 10 years ago when the three-year-average annual growth rate was approximately 10%. This year, the growth rate has again climbed, increasing to 6.3% in 2015, largely due to increases in prescription drug costs”
(link)

And even an article with a title as scary as “U.S. News Health Care Index Shows Massive Increase in Consumer Costs” supports the position that costs since Obamacare were passed are lower than the preceeding period:
quote:
“The agency projects the U.S. will spend more on health care during the next decade than during the recession, which began in late 2007, but that the rate of spending will be lower than from 1990 to 2008, when costs grew at an average of 7.2 percent each year, or 2 percent faster than the economy… Health care spending is now projected to grow at a rate of 6 percent per year from 2015 to 2023, or 1.1 percentage points faster than the economy, which is expected to rebound gradually”
[URL=http://www.usnews.com/news/articles/2014/09/26/whats-behind-the-slowdown-in-health-care-costs ]link[/URL]


quote:
In 2014, the Congressional Budget Office projected that premiums on policies bought in the marketplace would rise steadily to about $3,900 annually for a silver-level plan in 2015 to $6,900 a year in 2024. More recently, it’s less sure, and wrote in January that it anticipates it will lower its projections later this year.
link

quote:
An analysis from the consulting group PwC found premiums increased by about 5.4 percent across all 50 states in 2015, and by 5.3 percent in Florida, "a substantially lower rate of increase than had been the case in the pre-ACA years," said Jay Wolfson, a professor of health care policy at the University of South Florida. There is an expectation, too, that the increase in options in the marketplaces will encourage individuals to shop around and find cheaper policies.
link

Another angle on this issue is whether this government program is costing the taxpayers more than was promised (this may touch upon the comments of Charles in Charge and Seriati above - doesn't address them fully, but is perhaps peripherally relevant). I think Seriati was responding to me when he said "I can't believe you're still spouting the idea that this law is decreasing the deficit", but I have never intended to say that healthcare costs were cutting the deficit overall, I was arguing that they were cutting the deficit relative to what would have occurred without Obamacare, and later, relative to what was originally projected for Obamacare.The Wall Street Journal reports that regarding the costs to the government,
quote:
“the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010”
Wall Street Journal . (note: there are also intentionally misleading studies that take the original ten year period used for predictions and compare it to a different ten year period)

In fairness, I will note that there are some studies projecting the rate of cost growth to rise back to old levels of increase (the rate of cost growth appears to have increased more in 2014 than in the previous 4 years even if still close to 50 year lows), and there has been some unusual volatility in the monthly/quarterly data.

[ May 28, 2015, 12:12 AM: Message edited by: Greg Davidson ]

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Fenring
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Greg, since health care is one of the areas I'm least knowledgeable in I'll just ask you a question: Do you think there is (or ought to be) a correlation between the employment level in the U.S. and the amount spent (both privately and by the government) on health care costs? I'm not even sure how exactly this should correlate if it does, but would a high unemployment level potentially skew these figures? At present, for instance, there is a remarkably amount of full-time employment available in general, and many 'employed' people are in part-time.
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Greg Davidson
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Fenring, there's data on that as well - an anlysis at 538 suggests that a reduction in hours may have affected a small percentage of the workforce:
quote:
Taken together, the evidence suggests that the health law has likely led a few hundred thousand workers to see their hours cut or capped. That’s small in the context of an economy with 150 million workers. But it isn’t a minor issue for those workers. Most of them are among the economy’s most vulnerable: low-wage, part-time workers who likely have few other options.
538 link

But also note that the same article indicates that now that healthcare is not necessarily attached to full time employment, we are also seeing evidence of fewer people preferring to work full-time as opposed to part time - unclear if that accounts for some fraction of the several hundred thousand who have slipped below the 30 hours line.

There's also a May 2015 Rand Corporation study that notes the single biggest area of growth in insurance coverage is from employer-provided plans, which could be due to a combination of the growth in employment as well as an enhanced emphasis on health insurance, but at the same time let note some questions of that published result (despite the fact it might be considered pro-Obamacare) because other studies have not identified the same effect..
quote:
RAND researchers say the findings that the biggest gain in coverage was from employer-sponsored insurance runs counter to predictions that many employers may quit offering insurance in response to the Affordable Care Act
link
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Rafi
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The costs based on real world experience:
quote:
So the proposed 2016 Obamacare rates have been filed in many states, and in many states, the numbers are eye-popping. Market leaders are requesting double-digit increases in a lot of places. Some of the biggest are really double-digit: 51 percent in New Mexico, 36 percent in Tennessee, 30 percent in Maryland, 25 percent in Oregon.
The companies providing insurance under the exchanges are losing tens of millions. Why?

quote:
Since Obamacare went into effect, they're finding the insurance pool was considerably older and sicker than expected.
The death spiral is starting.
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yossarian22c
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The profits based on real finance reports of big insurers:

2014 Gross Profits
UnitedHealth Care Group: 37 billion up over 10% from 2013.
Aetna Inc: 15 billion up over 20% from 2013.
Cigna: 13.5 billion up over 20% from 2013.

Those are the first three I looked up. Is there any major insurer that lost money last year?

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Greg Davidson
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Rafi, above I provided data on what people actually paid on average, and the nightmare cost scenario that some predicted for May 2015 turned out to be false. . You are citing a statistic that at best refers to some insurers for some policies making a proposal to hike rates by an amount that the state insurance committees are likely to reject.
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Fenring
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Greg, I wasn't so much suggesting whether the new health laws may themselves have led to increased or decreased employment, but was rather asking after whether having an ever-decreasing amount of full-time work available might not be having an effect on the numbers you were inspecting above. In other words, if someone previously predicted X% increase in costs, although they didn't state it verbatim, predictions like this take certain constant factors as a given, such as rough population size, employment levels, and perhaps even the value of the dollar or other mechanical variations. If, for instance, employment plummeted by 3% over a few years, surely this would have an effect on the enrolment numbers for that year somehow without the change being a direct reflection on Obamacare. But at the same time if some social or economic factor was serving to increase enrolment in its own right (such as increased employment, etc) then that likewise should not be taken to reflect directly on Obamacare's success; maybe indirectly though.

It seems like a very complex problem to solve...

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Seriati
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I don't have much time today to respond, but cost is probably the single most difficult issue to parse accurately.

First there is little agreement as to what it's supposed to measure, a lot of what you're talking about are premiums for instance, which is a subsidized measure of price not actually cost. There's also deliberate confusion over cost per unit versus aggregate cost. And the add impact of tax increases and unfunded government spending.

Couple that with the amount of deliberate propaganda, and even the "official" measures like the CBO being required to run assumptions that are generated by politicians rather than the markets and the picture gets murky really quick.

For reference, my arguments have always been about the total cost, have specifically stated that price is manipulable and thus useless, and may have strayed in to per unit costs from time to time. I still maintain that there has been no decrease in cost based on Obamacare, and that in fact costs are rising as a direct result of the law.

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Greg Davidson
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Rafi, I agree that there are multiple factors driving outcomes, and Obamacare is just one of those factors. We should all remember that when we make predictions about the future. At the same time, when two sides in a debate make different predictions, and then actual events line up more closely with one side than the other, there is a higher burden for those whose predictions turned out wrong. For purpose of this exercise, as I said in the beginning, I was going to emphasize the most straight-forward explanations.

Also, you assert that there is a trend towards "an ever-decreasing amount of full-time work available", but one of the sources I just cited notes "the health law has likely led a few hundred thousand workers to see their hours cut or capped". It's unclear if this is an "ever-increasing" amount, and it certainly is a relatively minor effect in an economy of 150 million workers.

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Fenring
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quote:
Originally posted by Greg Davidson:

Also, you assert that there is a trend towards "an ever-decreasing amount of full-time work available", but one of the sources I just cited notes "the health law has likely led a few hundred thousand workers to see their hours cut or capped". It's unclear if this is an "ever-increasing" amount, and it certainly is a relatively minor effect in an economy of 150 million workers.

I didn't say that the ever-increasing lack of full-time work is related to Obamacare (although it may be, I have no idea). It's related to globalization, the economic crash, and technological innovation, and it will continue in this direction for the foreseeable future. I was just asking whether this trend will impact on your interpretation of cost and enrolment figures for Obamacare.
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Rafi
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quote:
Originally posted by Greg Davidson:
Rafi, above I provided data on what people actually paid on average, and the nightmare cost scenario that some predicted for May 2015 turned out to be false. . You are citing a statistic that at best refers to some insurers for some policies making a proposal to hike rates by an amount that the state insurance committees are likely to reject.

I'm citing real world numbers based in a full years actual data. The many changes in the law over the last few years have delayed the worst of it, not prevented it.

I agree that we will see the full implementation of fascism is the healthcare market as the state dictates prices. How long these companies can continue to bleed millions under the Onama regime's pricing is the only real question.

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yossarian22c
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Rafi, which insurers are you referring to loosing millions? The first three big insurers I looked up had large increases in profits for 2014.
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Greg Davidson
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Seriati,

I agree that there is uncertainty in the effect of Obamacare on total cost.

First of all, I have no doubt that costs will go up, because there is a 50 year trend of rising costs. There is a question of whether Obamacare makes the trend better or worse.

It could go either way. Normally, when you attempt to get more output out of a system (as in more health care services to people), it requires an increase in inputs. That is consistent with your position, and it is a very reasonable one. I have some optimism we might cut the rate of cost growth compared to the status quo with this particular system (American health care) because we are starting out from an unusually inefficient equilibrium (the US spends twice as much per patient as the next most expensive country and considerably more that twice as much as the average for developed economies that achieve similar or better health care results). On the other hand, we still retain our reliance on a for-profit healthcare model, and maybe that will wind up dominating the outcome.

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Greg Davidson
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Death Spirals - Part 5

quote:
No death spirals (Greg Davidson 11/18/2013)
quote:
a bailout/takeover will be necessary to keep Obamacare from bankrupting insurance companies especially when the young and healthy don’t fall for the scam (Cherrypoptart 11/28/2013)
quote:
Youth purchase of policies will lag 25% behind expected adoption of coverage for people aged 26- 35 (RedVW on a laptop 11/28/2013)
quote:
Insurance pools will have fewer insurer options as companies cannot acheive sustainable profit margins. Single provider will increase across additional medical care regions (RedVW on a laptop 11/28/2013)
quote:
28. Insurer maximums on dollar allocations will prove to be disasterous. Only the largest companies will be able to comply with the artificial horizon resulting in many regions having only 1 insurer availible in the pool. (RedVW on a laptop 11/28/2013)
quote:
29. Private insurance existing outside of the public pools will see an abandonment of the standard plan levels and show a strong migration towards private high premium low deductible Cadillac plans. Result forces most people into the public pools. (RedVW on a laptop 11/28/2013)
quote:
30. State sponsored pools of last resort collapse due to the expected elimination of most of the funds that provide states with budget shortfall coverage. (RedVW on a laptop 11/28/2013)
quote:
By the way, the death spiral ... They are not reaching near the number of sign ups for this needed to prevent that from happening.Not only that, of those that have signed up, it looks like only about half have actually paid the first premium that mean they actually have insurance - based on actual data from Washington State, Wisconsin and Minnesota and which conforms to previous estimates nationwide. We are very well positioned to actually see the death spiral occur. Something pretty dramatic is going to have to happen to prevent it - probably a insurance company bailout (G3 2/12/2014)
First, let me repeat my definition of a "death spiral", which may not be worded perfectly, but gets the idea across:

Death spiral = a higher share of those signing up for insurance are at risk of sickness than the insurers expect, leading to the need to raise premiums higher than anticipated, which pushes out more of the low-to-medium risk population, which leave the remaining pool of people as very high risk and thus very expensive, making premium costs prohibitive and thus exchanges collapse because insurers are no longer willing to participate at a reasonable cost. A key predictor of this in the debate was the percentage of the population who were younger, and thus at lower risk of high health care costs.

quote:
About 28 percent of customers during the 2014 enrollment period were ages 18 to 34. And there were 70 more insurance companies participating in the 2015 marketplaces than the previous year, according to data collected by the management consulting firm McKinsey and Company
link

And note that I have already shown in an earlier part that premium cost increases as of May 2015 did not go up to an enormous degree consistent with the death spiral hypothesis.

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Seneca
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quote:
Originally posted by Greg Davidson:
Seneca, I will lay out the predictions as you made them and we will all judge. For example, when you wrote that "many millions will lose their healthcare, lose their doctor and struggle to hit the reset button, start over and in some cases not sufficiently replace it in time or ever" (2/14/2014), we can look into quantitative data on how many lost their healthcare and doctor etc.

I am going to emphasize the most straightforward explanations, whether that makes my own predictions look better or worse (I included an example in part 1 where it rendered my prediction "wrong").

If you want to suggest a complex interpretation of the data to justify any predictions that you have made, you will be free to do so.

Tell us what you are willing to agree can't have been known by this time due to Obama's delays.

I'd prefer to find out if you are unwilling to acknowledge that before I put time into this.

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Greg Davidson
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Seneca,

I think that the biggest impact of delayed provisions is likely to be in regard to non-compliant policy cancellations.

There are also provisions of the ACA that escalate over time - the cost of the penalty for not having insurance is going to go up each year for several years. That might lead to more adverse effects over time, but all that was known when we made our predictions as to how things would be in May 2015.

But despite all the research that I have done, I don't know everything about delays. Here's a link to an anti-Obamacare website that list 50 "delays", 37 of which occurred after the start of this thread link Do you have specific provisions here that you believe will significantly change the findings I have reported on here, and are you willing to make a revised prediction accordingly?

Finally, if we do start looking at modifying the most straight-forward interpretation of these predictions, does that mean when we come to enrollment statistics that you will adjust actual results to add in all of the additional people who would have been covered by provisions of the ACA if not for the actions of state Republicans? It's the same principle for judging predictions that you are espousing, only it cuts the other way. Personally, I prefer the most straight-forward method because it is simpler and less ambiguous, but you can run this exercise fairly to both sides using either principle, as long as you are consistent both when it helps your case and when it harms it.

I hope you see this as a reasonable answer to your question, and I do hope you take time to engage in this discussion.

[ May 29, 2015, 02:08 AM: Message edited by: Greg Davidson ]

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