Wis. governor offers a way around ObamaCare problems

[Mycroft]

From the article-
"The Walker administration actually made two requests to Kathleen Sebelius, President Barack Obama's secretary of Health and Human Services. Both would allow consumers to receive federal subsidies under the health care law without going through the online markets known as exchanges"

We know one is with the federal requirements. What do you think is the other? TIA

The two requests were:

1. To allow consumers to buy policies and receive subsidies directly through insurance companies that already have a presence on the federal exchange.

2. To allow consumers to buy policies and receive subsidies directly through insurance companies even if they don't have a presence on the federal exchange.

The first request is in line with what the Obama administration has already been doing...on a selective basis. The second request is a departure from what Obama has been doing, but it has nothing to do with "inadequate insurance policies". It is only a broadening of the process Obama has already initiated. But, like I said, Obama isn't known for allowing MORE choices...only the choices he wants to allow. For that reason...and, I think, because this is a request from a Republican...it's not likely that the second request will be granted. The first request is more likely to make it...except that it's a Republican request. Obama COULD just deny the first request because he doesn't like Walker.

 

[Mycroft]

How can you get federal subsides without getting them at the source, in other words the healthcare.gov website operating as the federal exchange?

It's already happening.

Consumers are able to deal directly with some insurance companies who are able to calculate tax credits, subsidies and the like without either the consumer or the insurance company having to actually visit healthcare.gov. This process has already been set up by the Obama administration and is being used.

I've provided a link in another post in this thread with an example of just this thing happening.

 

[rabbitcaebannog]

The two requests were:

1. To allow consumers to buy policies and receive subsidies directly through insurance companies that already have a presence on the federal exchange.

2. To allow consumers to buy policies and receive subsidies directly through insurance companies even if they don't have a presence on the federal exchange.

The first request is in line with what the Obama administration has already been doing...on a selective basis. The second request is a departure from what Obama has been doing, but it has nothing to do with "inadequate insurance policies". It is only a broadening of the process Obama has already initiated. But, like I said, Obama isn't known for allowing MORE choices...only the choices he wants to allow. For that reason...and, I think, because this is a request from a Republican...it's not likely that the second request will be granted. The first request is more likely to make it...except that it's a Republican request. Obama COULD just deny the first request because he doesn't like Walker.

No, see the sentence that states both would allow consumers to receive subsidies from insurance companies off the exchange.. Then it goes on to state one that follows the minimal requirement which leaves the other not having to follow that requirement. That is not very fiscally responsible. Should it surprise anyone after what he tried with his medicaid residents? Costs to taxpayers is certainly not his first goal.

 

[Mycroft]

No, see the sentence that states both would allow consumers to receive subsidies from insurance companies off the exchange.. Then it goes on to state one that follows the minimal requirement which leaves the other not having to follow that requirement. That is not very fiscally responsible. Should it surprise anyone after what he tried with his medicaid residents? Costs to taxpayers is certainly not his first goal.

Ummm...

Tell me, what do you think these "minimal requirements" are? Hint: They are not the minimum standards all insurance policies must meet. Those standards have not been changed or abridged. That means the "minimal requirements" have to do with something else.

I'm interested in whether you are smart enough to figure out what they are.

The rest of your post...the "fiscally responsible", the medicaid and the rest are irrelevant to this discussion and it is dismissed.

 

[rabbitcaebannog]

Ummm...

Tell me, what do you think these "minimal requirements" are? Hint: They are not the minimum standards all insurance policies must meet. Those standards have not been changed or abridged. That means the "minimal requirements" have to do with something else.

I'm interested in whether you are smart enough to figure out what they are.

The rest of your post...the "fiscally responsible", the medicaid and the rest are irrelevant to this discussion and it is dismissed.

I didn't say all have been changed or abridged. Those that do not follow the minimal standard are not suppose to be covered with subsidies. That has everything to do with fiscal responsibility and the other point about medicaid only further highlights where Walker's interest lie.

 

[Mycroft]

I didn't say all have been changed or abridged. Those that do not follow the minimal standard are not suppose to be covered with subsidies. That has everything to do with fiscal responsibility and the other point about medicaid only further highlights where Walker's interest lie.

You didn't answer my question. I'll repeat it: what do you think these "minimal requirements" are?

 

[sangha]

I didn't say nor imply that they were.

But every insurance company that offers a plan...whether on or off any exchange...must comply with the minimum standards set by the rules of Obamacare.

No you didn't but the post you were responding to was talking about how giving subsidies to non-exchange plans (as Walker is supposedly proposing) would undercut the goal of the exchange.

 

[sangha]

Ummm...there is nothing in the two quotes you gave that says anything about Walker wanting to set up an exchange. In fact, the first quote you gave...from the article...specifically says that Walker wants his citizens to be able to "sidestep" the federal exchange. As in, getting their federal subsidy WITHOUT going through any exchange.

Doesn't sound like he want to set one up, now, does it?

Your argument is based on the mistaken notion that an exchange can only mean going through a web page.

 

[rabbitcaebannog]

You didn't answer my question. I'll repeat it: what do you think these "minimal requirements" are?

The plans must provide essential benefits and wellness programs.
Essential Health Benefits

The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures that health plans offered in the individual and small group markets, both inside and outside of Affordable Insurance Exchanges (Exchanges), offer a core package of items and services, known as “essential health benefits.” EHB must include items and services within at least the following 10 categories:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
The Affordable Care Act sets forth that EHB be equal in scope to benefits offered by a “typical employer plan.” To meet this requirement in every state, the proposed rule defines EHB based on a state-specific benchmark plan, including the largest small group health plan in the state. The rule proposes that states select a benchmark plan from among several options identified in the proposed rule, and that all plans that cover EHB must offer benefits that are substantially equal to the benefits offered by the benchmark plan. This approach balances consumers’ desires for an affordable and comprehensive benefit package, our legal requirement to reflect the current marketplace, and issuer flexibility to offer innovative benefit designs and a choice of health plans.

 

[sangha]

Yes...and what rules did he not want to have to follow? I'll tell you: The rule that says that subsidies can only be received by going through the exchange. He didn't ask that the rule about minimum standards for insurance policies be changed or that WI insurance companies do not have to follow them.

If you think he did, then you are going to have to show me where he said that.

You are wrong. Walker is asking that subsidies be allowed to be used to pay for *any* plan and not just plans that are available on the exchange. That is a loosening of the rule that limits subsidies to plans which are offered on the exchange.

 

[sangha]

sigh...

As I've already explained...with a link...ALL insurance policies offered by ANY insurance company in ANY state MUST meet the minimum standards set forth in Obamacare.

Yes, there are standards for ALL policies, but there are additional standards for plans sold on the exchange. It's those additional standards that Walker is seeking to ignore.

 

[Mycroft]

The plans must provide essential benefits and wellness programs.
Essential Health Benefits

The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures that health plans offered in the individual and small group markets, both inside and outside of Affordable Insurance Exchanges (Exchanges), offer a core package of items and services, known as “essential health benefits.” EHB must include items and services within at least the following 10 categories:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
The Affordable Care Act sets forth that EHB be equal in scope to benefits offered by a “typical employer plan.” To meet this requirement in every state, the proposed rule defines EHB based on a state-specific benchmark plan, including the largest small group health plan in the state. The rule proposes that states select a benchmark plan from among several options identified in the proposed rule, and that all plans that cover EHB must offer benefits that are substantially equal to the benefits offered by the benchmark plan. This approach balances consumers’ desires for an affordable and comprehensive benefit package, our legal requirement to reflect the current marketplace, and issuer flexibility to offer innovative benefit designs and a choice of health plans.

You really should provide a link when you quote a source.

Be that as it may, see the part I highlighted. That means these requirements apply to all insurance policies whether sold through an exchange or not. Unless you can quote Walker asking that these requirements be reduced as part of his proposal, they won't be changed...nor is he asking them to be changed.

But there are OTHER minimum standards required for an insurance company's policy to be included in an exchange. Those requirements are the sticking points here. Those requirements are what makes it unlikely that Obama will grant Walker's second request.

What are they?

Hint: Think about the differences between a "public" exchange and a "private" exchange.

 

[Mycroft]

Your argument is based on the mistaken notion that an exchange can only mean going through a web page.

It is not.

Web page, call in help person, paper application...they are all part of the exchange system. The trainwreck that is healthcare.org affects all of them.

 

[sangha]

You really should provide a link when you quote a source.

Be that as it may, see the part I highlighted. That means these requirements apply to all insurance policies whether sold through an exchange or not. Unless you can quote Walker asking that these requirements be reduced as part of his proposal, they won't be changed...nor is he asking them to be changed.

But there are OTHER minimum standards required for an insurance company's policy to be included in an exchange. Those requirements are the sticking points here. Those requirements are what makes it unlikely that Obama will grant Walker's second request.

What are they?

Hint: Think about the differences between a "public" exchange and a "private" exchange.

The differences between plans in the exchange and non-exchange plans are many including but not limited to adhering to the various guidelines for Gold, Bronze, Silver classification of plans (ex co-insurance and co-payment rates, etc) As many have noted, the plans that can be subsidized tend to have high deductibles and co-payments and lower co-insurance rates which discourage unnecessary procedures because the insured has to pay part of the cost.

Allowing subsidies to be applied to plans with low deductibles and high co-insurance rates encourages people to buy plans with high medical utilization rates which ends up raising costs for everyone - the exact opposite of the exchanges' goal.

 

[rabbitcaebannog]

You really should provide a link when you quote a source.

Be that as it may, see the part I highlighted. That means these requirements apply to all insurance policies whether sold through an exchange or not. Unless you can quote Walker asking that these requirements be reduced as part of his proposal, they won't be changed...nor is he asking them to be changed.

But there are OTHER minimum standards required for an insurance company's policy to be included in an exchange. Those requirements are the sticking points here. Those requirements are what makes it unlikely that Obama will grant Walker's second request.

What are they?

Hint: Think about the differences between a "public" exchange and a "private" exchange.

I'm dying to hear this one. Do pray tell.

 

[Mycroft]

No you didn't but the post you were responding to was talking about how giving subsidies to non-exchange plans (as Walker is supposedly proposing) would undercut the goal of the exchange.

Actually, she didn't say that. She said: "offer subsidies on plans that undercuts adequate health insurance".

That's not true. ALL insurance plans must include what Obamacare considers adequate health insurance.

 

[sangha]

It is not.

Web page, call in help person, paper application...they are all part of the exchange system. The trainwreck that is healthcare.org affects all of them.

And Walker wants to set up another exchange, something he had the ability to do under ACA a long time ago. Instead, he rejected that option and now he wants to cover up for his mistaken decision to opt out

 

[rabbitcaebannog]

Actually, she didn't say that. She said: "offer subsidies on plans that undercuts adequate health insurance".

That's not true. ALL insurance plans must include what Obamacare considers adequate health insurance.

False

 

[sangha]

Actually, she didn't say that. She said: "offer subsidies on plans that undercuts adequate health insurance".

That's not true. ALL insurance plans must include what Obamacare considers adequate health insurance.

Allowing subsidies to be applied to non-exchange plans will undercut the goal of ACA and exchange plans provide benefits beyond subsidies to ensure adequate coverage

 

[Mycroft]

I'm dying to hear this one. Do pray tell.

sigh...

You disappoint me. Even with my hints, you can't come through.

This will help you: Sibson Consulting's Perspectives - Thinking of Joining a Private Health Insurance Exchange? Look Before You Leap

 

[Mycroft]

And Walker wants to set up another exchange, something he had the ability to do under ACA a long time ago. Instead, he rejected that option and now he wants to cover up for his mistaken decision to opt out

Oh, you are back to that again...making a statement with nothing to back it up but, "No it isn't!!".

 

[sangha]

sigh...

You disappoint me. Even with my hints, you can't come through.

This will help you: Sibson Consulting's Perspectives - Thinking of Joining a Private Health Insurance Exchange? Look Before You Leap

According to that article, the difference between a public and a private exchange is that subsidies can not be applied to a plan purchased through a private exchange. If the subsidy can be applied to plans purchased through such a network, as Walker is requesting, then it becomes a public exchange.

 

[sangha]

Oh, you are back to that again...making a statement with nothing to back it up but, "No it isn't!!".

It's exactly what Walker is doing. He wants to set up a system whereby people can buy insurance and get subsidies for it - *that* is what an exchange is

 

[rabbitcaebannog]

sigh...

You disappoint me. Even with my hints, you can't come through.

This will help you: Sibson Consulting's Perspectives - Thinking of Joining a Private Health Insurance Exchange? Look Before You Leap

I'm waiting for you're explanation:?:

 

[Mycroft]

Allowing subsidies to be applied to non-exchange plans will undercut the goal of ACA and exchange plans provide benefits beyond subsidies to ensure adequate coverage

As I said...ALL health insurance policies must include those requirements that Obamacare considers adequate coverage.

Now, I agree that allowing subsidies to apply to plans other than the "metal" plans in the exchanges will undercut the goal of Obamacare...that goal being to restrict the choices of consumers. That goal will be the main reason that Obama denies Walker's second proposal.