Looking at Landrieu’s plan

As a political matter, I understand the desire for Democrats to get out of the way of pissed off middle class people who actually have to pay a little more to get good health insurance that actually pays out.  As a policy matter, I really don’t care that there are some losers in a political process.  However politics creates the contours of policy and 50 Senate Democrats on Jan. 5, 2015 creates much better policy outcomes than 47 Senate Democrats.

Sen. Landrieu has an elegant work-around to the matter that individual insurance policies are getting cancelled.  Here are the major points:

  1. Date change of grandfather status from day of PPACA being signed into law to 12/31/13 for individual only plans.
  2. No new enrollment allowed into individual plans
  3. Insurance companies must continue to offer grandfathered plans until no subscribes elect to renew
  4. Currently covered individuals on newly grandfathered plans are Exchange and subsidy eligible.
  5. Annual renewal notice stating that the insurance being bought is crap insurance.
  6. Cancellation notices that require actual reasons with relevant citations for cancellation — ie not “Obamacare made us do it”

This is an elegant kludge that nicely gets around the political problem without causing long term damage to Obamacare’s risk pools.

The key item as to why this is not serious damage to the risk pooling mechanism is point #2.  The individual insurance market is a high churn market.  People get on it for short time periods until something better comes along through either group policies or government programs in most cases.  With the introduction of Exchanges and subsidies, the universe of “something” better has gotten larger and more accessible to more people.  As long as the newly exempted risk pool are only current enrollees in non-compliant policies, natural churn will quickly make these plans uneconomical.  For instance, the work that I do for my company is scale invariant — the same task that impacts eleven members takes the same time as an identical task that impacts fourteen thousand members, but my costs are spread out to either several dollars per member or fractions of a penny.  And at that point, point #6 comes into play and the health plans will have to either say the plans are uneconomical at which point the remaining young and healthy people move to Exchange risk pools or explain in a seven step process how the Landrieu Amendment forces cost amortization over decreasing population bases and thus blame Obamacare.  If that is the case, the Exchange risk pool does not improve as numerous previously young invincibles keeled over from boredom.

If this passes, the risk pool is a little bit older, and a little bit sicker than it would otherwise be in the Exchanges.  That is okay,  there are numerous risk and cost transfer mechanisms built int the law.  A slightly sicker and more expensive risk pool in 2014 that normalizes as the grandfathered individual plans lose members in 2015 and 2016 would work out fine.  The subsidy costs would still come in massively below initial CBO estimates.

The key is to the policy change is whether or not the grandfather plans are allowed to enroll new individuals.  If they are not, it is a tweak to provide political cover without damaging the underlying law.  If new enrollees are allowed, it is a full fledged flanking attack on the law.

 

109 replies
  1. 1
    David22 says:

    Shiny!

  2. 2
    MikeJ says:

    This is an elegant kludge that nicely gets around the political problem without causing long term damage to Obamacare’s risk pools.

    Some people believe that all laws should always be clear and straightforward without exceptions (or “loopholes” as they’re called when they apply to other people). People also want to design software the same way. For both software an law, it may work ok until you have to deal with the external world. At that point you start kludging in fixes. Finding a way to work with the real world doesn’t make your system “bad”, even if it does make it impure.

    Until now I never thought about the similarity in corner cases in software and the saying “hard cases make bad law.”

  3. 3
    David in NY says:

    @MikeJ: I think people would understand this as an “Obmacare patch.” Just give the patch some inscrutable number, and you’re good to go.

  4. 4
    Felinious Wench says:

    Fine with me if it will get people to just shut up. If the whiners want their crap insurance, let ’em have it and accept the risk. But I don’t want to hear one word from any of them when it turns out their insurance is crap and they end up going bankrupt with medical bills when they have a crisis.

    Not…one…word.

  5. 5
    Johnnybuck says:

    Seems like a fix for a temper tantrum for the most part, which is why Ol’ Grover called it a mandate and refuses to support it, which means it won’t go anywhere.

    But it seems reasonable enough

  6. 6
    Mike R. says:

    I’m pretty sure that the only component that inspired the furor is the cost of a plan. Even if the plans are grandfathered with all the limitations but the price goes up on them then attacks continue. I continue to believe that most people have no idea of their current coverage vs. coverage through the exchanges but they do know how much each one costs. Also the lid on Pandora’s box would be cracked for all kinds of mischief.

  7. 7
    jl says:

    Thanks for very timely and informative post. I was wondering whether the Senate Democrats had good ideas for fixes, or were going to start dismantling the reform (perhaps unwittingly). Sounds like good news if something like Landrieu’s plan gets passed.

  8. 8

    Insurance companies must continue to offer grandfathered plans until no subscribes elect to renew

    And what if the states don’t want those plans to continue to be offered? Does this supersede the authority of states to eliminate those crap policies?

  9. 9
    Chris says:

    @Felinious Wench:

    Neither do I, but you know it’s going to happen. From now on every idiot who kept his shitty plan, once that plan turns out to be shitty, will blame Obamacare, and the Village will carry that message far and wide. Don’t ask me how, but they’ll find a way.

  10. 10
    NCSteve says:

    But, but, but . . . a tiny handful of white middle class people who managed to be lucky enough to be able to constitute a good one person risk pool are losing, and that’s the only thning that matters.

  11. 11
    NCSteve says:

    But, but, but . . . a tiny handful of white middle class people who managed to be lucky enough to be able to constitute a good one person risk pool are losing, and that’s the only thing that matters.

  12. 12
    jl says:

    @Felinious Wench: I agree, but the thing seems to have become a political issue we have to deal with. I don’t see how Obama lied or was misleading at all.

    If I had an aged doc, and Obama said I could keep my doc, and my doc retires, can I get myself on TV to whine that Obama lied? Looks like I have a good chance.

    I read someplace (here, maybe?) that some of these plans were being peddled after the ACA was passed and insurance companies had a good idea how things would play out. They were thinking they could squeeze one last dime out of dupes, or people that had no other choice for a few years?

    Sean Baker at his Beat the Press blog has some recent posts calling BS on the issue, and I agree with Baker completely.

  13. 13
    hoodie says:

    A fine idea, especially considering the source. Which is why what Bill Clinton said may have been a trial balloon, not a stab in Obama’s back. This bill could put the GOP in a bind. They have a Trojan Horse alternative, but they’d never get that through the Senate and past Obama with this more straightforward alternative out there. The House GOP will have to pass it or explain why they don’t want to let people keep their wonderful plans.

  14. 14
    Elizabelle says:

    John Cole bait: top of NYTimes website: headline under solemn picture of this critter, lit from above:

    Seeking the Center, Senator Breaks Ranks.

    Yup. It’s who you think.

  15. 15

    OK, this one… sounds like a good tweak that actually makes the law better, on the whole.

  16. 16
    humanoid.panda says:

    Off, or perhaps on topic: according to Ezra Klein, there are 1.5 million people who completed the ACA application, but did not choose an actual plan. This seems to be like an enormous piece of news no one is talking about, no? If I understand it correctly, this mean that there are more than more than one million people who 1) got through most of the process online despite the tech crash, and 2) are interested enough in health insurance to shop 3 to 6 months ahead of time. Am I getting this right?

  17. 17
    geg6 says:

    However elegant it may be, it’s dead in the water. First, Grover Norquist has come out against it. But it would be dead anyway because it it’s something that fixes a problem with the ACA, you know Boehner and Co. will never let it hit the floor.

  18. 18
    EconWatcher says:

    First, Cole is to be commended for recruiting you to this site; you’re very helpful, and I appreciate it.

    Second, it strikes me as absolutely essentially to offer a reasonable fix for this before we hit the next debt ceiling, or else the alignment of forces and public opinion could be very different when the next act of extortion against ACA is attempted.

    You can reasonably argue about whether the cancellations are a real problem or just a political and perception problem. But for purposes of the next debt celing fight, that’s a distinction without a difference.

  19. 19
    raven says:

    @geg6: Ding, we have a winner in aisle 17.

  20. 20
    EconWatcher says:

    @geg6:

    From a purely political point of view, it may not be so important that this can actually pass. It’s just important that Dems are offering a reasonable fix, and that it be perceived that way, so that the next attempt to kill ACA by extortion on the debt celing will be seen for what it is.

  21. 21
    Mandalay says:

    @MikeJ:

    Finding a way to work with the real world doesn’t make your system “bad”, even if it does make it impure.

    Exactly right. In fact if the real world scenario that you are addressing is complex then a “pure” solution is almost certainly inappropriate, both with software and with law.

    A while ago Republicans were arguing that folks should be able to send in their tax return on the back of a postcard, even though Congress has created a gazillion rules associated with filing tax returns. Sure they had a “pure” solution, but it was mindless because it didn’t reflect the real world. They might have had a point if they had concurrently proposed the abolition of deductions for kids, mortgages, medical expenses, investments and charitable donations, but I don’t recall them doing that.

  22. 22
    catclub says:

    @👾 Martin: “natural churn will quickly make these plans uneconomical.”

    This and your point seem to make two poison pills ( ha!) that the insurance companies will hate intensely, and so kill the law before it is born. If that is the intent, Mary Landrieu is MUCH smarter than I thought. Since she has been re-elected in LA as a Democrat, she may just be that.

  23. 23
    Chris says:

    @jl:

    I also think it wouldn’t have been a good idea for Obama to go into all the “unless,” “however,” “what I mean is” complexities back when he was making the case for the ACA instead of the blanket “you can keep your insurance plan.” When you start explaining subtleties, people’s eyes start glazing over, and Republicans start to use the caveats to drive the fear campaign up several more notches.

    Like this:

    “Now yes, if you have an awful plan that doesn’t cover anything, the ACA might force that one out of business…”
    “SEE! SEE! And WHO decides whether your plan is worthy or not? OBAMA, that’s who! DEATH PANELS! COMMUNISM!”

    “Look, insurance companies might decide to retire your plans or jack up insurance rates, but – ”
    “Ah HA! UNCERTAINTY in the markets! Your socialist plan IS creating it! And consumers are paying the price!”

    Outlining all the caveats wouldn’t have done him any good and would probably only have given the Goopers more ammo.

  24. 24
    Stan Gable says:

    This is an elegant kludge that nicely gets around the political problem without causing long term damage to Obamacare’s risk pools.

    But it’s also pure downside for the insurance companies, right? These plans don’t bring in much revenue individually and only make sense because they come with very little risk. From my understanding, they’d mostly continue to get similar revenue numbers but the risk would continue to build until they were taking an absolute bath on the limited number of them that were leftover.

    Right?

  25. 25
    Redshift says:

    @Mike R.: As I said in the last thread, the only thing anyone “likes” about an insurance plan is the price. In every case I’ve seen where there’s been a media frenzy about someone losing their beloved coverage, if it turns out there’s a cheaper plan on the exchanges their reaction is “great!,” not “but I like old my insurance!”

  26. 26
    catclub says:

    @EconWatcher: “to offer a reasonable fix ”

    Medicare enrollment. See the previous post and thread.

    An expansion of medicare by a few million over the US is probably not hard.

  27. 27

    imma put this here:
    Joy Reid ‏@TheReidReport 13m

    More data: 975,407 “no people” have created profiles but not picked a plan as yet, and 396,261 have been found eligible for Medicaid or CHIP

    BUT BUT TEH WEBSITE!

  28. 28
    Tone in DC says:

    However elegant it may be, it’s dead in the water. First, Grover Norquist has come out against it. But it would be dead anyway because it it’s something that fixes a problem with the ACA, you know Boehner and Co. will never let it hit the floor.

    Grover can jump in the damn Potomac. If the current doesn’t get him, then the cold will.

    As for Boehner and the rest of Clown Caucus, they won’t be able to say no fast enough. No argument, there.
    I can only hope that Grayson, Grijalva or Pascrell can find some live microphones quickly to show that, as usual, the g00pers are the problem. The few dems who are sick of the unprecedented obstruction have been cutting loose on camera more and more often, as of late.

  29. 29
    EconWatcher says:

    @catclub:
    Not sure I get it. Medicare for everyone might have been a better alternative to Obamacare, but it wasn’t in the cards. Wouldn’t it seem arbitrary to offer Medicare to just a group of people who would have been grandfathered under individual plans, but got canceled? How would that sound fair or tailored to the particular issue?

  30. 30
    catclub says:

    The more I look at those points in the Landrieu plan, the more I think they are poison pills to get the insurance companies to hate any changes to the ACA.

    This was brought up on NPR this morning. The insurance business no longer has the time to quickly switch gears, and any rapid change will be something they will hate.

  31. 31
    Fair Economist says:

    I like Landrieu’s plan. It’s 7 weeks to Jan 1 – with the site troubles, it’s very unlikely all these people would be able to get coverage in time. Access to healthcare/ health insurance is properly a right, including for folks who already have insurance. They should NOT be forced into a lapse of coverage, or even into having their holidays ruined trying to find insurance at the last minute. It doesn’t endanger the long term success of the exchanges at all – most of the exchange candidates are currently uninsured, and insurance company churn will drive the rest onto the exchanges in a few years tops. And it will, properly, make it clear than the insurance companie are the cause of people’s insurance problems.

  32. 32
    a hip hop artist from Idaho (fka Bella Q) says:

    It does sound like an elegant kludge, which is why I have little hope for its passage. Clearly it’s an issue with a new debt ceiling circus coming up.

    @raven: Hey man, I hope your bday was a good one. I left a couple wishes in dead threads Sunday.

    PS, sorry eemom, I had to omit the “of” just for you.

  33. 33
    catclub says:

    @EconWatcher: I said nothing about fair.
    I think the previous post was asking for a simple solution for that particular group of noisy crybabies.
    I proposed one.

    If there is anything that the government can be, it is arbitrary, so I do not see that as a bar to it.
    The government does have the website and apparatus to enroll an extra 1 or 2M people in Medicare.

  34. 34
    cleek says:

    since none of them will pass, plans for fixes or patches or adjustments only add fire to the discontent.

  35. 35
    EconWatcher says:

    @cleek:

    I’d sure rather be able to say that we have a simple fix to a narrow problem, that the Republicans are obstructing, than to say we got nothing, and tough luck to all those whose policies were cancelled and are now in the spotlight. Wouldn’t you? Because you know they’re going to offer a solution at the next debt-ceiling fight; their solution will be to defund or repeal Obamacare.

  36. 36
    cmorenc says:

    But what happens in the conference committee when Landrieu’s bill passes the Senate (assuming the ReThugs don’t filibuster it) and the House passes it’s bill to nominally do a similar thing (although substantively their bill is designed as sabotage rather than as any true bone fide fix)? Well, Boehner may not even be willing to agree to any conference committee at all, figuring the posturing of having passed a bill in his house gives more political benefit than actually doing something with less political risk, but one of the things the Obama admin and Senate dems risk in a coference committee is coming under pressure to pass out a rather odd duck hybrid that is counterproductive to the ACA’s purposes.

  37. 37
    Richard Mayhew says:

    @Stan Gable: At which points the insurance company cancels the plan because it is uneconomical to keep a plan design that has eleven enrollees in it. This is a 3 year kludge

  38. 38
    JGabriel says:

    Richard Mayhew @ Top:

    This is an elegant kludge that nicely gets around the political problem without causing long term damage to Obamacare’s risk pools

    Can’t say I like Landrieu’s bill, but thanks for confirming what I’d already begun to suspect: that it won’t in fact do that much damage. I think most of the people who were losing their plan will select an exchange plan anyway, once they realize they can get much better coverage for not much more money.

    That said, I think the Landrieu plan needs one more constraint. The Annual renewal notice stating that the insurance being bought is crap insurance should also include information on the pricing and better coverage options available from the exchange — so that customers will know what their options are. Otherwise, I’m afraid that some insurers might take advantage of the crappy grandfathered plans to save on payouts without letting their policy holders know specifically which better options are available, and at what prices.

    .

  39. 39
    rikyrah says:

    nothing but a bunch of punk ass muthafuckas.

    plain and simple.

    they remind me why they make me sick on a regular basis.

  40. 40
    retr2327 says:

    An interesting note on the politics of this proposal from (of all people) Erick son of Erick, etc. (via Weigel). See Weigel for details. Short version: he fears that the house will pass some Repub version; the Senate will pass Landrieu’s, and substitute it in place of the House bill; and the Senate will then send that passed bill back to the House, forcing the Repubs to either pass it or vote against a fix to the problem they are having such a good time screaming about. .

    Which means, of course, that I hope he’s right . . .

  41. 41
    boatboy_srq says:

    @David in NY: Obamacare v1.3.2009955823.

  42. 42
    imonlylurking says:

    @JGabriel: I would add another piece: if you buy this grandfathered plan which is known to be crap and you have a major medical expense that your insurance does not cover (because it is, afer all, crap)-you do not get to file medical bankruptcy. If you really want to go with some cheap pos then do it. Just don’t expect to dump your medical costs onto the rest of us. (Can you tell I’m tired of hearing my bosses-two upper-middle class white males, tea party/libertarian types, whine?)

  43. 43
    Richard Mayhew says:

    The @JGabriel: the propsal would include a pointer to the Exchanges

  44. 44
    KXB says:

    My agent just came by my office, and he walked me through the Blue Cross Blue Shield of Illinois site. It took less than 10 minutes to enroll. A couple of weeks ago, he showed me how to look at different Blue Cross plans, and I spent weeks going over details.

    In sum – my new plan is better, on paper. It is $100 less per month, which balances out against my deductible going from $1,000 to $3,250. But after that, they cover 100%, versus only 80% of my current, cancelled plan. My office visits will be $30, which can be applied towards the deductible.

    I asked my agent what he thinks the future holds. He was skeptical that it would last in its current form. A number of his older customers are wondering why their plans must have maternal care as part of the package. Plus, the more people hear about companies getting waivers or delays, he thinks individuals will clamor for the same.

    I’m still wondering why the focus is just on the website. You can shop for ACA compliant plans on almost every private insurance company’s website. Or, just look up an insurance agent to handle all the application stuff for you.

  45. 45
    Chris says:

    @imonlylurking:

    I would add another piece: if you buy this grandfathered plan which is known to be crap and you have a major medical expense that your insurance does not cover (because it is, afer all, crap)-you do not get to file medical bankruptcy. If you really want to go with some cheap pos then do it. Just don’t expect to dump your medical costs onto the rest of us.

    In a just world, voting Republican would be an immediate disqualifier for receiving any kind of government service. You want your Randroid/Paultard utopia? You got it. But no roads for you, no police protection for you, no clean water for you, no safety regulations for the food that you eat, no safety net at all if you fuck up. You’re always telling us how much you could shine if the government got out of your life. It’s out of your life. Now go live in your cave.

    Alas, that is simply not practical for all kinds of reason. But damn, it’s a thought.

  46. 46
    What Have the Romans Ever Done for Us? says:

    @geg6: Yeah, but the point is it puts them on the defensive. They kill it and then the Dems can say they tried to be reasonable and fix the problem for people who want to keep their insurance but the republicans said no. And, the original law is still in effect so people get health insurance.

  47. 47
    Omnes Omnibus says:

    So it would allow the people who want to keep their crap insurance to keep it while forcing the insurance companies to tell them it is crap? At the same time, it would allow Democrats to say they are continually working on improving the law and force Republicans to either vote for it and piss off the Tea People or to vote against it and be on record yet again as pure obstructionists. Sounds reasonable to me.

  48. 48
    What Have the Romans Ever Done for Us? says:

    @KXB: The focus is on the website because what’s bad for Democrats is the big story.

  49. 49
    Aimai says:

    @retr2327: this sounds really familiar. For once im loving landrieu. Sounds like shes jacking the house republicans up against the crazy caucus.

  50. 50
    les says:

    I assume the plan has to get through the whackjob House, and, as an improvement to the hated O’BummerCare, doesn’t have a prayer of happening. As kludge goes, it’s almost elegant.

  51. 51
    KXB says:

    @What Have the Romans Ever Done for Us?:

    I expect that from the press, but why is the Obama administration so flat-footed in pointed out other avenues to enroll?

  52. 52
    piratedan says:

    play it off as “we’ve heard your voices and we’re doing what we can to make this transition as easy as possible” and then let the R’s hang themselves again.

  53. 53

    Ok, enrollment numbers are low, but promising:

    106,185 signed up and picked a plan. 79,400 were from state exchanges, 35,400 from CA alone.
    975,500 have submitted applications but not picked a plan. Basically, these people are still shopping.
    396,261 have gotten eligibility for Medicaid and/or CHIP.

    That’s all through Oct 31. That’s not great, but it’s encouraging. It’s about 1.1 million people either done or in process.

  54. 54
    Capt Seaweed says:

    @geg6:

    This fix will hit the floor like a dead cat because it has the potential to fix something the other side doesn’t want fixed. Ever.

  55. 55
    boatboy_srq says:

    @Mike R.:

    I continue to believe that most people have no idea of their current coverage vs. coverage through the exchanges

    @JGabriel:

    That said, I think the Landrieu plan needs one more constraint. The Annual renewal notice stating that the insurance being bought is crap insurance should also include information on the pricing and better coverage options available from the exchange — so that customers will know what their options are. Otherwise, I’m afraid that some insurers might take advantage of the crappy grandfathered plans to save on payouts without letting their policy holders know specifically which better options are available, and at what prices.

    This is key. And it goes right back to how the insurance industry has been eating everyone’s lunch for decades. When I read the posting I misread “The individual insurance market is a high churn market” as “The individual insurance market is a high chum market” and thought to myself “insurance sharks in the water – how appropriate”.

    There’s also an almost-deliberate incuriosity at work here as well: so many folks are too used to going to their insurance agent and buying what they’re told to buy: all this Website and choices and decisions are new and scary. Some of it is no doubt from the change required, and some of it comes from going to [gasp] a public resource instead of the Highly Paid Professional to whom they’re used to delegating the number-crunching – and who’s been getting rich off their ignorance all this time.

    Insurers certainly aren’t helping themselves here, either. A friend learned just the other week that his employer was going to an all-HSA-based employee health plan option because Obamacare!!!11!1! and some fairly direct questions for the insurers just weren’t asked – and couldn’t be answered by the insurers reps when the change was announced. They’re feeding the panic, both in the individual markets and the business ones.

  56. 56
    Gypsy Howell says:

    Thank you for the explanation Richard. I think my blood pressure just went down a bit reading it.

  57. 57
    Davis X. Machina says:

    I don’t see a bullet point for restoration of our freedom™.
    Never mind massive increases in freedom™.
    Because it is all about the freedom™, right?

    (Freedom™ is a registered trademark of the Republican National Committee. Used with permission. All rights reserved)

  58. 58
    kindness says:

    I’ve read elsewhere that Landrieu’s plan still will undercut the ACA.

    So I’m not sure what to think other than I don’t think good things about Democrats in Congress running scared.

  59. 59
  60. 60
    piratedan says:

    @kindness: well it would be novel to see the Senate actually helping the President for a change

  61. 61
    Omnes Omnibus says:

    @kindness: Unless one is going to argue that the ACA is a perfect solution as it stands (and I seriously doubt anyone ever argued that), it will be modified over time to fix problems, to extend care, and so on. It turns out that ACA has a problem; some people like their crappy insurance. They probably like it because they are ignorant, but they like it. It is creating a political problem. This bill should take that political problem off the table. Democrats look like they are listening to constituents while still supporting the ACA.

  62. 62
    kc says:

    Richard, if you’re reading, any comment on this? http://www.balloon-juice.com/2.....nt-4708370

    This, if true, is . . . unnerving.

  63. 63
    jefft452 says:

    @Aimai: “For once im loving Landrieu”
    Agreed, our current crop of conservadems are a whole lot better then the past versions

  64. 64
    pseudonymous in nc says:

    @boatboy_srq:

    so many folks are too used to going to their insurance agent and buying what they’re told to buy: all this Website and choices and decisions are new and scary.

    Or not going to an agent at all. Honestly, this is where the civilised world’s models would have made sense, where the choices and decisions are basically around the margins, or at most about network preference.

  65. 65
    burnspbesq says:

    @Tone in DC:

    Grover can jump in the damn Potomac.

    There are things I’d like to do to Grover that go far beyond anything even Villago could dream up.

  66. 66
    Mandalay says:

    Only partially OT, the Rolling Jubilee project has come up with an elegant solution to assist those suffering from massive medical debts

    Across the United States, 2,693 people have received a letter in the last few months, which identified a debt and read: “You are no longer under any obligation to settle this account with the original creditor, the bill collector, or anyone else.” This is the work of the Rolling Jubilee project – a non-profit initiative which buys personal debt for pennies on the dollar in the secondary market (where debt is sold to companies who then resell it to collection agencies) but then simply cancels it.

    YMMV, but I think that’s just beautiful.

  67. 67
    K. Walker says:

    Hi,
    I’m really curious about how the increased access to healthcare will be met. I’m a nice American up here in Canada working in health policy. Canada lets in hundreds and thousands of internationally educated healthcare professionals (physicians, nurses, physiotherapists, occupational therapists, etc) and then prevents them from practicing in Canada. Sort of a Damocles sword over the Canadian born, so to speak. It does seem a shame that healthcare workers are left basically unemployed, or at best under-employed, when there will be lots of new patients in the US. Surely the US universities and medical schools will not be able to crank out enough health care workers to meet the new demand? How can Canadian immigrants (seriously-thousands of IMGs are practice ready) benefit from this. I’m so fed up with how badly they have been treated. If anyone can enlighten me, I would appreciate it!!

  68. 68
    Suffern ACE says:

    4.Currently covered individuals on newly grandfathered plans are Exchange and subsidy eligible.

    What does this mean anyway. Doesn’t this mean that any plan that is grandfathered in is ACA compliant? So if you were one of those people who has a crappy plan, it is now considered to be compliant? Are we going to be subsidizing bad plans?

  69. 69
    catclub says:

    @Suffern ACE: NO. It says “covered individuals ” are eligible.
    So they can switch to the exchanges. It should NOT mean they can get the subsidy and keep theri old crap plan.

  70. 70
    Chris says:

    @Mandalay:

    YMMV, but I think that’s just beautiful.

    That’s putting it mildly. If I ever had anything against the OWS crowd, this cured it.

    The beautiful irony of it? This is that “private charity” that wingnuts, especially the teabangelical kind, are always whining that they’re all about. Or would be, if their taxes weren’t so damn high or charities weren’t so damn liberal or the dog didn’t eat their homework. Only instead of talking about it when they’ve got a government program to tear down and then forgetting all about it, the Dirty Fucking Hippies are actually doing it.

    Your move, teabaggers. Go ahead, do something worthwhile for once in your miserable lives. I’ll wait.

  71. 71
    NObama says:

    @Felinious Wench: AGREED!! If people still want that Obama garbage with doubled deductibles and much higher costs while allowing some government buffoon to dictate how they live their lives then so be it!! And I don’t want to hear anything from those obamabots either, not a peep. Let the obamacare tax do them in.

  72. 72
    dp says:

    I admit I’m impressed. When my senior senator announced this, I assumed it was going to completely undermine ACA (the way so many of her ideas undermine even the mildly liberal ideas that escape the Democratic party). I have to say that I’m proud of her.

  73. 73
    piratedan says:

    @Mandalay: we actually had a whole morning thread on this yesterday… but I think that it can’t be promoted enough, tangible results for real people. Just a shame that so many people are out there that need this post our former “national health care system”

  74. 74
    Omnes Omnibus says:

    @Mandalay: The only potential problem I can see with this is that cancellation of debt is considered income under the tax code. These people may get hit by a big tax bill on this at some point. Obviously, a (pulling numbers out of my hat here, so don’t read anything into them) $25,000 tax bill is much better than an a $750,000 medical bill, but that aspect is still there.

  75. 75
    retr2327 says:

    @KXB: I could be wrong here, but my general impression is that you have to go through the website to qualify for the subsidies; direct purchases from the insurers don’t get subsidized.

    Anyone with better knowledge care to chime in on that?

  76. 76
    cckids says:

    @Felinious Wench:

    But I don’t want to hear one word from any of them when it turns out their insurance is crap and they end up going bankrupt with medical bills when they have a crisis.

    A-fucking-Men

  77. 77
    Gretchen says:

    This came with my company’s health plan information this year:
    “In addition to the regular challenges of high claims cost and medical inflation that we face every year,we are now burdened with additional taxes and fees imposed on the Plans by the Affordable Care Act. The taxes and fees that ACA is charging on our Plans in 2014 are almost $100,000. These taxes and fees are scheduled to increase every year.” True, or the views of the head wingnut? The company is privately owned and employs about 600 people. They increased the deductible this year but the cost is the same as last year, which hasn’t happened in many years.

  78. 78
    Kent says:

    In point of fact, there are probably dozens of relatively minor problems with how the ACA was written that eventually need to be fixed with legislation of some sort. I don’t think this is one of those problems but that is neither here nor there. Serious Democrats should actually take something like the Landrieu bill and amend it to actually fix some of the real problems with the ACA. The whole thing will be shot down by the house anyway, but at least Senate Dems will have been on record as voting to actually improve the law rather than this sort of gutless political farting around.

    In any event, with the pace at which this Congress passes legislation, it will be 2025 before they actually get around to trying to fix anything within the ACA.

  79. 79
    KXB says:

    @retr2327:

    That might be true. I did not qualify for subsidies anyway. But, I am saving $100 month in premiums.

  80. 80
    MattR says:

    @Omnes Omnibus: They say that they have had tax lawyers look into it and there will be no tax implications for the debtors who are now out of debt. They claim “forgiveness of the debt does not result in income to the debtor if that forgiveness comes from a detached and disinterested generosity. Lion said these debtors seem to have a good case that they’re receiving an exempt gift rather than a taxable gain.Mayer agreed, saying the debt forgiveness counts as a gift under section 102. He said that when Rolling Jubilee buys the debt, it doesn’t know who the beneficiaries are but discharges the debt purely out of a desire to benefit those who incurred it.”

  81. 81
    Citizen_X says:

    @Omnes Omnibus: According to their website (see the FAQ), no. They set this up with a team of attorneys, who

    have thoroughly researched the tax implications and do not believe that beneficiaries are obligated to pay taxes on debts the Rolling Jubilee abolishes in this manner. It is the Rolling Jubilee’s position that it is making a tax-free gift to the people whose debt it is abolishing.

    See Mandalay’s link.

  82. 82
    hitchhiker says:

    I would bet a bucket of your favorite anything that Mary Landrieu was working with the White House to craft this very reasonable fix.

    She needs to look like a problem solver.
    She needs to be able to say she took on the White House.

    Obama does not need chops, at this point — but the senators up for re-election definitely do. And he needs them to win in order to have any hope for getting things like judges appointed done between now and January 2017.

    Also, it really is an okay to thing to do. I love that it would require insurance companies to say exactly what it is that the ACA requires that their wonderful policy doesn’t provide.

  83. 83
    Foxhunter says:

    I know it’s late to this post, but I think ML’s ideas are satisfactory and really not that unusual, at least from the perspective of another insurance market.

    Auto/Home/Boat insurance (personal lines, in insurance speak) is written on paper under a set of rates that is deemed ‘acceptable’ by state regulatory agencies. When the overall performance of a particular ‘book’ of business begins to sour, companies try their best to either raise rates or ‘close the book’.

    Raising rates requires regulatory approval (for the most part) and closing a book grandfathers existing policy holders and prevents new policyholders from entering that book. It stays this way until the last policyholder exits the book, then it’s forever mothballed.

    Aside from politics/optics, I fail to understand why this is not an amenable solution to the ‘keep your plan’ problem, but then again I’m not well versed in health insurance regulatory mumbo jumbo.

  84. 84
    Irony Abounds says:

    Two points:

    1. It won’t pass the House, but at that point it will be Republicans that are preventing the plans from continuing not Obama.

    2. Everyone keeps saying that all the cancelled plans are crap plans. That is NOT the case. I have an HSA Plan that covers me and my daughter with an annual out of pocket limitation of $12,000, which is not unlike Bronze Plans that qualify. It is not grandfathered in (and even if it were, Blue Cross would simply make some changes and poof it’s gone), so it goes away come January 1. It’s is by no means a crap plan like those with a $25K deductible and $25K in coinsurance. It has worked fine for me, is approximately $150 a month cheaper than anything I can get on the Exchange (assuming HealthSherpa’s numbers are correct – I still haven’t been able to get my application accepted on the website or over the phone so I haven’t seen the official prices), and my preference would be to keep it. While many cancelled plans may well be crap, not all are.

  85. 85

    Wouldn’t it be better to fix the PPACA cost issues? I don’t think there would be many objections if the cancelled plans were replaced with reasonable plans at similar costs. The problem is that many people are facing financial hardship because of the requirements of the PPACA, not that people want to keep their junk insurance.

  86. 86
    Omnes Omnibus says:

    @MattR: @Citizen_X: Until the IRS takes takes a position on it, I still think the possibility is there. Nevertheless, I think it is a great thing even if there are negative tax implications down the road.

  87. 87
    cckids says:

    @KXB:

    A number of his older customers are wondering why their plans must have maternal care as part of the package

    That is getting on my last nerve. It fits perfectly with all the olds who retire here to S.NV & then try over & over to get their communities exempted from the portion of property taxes that go to schools, because they don’t have kids here.

    The ignorance combined with the bare-faced selfishness just infuriates me. I want to tell them, “ok, we’ll take maternity care off your policy. You can be in a risk group JUST WITH PEOPLE YOUR OWN AGE”. Guess whose health care expenses will be higher, assholes.

  88. 88
    PopeRatzo says:

    @humanoid.panda: No, you don’t have it right. The people in the states who signed up (50k in Colorado, for example) didn’t go through the healthcare.gov site to sign up.

    Problem is, 40,000 of the Coloradans are new medicaid recipients, which is OK as long as the healthy young’n’s sign up as hoped.

    I think a lot of people who are reacting badly just don’t like the additional uncertainty that Obamacare has created in the short run. If you’ve got a law that you know is going to stress people out, then for chrissake sit on peoples’ necks to make sure the goddamn rollout goes smoothly. I really expected a measure of competency from this administration. I don’t like that they end up looking like a bunch of jerkoffs.

  89. 89
    pseudonymous in nc says:

    @cckids:

    You can be in a risk group JUST WITH PEOPLE YOUR OWN AGE”. Guess whose health care expenses will be higher, assholes.

    Even better, special snowflake, you can send a cheek swab to the insurance company to run a DNA test and they can come up with a very special premium rate based on your prospects.

  90. 90

    […] which don’t do anything but help insurance companies shed high-cost enrollees. I support Sen. Mary Landrieu’s plan. It’s simple and it ensures people who like their insurance can keep it, no matter […]

  91. 91
    JoyfulA says:

    Is there all that much churn? I had the same policy for 15 years, then switched because I moved out of the coverage area, and held that policy for 15 years until I reached Medicare age. My husband’s held the same policy for 11 years and has been delighted with it because it was half the price of a COBRA he had, with better coverage.

  92. 92
    What Have the Romans Ever Done for Us? says:

    @KXB: That I can’t explain.

  93. 93
    What Have the Romans Ever Done for Us? says:

    @KXB: That I can’t explain.

  94. 94
    What Have the Romans Ever Done for Us? says:

    @KXB: That I can’t explain.

  95. 95
    What Have the Romans Ever Done for Us? says:

    @KXB: That I can’t explain.

  96. 96
    Kropadope says:

    How is this an elegant workaround? This is a ham-fisted, likely unconstitutional, power grab like the Republicans are (usually erroneously) warning about. How can the government mandate that insurance companies offer particular plans? What if those plans aren’t economically viable for the insurance company? Sorry, now I think Landrieu and them should be out of the job.

  97. 97
    Micheline says:

    @Kropadope: Your answer makes no sense. Since people are bitching about their policy then they are able to keep them. It was the insurance companies that initially offered these policies, so the ins. cos. cannot turnaround and say that they are now not profitable.

  98. 98
    Kropadope says:

    @Micheline: They offered them in previous years. They can end or modify them just like they could end or modify plans in previous years. The reason these plans weren’t subject to the grandfather clause of the ACA is that they were changed or created since 2010.

    How could this conceivably be okay? Changin a law just because people are angry and playing to the news cycle is a terrible way to govern. What’s next? Should the government mandate that gas be sold for 89 cents per gallon?

  99. 99
    Micheline says:

    @Kropadope: Yes but right now the optics look really bad.

  100. 100
    Kropadope says:

    The reason I don’t vote Republican is prioritization of optics over policy. If Dems lose the high ground on actually being interested in governing, what do they have to offer?

  101. 101
    robotswillstealyourjobs says:

    @Kropadope:

    If you don’t have good optics you don’t get to make policy.

  102. 102
    Kropadope says:

    @robotswillstealyourjobs: If they pass this policy the good optics will end after about a week. Then they’ll have a bigger mess on their hands, both in policy and optics.

  103. 103
    Kropadope says:

    @robotswillstealyourjobs: In fact, I strongly doubt that the optics of this will even be that good on day one. The insurance companies will be caterwauling, for good reason. The plans they are offering for the coming year were designed for existing law. Now they’re going to be forced to offer plans they, whether for statutory or economic reasons, were not previously able to offer. This will result in the new plans being offered on the exchanges being less economically viable.

    This policy Landrieu is offering will completely undermine the ACA and Democrats’ reputations to make them look marginally better, if at all, for ONE news cycle. Give me a break.

  104. 104
    PJ says:

    @KXB: It’s my understanding that you are not eligible for a government rebate/subsidy unless you sign up through one of the state or federal exchanges.

    I don’t understand why there is all this fuss about the numbers of people signing up through the exchanges at this point. Apparently, “signing up” means actually paying for insurance. I created an account on the NY site about a week after it went live, and selected a plan, but it took about a month before I received a form from my selected insurer, a COOP, to pay for the insurance. I went ahead and paid for the first month this week, but I could have waited until the end of December to do it, because the insurance doesn’t start until next January. I am sure there are many other people who have created an account but are taking their time to sort through plans or to pay for the plan they have selected.

  105. 105

    […] over Obamacare’s rocky rollout. ALSO: Lousiana Sen. Mary Landrieu is offering a fix that Richard Mayhew thinks wouldn’t do much damage to the law. BUT: A different bill in the House would, according to TNR’s Jonathan Cohn, represent a vote […]

  106. 106
    KenD78 says:

    They are not all “crap plans.” Calling them that is another Big Lie. Most times, the reason the existing plan was killed by Obamacare was because it did not include something like birth control. As a 40 year old single man with a vascetomy, that “crap plan” works just fine for me. Buy your own birth control and leave me alone.

  107. 107
    JGabriel says:

    KenD78:

    As a 40 year old single man with a vascetomy, that “crap plan” works just fine for me. Buy your own birth control and leave me alone.

    Been listening to Rush Limbaugh again?

    As a society, it’s in the best interest of ALL of us to ensure that children are raised in healthy environments. Birth control helps in that goal by preventing unwanted children.

    Furthermore, birth control helps lower insurance costs for everyone: Pregnancy and delivery cost a lot more than birth control prescriptions. So insurance companies have a self-serving interest in providing birth control, and you have a self-serving interest in it too, since less costly payouts translate to cheaper insurance.

  108. 108
    KenD78 says:

    @JGabriel:

    If it was in the insurer’s interests, they would have all already covered all of this – or charged me more if I wanted to exclude them.

    I also do not need and will never need breastfeeding support and supplies, or maternty care or domestic violence counseling, or cervical cancer screening, or even substance abuse treatment, and I resent being forced to pay for a policy that covers these things (without even any co-pays or deductibles). for nothing more than purely political reasons.

    But all of that is beside my point, which you have apparently conveniently (intentionally?) ignored. Whether those things are all good for “society” as you put it is one thing. Whether the lack of coverage for those things in my own insurance policy makes it a “crap insurance policy” is something else altogether.

    Omitting these coverages that I will NEVER need from my insurance policy does NOT make it a “crap insurance policy.”

    BTW, I don’t listen to talk radio. And FYI, I voted for Obama twice (or really, voted against his even-worse opponents twice).

    And when your argument against someone’s view or position is that they have the same view or position as Rush Limbaugh, you are really just stooping to the same level as these talk show guys. So congrats on that.

  109. 109

    […] other plan already out there is Sen. Mary Landrieu’s. This plan would compel insurers to keep the old substandard plans going for those already […]

Trackbacks & Pingbacks

  1. […] other plan already out there is Sen. Mary Landrieu’s. This plan would compel insurers to keep the old substandard plans going for those already […]

  2. […] over Obamacare’s rocky rollout. ALSO: Lousiana Sen. Mary Landrieu is offering a fix that Richard Mayhew thinks wouldn’t do much damage to the law. BUT: A different bill in the House would, according to TNR’s Jonathan Cohn, represent a vote […]

  3. […] which don’t do anything but help insurance companies shed high-cost enrollees. I support Sen. Mary Landrieu’s plan. It’s simple and it ensures people who like their insurance can keep it, no matter […]

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