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For GOP: MNSure Is The Target - Solutions Are Not Wanted

Category: Health Care
Posted: 09/02/16 14:51

by Dave Mindeman

We are going to get another round of gleeful criticism of MNSure from the legislative Republicans.

But it is kind of ironic - they don't seem to understand the system well enough to focus on the actual problems.

Let's try to get this right. MNSure is not the reason that insurance premiums are increasing. Got that? MNSure itself has nothing to do with it.

All MNSure does is provide the marketplace for the insurance companies to allow the public to compare what they have decided to charge.

MNSure does have issues. It still has difficulty with technical problems. It has difficulty coordinating with Minnesota Care. It has long wait times to answer questions.

Those things are fixable over time. But insurance premium increases? That is a problem that is still rampant within the insurance system itself.

What did we want the ACA to do? What was its original purpose? It was to reduce the number of people that did not have access to health insurance. To relieve the burden on hospitals to deal with costs of helping those who did not have insurance. To provide government help with affordability.

The ACA is doing those things. I realize affordability has become a bigger issue, but the ACA still provides the subsidies that help the working poor get to affordable options. The ACA is doing its job - the original intent.

But blaming the ACA for having to deal with an insurance based health care system out of control is foolishness.

The biggest change in health care that is causing the current rash of crazy premium increases is the inclusion of people with pre-existing conditions. In the past, the major insurance companies have always developed ways to push them out - to force a government solution to chronic illness. Prior to the ACA, those people went largely uninsured or were thrown into inadequate catastrophic plans that still left them with unaffordable out of pocket expenses.

When the ACA became law, everyone was put on notice that denial of coverage would now be a thing of the past. The insurance companies had plenty of time to prepare and adjust for that coming issue.

But, as usual, they mismanaged it. Some of the companies set up unrealisticly low premiums hoping to capture a bigger share of the market and worry about the cost adjustments later. Some of the companies just completely misinterpreted the new risk pool. Most had the number of new entrants too low - forgetting how many people they had refused to accept.

At the very beginning of creating the new health care law, the ACA made concessions to the insurance companies in exchange for their participation. It was the only way to get such a broad and detailed piece of legislation through Congress.

But the insurance carriers have not held up their part. They refused to let the government negotiate drug prices. They blocked the addition of a public option. They demanded that the government make up the shortfalls.

And now, as everything kicks in, the insurance companies want more concessions.

If the insurance carriers are not going to make a competitive market, then we might as well have the government use a public option to take on what the insurance companies are reluctant to do.

That was the original plan and I suspect that if Democrats win control of the Senate and the Presidency that this will be on the agenda.

But let's get back to MNSure for a minute. The Minnesota Republicans are blaming all the foibles of the insurance market on MNSure. And if we are realistic, that is a stretch. MNSure is not the ACA - it only implements the requirements of the ACA. MNSure does not control the pricing structure - the insurance companies control that. MNSure does not write the policies - they only act as a go between for comparison.

Don't get me wrong - there are plenty of things about MNSure that need fixing, but the MN GOP is not talking about any of those. No, they are pretending that MNSure is to blame for all of our current health care problems - and that is simply not true.

Minnesota started this exchange because we wanted Minnesota to have some control over how Minnesotans would get access. The MNSure system had immediate flaws on technical grounds, but access is improving - although much too slowly.

However, eliminating MNSure would not solve the premium increases and the way the policies themselves are structured. That is outside of MNSure's jurisdiction.

But as far as Republicans are concerned it is a simple easy target. And if they can add confusion and complexity, hey why not.

The GOP is not going to help fix anything.

And quite frankly, that is the main problem here.
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In Dist 57 Senate- GOPer Cory Campbell Thinks It Is Him Vs. ACA

Category: Health Care
Posted: 09/02/16 02:03, Edited: 09/02/16 02:04

by Dave Mindeman

In District 57, the State Senate candidate is named Cory Campbell. He tweeted this on August 15th....

Cory Campbell ‏@Campbell4MN Aug 15
Lost job one year ago yesterday Running for Senate making sure gov't doesn't do to others companies what they did to my previous employer

Well, you say, sounds like there is a story behind that. OK, let's begin.

When Campbell announced that he intended to run against incumbent State Senator Greg Clausen, the local paper had him answer a questionaire...

Here is one of those questions:

SunThisWeek: Why are you running for state Senate?

Campbell: I am running for state Senate because government has gotten too big and too powerful and looks to control everything we do. I have personally been a victim of overreaching government. I had a position at Assurant Health (Time Insurance Company) which was in business over 100 years and within two years under the Affordable Care Act we were out of business. One million people lost their health insurance, over 5,000 lost their jobs including around 500 in Minnesota. We all had health insurance, company provided pensions, 401k etc. It is all gone due to the Affordable Care Act (Obamacare). It is not government's job to create winners and losers, but to create an environment which allows Minnesota businesses and families to expand and grow.

At first glance, that sounds like a terrible outcome. What happened? Well, let's look into the background of Assurant Health.

In a Milwaukee Journal-Sentinel article (about a year ago) we begin to get the picture. When the ACA became law, insurance companies needed to adapt. And many were not sure of the full effects.

However, Assurant Health had a business model that ran completely counter to the goals of the ACA.

Without question, the Affordable Care Act was certain to yield winners and losers, and Assurant Health was among the health insurers most vulnerable to the far-reaching changes imposed by the law.

Why, in particular, was Assurant Health most vulnerable?

It was because of how they developed their policyholders....

The biggest change was barring health insurers from withholding health insurance from people with pre-existing health problems. The task of screening people most likely to have medical claims -- those who are the greatest risks to insure -- is known as underwriting, and it was considered one of Assurant Health's strengths.

Assurant Health's success depended on denying people with expensive pre-existing conditions access to a policy. Essentially, they only sold policies to people in the lowest health risk categories. They were well known in the industry as being particularly good at finding the profitable clients.

Prior to the ACA, that was something that insurance companies were allowed to do. The uninsured were often the people with chronic illnesses or in vulnerable health situations. Assurant Health was particularly good at recognizing these high risk clients - and moving them off of their insured rolls.

But, once the ACA took effect, that denial of coverage was no longer allowed. Too many For Profit health insurers have not found ways to properly adapt to the new market. That is why premiums have been so volatile and many insurance carriers are moving out of exchanges.

And Assurant had additional problems....

Assurant Health also has faced other challenges. Unlike other health insurers, it doesn't sell insurance to large employers or manage their health plans. (Most large employers self-insure, paying most of the medical claims of employees and their families.) It also sells insurance in 41 states. As a result, it doesn't have a large presence in any one market.

More than likely, Assurant didn't get into large employer contracts because they couldn't use their strength - patient selection. With a large employer contract, they had to cover all of that company's employees.

And interestingly enough, Assurant sold policies in a larger number of states (something that Republicans think is a solution to replacing the ACA)....except that the broad nationwide marketing didn't focus and adapt to one particular market. They stretched themselves too thin.

Instead of negotiating contracts directly with hospitals, doctors and other health providers, Assurant Health pays Aetna to use its network. That, in turn, increases its costs.

Essentially, Assurant's business model is obsolete. To increase coverage of the uninsured, which the ACA was designed to do, these pre-existing condition exemptions had to go.

A Kaiser Family Health analyst and a Georgia State University professor summed it up this way:

"These companies (like Assurant) were more niche players," said Gary Claxton, a vice president of Kaiser Family Foundation and director of its Health Care Marketplace Project. Claxton was surprised Assurant Health tried to sell health plans on the marketplaces.

The marketplaces were designed to make it easier for people who don't get insurance through an employer to shop for health plans and compare prices, increasing competition among insurers. That puts health insurers with higher costs, such as Assurant Health, at a competitive disadvantage.

"They would be the poster boy for the type of insurance plans that were becoming increasingly obsolete and were made obsolete by the Affordable Care Act," said (William) Custer of Georgia State University. Assurant Health was skilled at managing risk, he said. The future is managing costs.

Assurant Health would still be in business if we allowed pre-existing condition denials to continue.

Maybe that seems unfair to Assurant Health - but then how fair was it to dump so many people with chronic illnesses out of coverage?

Assurant Health insured about 1 million customers. Cory Campbell says they "lost" their insurance coverage. Actually, they simply went to another carrier because, you see, these are the people that have the least problem getting new insurance.

Yes, the ACA may have put Assurant Health out of business; but a company that depends on pre-existing condition denials is not a business model that we want to protect anymore.

Cory has moved on to a new job -as a Financial Services Representative. Assurant Health is not in health care anymore, but I gather that almost all of those clients have found insurance in other places. Many probably used the ACA exchanges.

This is not a story about a regulatory system run amuck - rather this is a story of how health care in America has had to change in order for all of our citizens to have the opportunity to get access to health care.

I guess, in the end, it either about the need for universal care or the need for profit.
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The Myth Of Job Losses Via Obamacare

Category: Health Care
Posted: 03/20/16 23:20

by Dave Mindeman

I think it is time that we debunk something once and for all.

The myth that Obamacare is killing jobs just needs to end.

According to a report released in the journal Health Affairs in January from three researchers, the Affordable Care Act has had little change on part-time employment as of 2015. Even in a handful of subgroups where a shift (which the authors noted was negligible) of about 0.5% was witnessed from full-time employment to part-time (workers with high school diplomas and pre-retirees aged 60 to 64), researchers were able to explain this shift as nothing more than subgroups that were responding to subsidies offered via the individual exchanges. Since subsidies are tied to the number of hours worked (among other things), these subgroups appear to have voluntarily chosen to reduce their hours in order to obtain a subsidy. In other words, this wasn't a corporate maneuver to push employees into part-time work but a move made by (a negligible number) of employees themselves.

There are plenty of things to fix about Obamacare. And nobody argues with that. But this constant harangue about job loss via Obamacare is just not close to being factually accurate. People (and by people, I mean Republican talking heads) have distorted the CBO report on job hours to mean huge losses in jobs. Despite the fact that the report indicated exactly what the above report confirmed about part time work and despite the fact that we have monthly job gains of record length.

There is also evidence that if the Red States that have refused to take expanded Medicaid had opted to do so...that more jobs would have been created than already have been.

These are fabricated talking points and they need to end. Really.
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